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@awrightintern-blog
Internship Week 10
This is the last week of my internship! My last day was Thursday 7/28. I was at the main eye center in Oakland from 8:30am-5:30pm for my last day. I was able to shoot some FA’s as well as perform some OCTS.
I had such a great time doing this internship and I’m so glad I was given the opportunity to do it! I’ll be posting more photos from it.
Photo and OCT examples of non-exudative (dry) ARMD (age related macular degeneration).
Photos used with permission.
Photo examples of an FA in progress. Taken by me, used with permission.
Internship Week 9
This is the next to last week of my internship! I have learned so much and I am thankful for my time spent learning something completely different than what I have been studying for the last 4 years.
This week I was able to give more OCTs and assist with patients.
I was at my internship on Tuesday the 19th from 8am-4:30pm, Thursday from 8am-4:30pm, and Friday from 8:30am-4:30 pm.
Photo and OCT examples of a case of exudate (wet) age related macular degeneration. (ARMD).
First photo shows a color fundus image, next is an FA image at 2:15, and lastly an OCT scan showing macular thickness of the right eye.
Wet form. The "wet" form of macular degeneration is characterized by the growth of abnormal blood vessels from the choroid underneath the macula. This is called choroidal neovascularization. These blood vessels leak blood and fluid into the retina, causing distortion of vision that makes straight lines look wavy, as well as blind spots and loss of central vision. These abnormal blood vessels and their bleeding eventually form a scar, leading to permanent loss of central vision.
The scar is viewed best on the FA photo, where the mass is visible to the left of the optic nerve.
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Internship Week 8
This is the second to last week of my internship!
This week I spent my time at the main eye center in Oakland.
I got to give a few more tests such as HVF, OCT, and practice with the fundus cameras.
All in all I was there on Thursday, July 14th from 8:30am-4:30pm, and Friday July 15th from 8:30am-4:30pm. Only 4 days of my internship left!
Photo examples of dry ARMD. ARMD stands for age related macular degeneration. From top to bottom, photos show a color image, an FA at 3:02, and an OCT.
All photos used with permission.
Internship Week 7
This week I was at the main eye center in Oakland. I was there Wednesday, 6/29/16 from 8:00am-4:30pm, Thursday, 6/30/16 from 8:30am-4:30pm, and Friday 7/1/16 from 8:30am-4:30pm.
This week I observed some of the testing that other techs do in the eye center other than photography. I observed flash VEP's, Goldman HVF's, and various other VEP's being performed. The VEP stands for visual provoked potential. This test measures the response from the nervous system following the presentation of a stimulus. This allows the test results to be read by a doctor to accurately determine the acuity of the visual pathways.
In addition I also practiced more on the OCT machines as well as the other cameras. I also took a few patient photos on the optos machine.
Shown above are photo examples of CME, and radiation retinopathy. Mentioned in a few posts before, Cystoid macular edema or CME, is a painless disorder which affects the central retina or macula. When this condition is present, multiple cyst-like (cystoid) areas of fluid appear in the macula and cause retinal swelling or edema.
Radiation retinopathy is damage to retina due to exposure to ionizing radiation. Radiation retinopathy has a delayed onset, typically after months or years of radiation, and is slowly progressive. [source]
From left to right along the top (three photos) shows a color fundus image, a red free fundus image (black and white), an FA image, and an OCT showing the analyzation of the macular thickness. The diseases can be seen throughout the eye in its various photos and OCT analyzation.
All photos used with permission.
Examples of ganglion cells in the optic nerve.
The definition of a ganglion cell is ~a neuron of the retina of the eye whose cell body lies in the ganglion cell layer. The axons of ganglion cells form the optic nerve.
The equipment used to capture the ganglion cell is a Spectralis OCT. It is a specialized version of the Cirrus OCT as it focuses on the cornea opposed to the retina.
Shown here in these fundus images is CME, or cystoid macular edema. Shown from left to right is the color photo, red free image (black and white) and FA (fluorescein angiogram at 45 seconds.)
What Is Cystoid Macular Edema (CME)?
Cystoid macular edema or CME, is a painless disorder which affects the central retina or macula. When this condition is present, multiple cyst-like (cystoid) areas of fluid appear in the macula and cause retinal swelling or edema.
Symptoms
Blurred or decreased central vision (the disorder does not affect peripheral or side-vision)
The symptom described above may not necessarily mean that you have cystoid macular edema. However, if you experience this symptom, contact your eye doctor for a complete exam.
Causes
Although the exact cause of CME is not known, it may accompany a variety of diseases such as retinal vein occlusion, uveitis, or diabetes. It most commonly occurs after cataract surgery.
All photos used with permission.
Example images of a completely normal eye.
From first to last, a color fundus image, a red free fundus image (black and white), an FA (fluorescein angiogram) @ 2:13, and an OCT showing macular thickness.
When viewing a normal eye, this is what would be seen in the various tests.
Slit Lamp Biomicrography is the photography of the structures of the eye with a specially designed horizontally mounted microscope. The primary illumination for the microscope is produced by a light which can be adjusted from a very broad pattern to a very narrow slit of light. It is from this slit of light that the Slitlamp derives its name. The slit can be used to isolate structures in the eye. The photograph above illustrates the use of a narrow slit of light to identifiy the surfaces of the cornea and lens of the eye.
Slit lamp photos taken by me during my internship at UPMC eye center.
All photos used with permission.
Internship Week 6
This week of my internship was spent at the eye center in Oakland. I was there Thursday, 6/23/16 from 8:30am-4:45pm, and Friday 6/24/16 from 8:30am-INSERTpm.
I spent this week practicing photographing on the topcon camera getting more acquainted with fundus photography. As always I also observed all of the visual testing being performed and read more on eye diseases and assorted eye terminology.
The photo below is of a top con retinal camera, and it is close to the model that is at the eye center in Oakland. You can click the Topcon link above to find out more about their function and how they work.
Today I also got to practice slit lamp photos, which are photos of the front of the eye (cornea) to document anything wrong with the cornea, etc. I will be posting those photos later, along with a link further describing the technology behind the equipment.
All in all this week I was at my internship on Thursday, June 23rd from 8:30am-4:45pm, and Friday, June 24th from 8:30am-4:30pm at the main eye center in Oakland.
Definitions to Remember
Amblyopia- Decreased visual acuity without any apparent disease of the eye
Aphakia- Absense of the crystalline lens of the eye
Endocyclophototcoagulation (ECP)- Laser treatments; designed to decrease aqueous pressure
Floaters- Small particles consisting of cells or fibrin, which move in the vitreous (usually harmless)
Iritis- Inflammation of the iris, a condition marked by pain, discomfort from light, contraction of pupil, and discoloration on iris
Keratitis- inflammation of the cornea
Nystagmus- An involuntary rapid movement of the eye; may be lateral, vertical, or rotary
Phakic Lens- The natural lens
Ptosis- A paralytic dropping of the upper lid
Tear Film-Layer of watery liquid that bathes the front portion of the eye
Cornea- Chief refracting tissue; the cornea is transparent because of the highly ordered arrangement of collagen fivers within and the absence of blood vessels. There are 5 layers of cornea cells
*Epithelium- outside layer of cells acts a barrier against damage and infection
*Bowmans membrane- tough membrane
*Stroma- consists of collagen fibers and accounts for 90% of the corneas thickness
*Descemets membrane- thin membrane of collagen and fibers
*Endothelium- thin layer of cells that cannot regenerate and are responsible for maintaining partial corneal dehydration and transparency\
Exotropia- A condition in which one or both eyes turn too far outward; sometimes called divergent strabismus
Tropia- A deviation of the eyes from their normal straight alignment
Myopia- Most common refractive error of the eye (Nearsigntness)
Retinopothy- Any disease of the retina- the light sensitive membrane at the back of the eye.
Retina- 2 types of light sensitive cells - Together they allow the eye to comfortably view objects
Rods-Direct light
Cones-Direct color
Above are more fundus photos, taken by me in the 6th week of my internship. They have improved since I took my first one. This is an example of a the various positions the eye is photographed in in order to get a full view of the back of the retina. I took these on a Topcon camera, which is outlined and detailed in my other posts before this. The optic nerve is the bright white ball, and the macula (depending on which way the eye is turned) is the dark spot either directly left or right from the optic nerve.
Photos used with permission.
The above photos show a left eye with optic nerve (disc) hemorrhage, and wet ARMD.
From left to right the photos show a color image, a red free image (black and white) and last an angiogram fluorescein image taken at 27 seconds.
An optic disc hemorrhage is harder to spot during an exam, but usually occur at the border of the optic disc in the neurofiber layer, although they may also occur inside or just outside the disc edge. They're sometimes called splinter hemorrhages, because they look like splinters running parallel to the nerve fibers in the nerve fiber layer.
There is a correlation between glaucoma and optic disc hemorrhages, although optic disc hemorrhages can occur in patients with no glaucoma. After an optic disc hemorrhage though, patients are monitored for signs of glaucoma. For more photo examples and a longer explanation of optic disc hemorrhages click here.
Wet ARMD (Age related macular degeneration) have the condition, it accounts for 90 percent of the severe vision loss caused by macular degeneration.
With this type, the membrane underlying the retina thickens, then breaks. The oxygen supply to the macula is disrupted and the body responds by growing new, abnormal blood vessels. These begin to grow through the breaks of the membrane behind the retina towards the macula, often raising the retina.
To visualize this, imagine the roots of a tree growing and spreading until they crack and grow through a sidewalk. Then imagine rainwater seeping up throughout the cracks. These abnormal blood vessels (the “roots”) tend to be very fragile. They often grow and leak or bleed, causing scarring of the macula. This fluid is called exudate and wet AMD is sometimes called exudative macular degeneration.
This damage to the macula results in rapid central vision loss. Once this vision is destroyed, it cannot be restored. However, there are several treatment options for wet AMD which can be very effective if applied early. (credit & longer explanation click here.)
Photos used with permission.