ICOP 2011 OXFORD UK REPORT ON THE INTERNATIONAL CONFERENCE ON OPHTHALMIC PHOTOGRAPHY 2011

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1 ICOP 2011 OXFORD UK REPORT ON THE INTERNATIONAL CONFERENCE ON OPHTHALMIC PHOTOGRAPHY 2011 Report compiled by: Rahila Bashir and the MEDICAL IMAGING UK Ltd conference team On September the 22 nd we saw the beginning of a spectacular three day event based in Oxford. Over 150 ophthalmic photographers and ophthalmologists from around the globe had assembled at The Examination Schools to learn from the exciting educational programme that had been in the planning for nearly 2 years. This year it was the turn of OIA, (Ophthalmic Imaging Association UK) to host the event. Our key note speakers being, Professor Paulo Stanga, Mr David Clark, Mr Wagih Aclimandos and Professor Giovanni Staurenghi. There was joint participation from members of the Ophthalmic Photographers Society (OPS), the Australian Institute of Medical & Biological Illustration (AIMBI), Oogheelkundige Fotografie Nederland (OFN), and the Ophthalmic Imaging Association, (OIA) UK. In addition to the scientific programme, the three days involved an evening reception at the Bodleian library, banquet dinner at RBS Williams F1 Grand Prix Headquarters. Here it was also a great honour to have a special guest for the evening, Colin Dexter OBE, legendary author of the Inspector Morse books and TV series. The welcome address on day 1 was given by Mr Steve Aldington, Conference Chair. This was followed by a brief introduction and history of ICOP by two representatives from the Ophthalmic Photographers Society (USA). Session 1: Diabetes. Our first speaker was Mr Richard Dewhirst (UK) who presented on some research work relating to improving retinal image quality via a physical model of contrast degradation. Software has been developed for use in diabetic eye screening and grading clinics that enhances quality of otherwise poor quality images due to media opacities. He presented results of a study that showed a number of otherwise ungradable images were assessable using this software. Our next speaker was Mr Chris Barry (Western Australia). He presented on the challenges being faced in delivering diabetic eye screening services to remote communities in Western Australia and ways of overcoming these problems by utilising the skills of indigenous health workers using nonmydriatic cameras. This was followed by a presentation by Sarah Moyer (USA). Her talk looked at the oxygen saturation of retinal vessels following PRP laser by means of retinal oximetry. Her study proved that oxygen saturation increases after PRP in a patient with proliferative diabetic retinopathy. Mr Chris Barry presented again reporting on the results of providing a 3 year diabetic eye screening service within the metropolitan government prison system. He showed that diabetic eye screeners and graders play a key role in the development and provision of such programmes to the prison community. Before lunch our first of four keynote lectures was given by Professor Paulo Stanga (UK). He presented indications and results of the Argus II electronic epiretinal implant for blindness. Clinical criteria for using the implant were explained and how the implant is surgically fitted was also shown. By using video clips, Professor Stanga was able to show how patients benefit by having the implant. These patients were totally blind but can now make out door frames, roadside kerbs and large size words on a computer screen using the implant.

2 Lunch coincided with the opening of our trade show 12 leading ophthalmic imaging distributers and software companies filled the large North School Hall of the Examination Schools. They exhibited the very latest equipment in ophthalmic photography and OCT imaging. Session 2: Anterior Segment Imaging. Our first speaker was John Mould (UK) who talked about the photography of animal eye specimens that have been removed due to serious injury or disease. He described this as a kind of hobby, because it s not what he generally does in his normal day job (veterinary ophthalmologist)! He described how eye specimens, fixed in formalin, are sent to him by veterinary surgeries from all over the country. In the case of eyes removed due to injury, he always finds it helpful to have an external photograph of the eye before it is removed from the animal concerned. He explained his photographic method to photograph the specimens, using a water bath and fibre optic lighting against a black background. Vitreous changes, a giant tear in a dog s eye (image courtesy of John Mould) Our next speaker, Denise Cunningham (USA), described a digital imaging protocol she has developed documenting scleral inflammation. She described how the need to document sclera inflammation is of upmost importance in therapeutic decision making for managing patients with uveitis. Using a standardised protocol when photographing these patients was described so that disease progression can be carefully monitored. Her method involved taking 9 separate but contiguous external areas of both eyes to obtain a comprehensive view of the sclera coat. Sarah Moyer (USA) then presented some work she had done using enhanced depth imaging (EDI) OCT of sclera cysts. She presented a case report of a 68yr old male presenting with choroideremia. EDI imaging of the deep choroid showed a sclera cyst. To her knowledge this was the first identification using EDI of a sclera cyst. Denise Cunningham (USA) presented her second paper on the photographer s role in developing a digital grading scale for corneal verticillata. She described in great detail the role of the ophthalmic photographer in the genesis, design, development and validation of a grading scale for vortex keratopathy. She described how a reference set of black and white drawings was used to grade the superficial lines while a reference set of on screen digital images was employed to judge the vortex. The resultant grades were assessed for intra and interobserver variability with the aim of developing a valid and reliable grading tool. Session 3: Education. The first day finished with a selection of talks from speakers experienced in maintaining high standards of training and education for ophthalmic photographers and how career profession, registration and accountability is becoming the norm for ophthalmic photographers all around the world.

3 Session 4: Medical Retina 1. Our first speaker on the 2 nd day was Mr Colin Clements (UK). He described the need and importance of red free imaging. As imaging technology changes we should not neglect the simple and well established techniques such as red free imaging. He described in detail how red free imaging works and showed many clinical examples of why we should still use this photographic modality in every imaging protocol. Our second speaker, Mr Richard Hackel (USA), presented on getting the most out of using the Cirrus SD OCT. Application and technique was described in great detail. An overview of software capabilities was also covered. Mr Richard Hancock (UK) then presented his talk on developing a new model care for the AMD patient by using photographer led diagnostic clinics. He showed that photographer led clinics have helped reduce risk in ensuring all treated AMD patients are followed up in a timely manner and that a study showed that there was 100% agreement between himself and a consultant ophthalmologist on clinical findings. There was 94% agreement on clinical outcome. Our next speaker, Dr Xiao-Ling Liu (China) presented her observations using SD OCT in patients presenting with central serous chorioretinopathy. By using SD OCT she showed in great detail the relationship between the RPE, Bruch s membrane and the choriocapillaris complex. She concluded that examining Bruch s membrane very closely with OCT may help describe the pathogenesis of CSR. Our last speaker for this session was Rebecca Smith (UK). She presented her findings on using enhanced depth imaging (EDI) OCT imaging with the Heidelberg Spectralis. This relatively new imaging modality is becoming used more and more in medical retina clinics. She described the techniques involved and how she has developed a standardised imaging protocol now being used in her department. Our second keynote speaker was Mr David Clark (UK). He presented on imaging and treating Retinopathy of Prematurity (ROP). An overview was given of this sight threatening condition, history of recognising and treating ROP was also given. He then described how he documents ROP, carrying out a screening service. If a baby requires treatment (laser and/or Avastin) he may undertake fundus fluorescein angiography. He described that he follows up his patients longterm. Colour Fundus photography and OCT imaging helps monitor any further change. Session 5: Paediatric Ophthalmology. After lunch, Mr Wagih Aclimandos (UK), presented our 3 rd keynote address. He presented a case highlighting the moral dilemma, now more apparent since there have been recent advances in pre-natal imaging techniques. He discussed the legal, social and ethical considerations related to termination of pregnancy. Ditte Hess (USA) then presented a talk on how ophthalmic imaging is used in a busy paediatric unit in Miami. She described the many modalities now available that are used to diagnose, monitor and plan treatment for a wide range of ophthalmic paediatric disease. Our next speaker Cathy Williams (UK) described how advances in retinal imaging have enabled the study of the retinal microvasculature to emerge as an expanding area of research. In particular, looking at arteriolar and venular diameters in 790 children and correlating this to body weight and BP. Smaller size at birth was associated with narrower retinal arterioles at age 12. Ditte Hess presented her second talk on a retinoblastoma update from the USA. Her unit has photographed 5000 eyes, under GA, documenting retinoblastoma. Digital wide field imaging has helped diagnose and monitor disease regression/progression. Session 6: Medical retina 3: Our 3 rd day started with a presentation by Mr Dennis Orlock (USA). He talked about the importance of fundus autofluorescence (FAF) imaging. He discussed the differences in the latest imaging technology capable of documenting geographical atrophy by means of FAF. Interpretation of FAF images was also covered. Dr Mark Nelson (USA) gave a very dynamic presentation on the sub-classification of exudative age related macular degeneration based on multimodal imaging. Many clinical examples were shown using high resolution angiography coupled with SD OCT imaging. Paula Morris (USA) reported on a study looking at attenuated autofluorescence imaging, using the absence of lipofuscin to quantify and map concentrations of carotenoid pigments in normal maculas. Our next speaker was Mr Ethan Priel (Israel). His presentation covered multimodal imaging of chorioretinal diseases. Using colour fundus photography, fluorescein and ICG angiography, red free photography, autofluorescence imaging and SD OCT can all be used to give a comprehensive diagnosis in many chorioretinal diseases. By recognizing the disease specific strengths and limitations of each imaging modality we are able to best tailor our imaging protocols.

4 Dr Irina Gout (UK) concluded the morning session with a presentation on using ICG in chorioretinal pathology. With data collected over 10 years she showed how ICG is essential in diagnosing many chorioretinal diseases. After lunch our final keynote speaker presented. We were delighted to have Dr Giovanni Staurenghi (Italy) to talk on ICGA and is there still a role for it in the diagnosis of ARMD. Technique and application were covered in great detail and many clinical examples were shown. In conclusion, ICGA is still a vital imaging modality used in diagnosing the multifactorial disease spectrum of ARMD. Still on the theme of ICGA, our next speaker Mr Michael Kelly (USA), presented on techniques in the capture of dynamic high speed ICGA for optimal quality documentation of neovascular ARMD. Again, many clinical examples, including movie clips of ICGA, were shown. All of the last 3 talks proved that ICGA is as important as fluorescein angiography in detecting many retinal and choroidal diseases. Our conference closed with a lecture by an invited speaker, Mr George Turner (Manchester). He talked about the history of ophthalmic imaging and where, with many changes lying ahead for the NHS, he thinks we will be in the future. In conclusion, he felt our future was exciting with the advent of new technologies and new treatment therapies now being pioneered. ICOP returns in 4 years time, where is still being discussed. Watch this space.

5 Mr David Clark giving his keynote address International delegates (Australia, USA, Singapore and UK) Reception at the Bodleian Library ICOP organising committee