This person attended for a routine appointment. She is Diabetic and is enrolled in the National Screening Programme which checks for Diabetic changes, generally on an annual basis. She was seen for this screening just two weeks before the appointment with us and had received her ‘all clear’ letter the previous day.
MoorfieldsEyeHospital wishes it were possible for all diabetic patients to be screened using the OCT machine as well as the standard Retinal Camera. After we had explained the sound reasons for this advice our patient agreed, and we carried out our Gold Standard examination which includes the standard four OCT scans.
The Left Retinal Photo shows no evidence at all of treatable diabetic changes. This is the same type of photograph used as the standard in the National Screening Programme, and hence the letter our patient had just received reassuring her that all appeared to be well.
The ‘Shadowgram Central’ shows the line where the Central B Scan has been taken. This Scan is right through the centre of the macula area, and looks absolutely normal. It is this area of the retina that is used to see fine detail, and after seeing the scan we were confident that our patient should be able to read the letters on the test-chart completely normally, (and indeed she could.)
However, looking then at the ‘Shadowgram Lower’ you will see a shaded area in the lower left quadrant. The B Scan taken through this, at the level of the green line, shows a separation of the retinal layers at the bottom of the scan. This is caused by fluid building up due to leakage within the retina and through from underneath. The retina is becoming thicker at this point, and the fluid is causing it to lift.
This lady was referred straight back to the Hospital Eye Service and is now receiving treatment to preserve her vision. Left untreated the result could have been very much more serious. The fluid could easily have spread to her central vision, affecting her ability to see.
This demonstrates the importance of OCT over standard retinal photography and explains why Moorfields are so keen to promote the instrument.