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Image 1a: Standard retinal photograph of Maria’s right optic nerve and macula Image 1b: Anterior photograph showing Maria’s pseudoexfoliation and corresponding iris transillumination Image 2: Spectralis OCT 3D image of Sarah’s right optic nerve Image 3a: Standard photography of Anna’s choroidal naevus Image 3b: Red separation image on the Optomap highlighting the naevus

As the Centre for Eye Health celebrates its one year anniversary, we consider some of the contributions that this new model of integrated and accessible ocular health management has already made.

Says director Michael Kalloniatis “Whilst the growth in practitioner registrations and client referrals over our first year is a great achievement, it is the real patient outcomes of which we are all most proud.”

Case 1: Saving Sight

For many years Maria has supported the work of Guide Dogs NSW/ACT as a Puppy Pal. Her regular financial donations have helped to turn some of the cutest puppies into highly skilled and trained Guide Dogs.

Recently, Maria experienced another side of Guide Dogs services when she was referred to CFEH after her optometrist detected drusen in the back of the eye, predisposing her to early aged-related macular degeneration.  There was also an intra-ocular pressure (IOP) difference of 7mmHg between the two eyes.  As part of the assessment at CFEH, the macular changes were evaluated and a full evaluation of the optic nerve and corrected IOPs (after corneal thickness measures) suggested that both early macular and early pseudoexfoliation-related glaucomatous changes were present.   Identified so early, Maria’s conditions can now be appropriately managed to prevent loss of vision in the future.

After realising the connection between Centre for Eye Health and Guide Dogs, Maria said she was even happier that she has supported Guide Dogs over the years, especially now that she faced a serious eye disease herself.

Case 2: Saving Quality of Life

Sarah is a 12 year old who was referred to CFEH by her optometrist for further investigation of what appeared to be swollen optic nerve heads. The clinical team at CFEH performed a suite of tests to quantify the optic nerve changes (OCT and HRT) and liaised closely with the on-site consultant ophthalmologists and the referring optometrist. Analysis of the test results led to a referral for Sarah to a hospital neurology department where she was diagnosed with craniostenosis, a condition that may result in increased pressure on the brain resulting in optic nerve swelling.

Timely detection means the most appropriate management plan can be implemented and Sarah’s quality of life will be minimally impacted.

Case 3: Saving Lives

Anna was referred by her local optometrist to CFEH for photo documentation and measurement of what appeared to be a small naevus on her retina. In this case, the analysis by the team of optometrists and consultant ophthalmologists at CFEH confirmed that it was indeed an innocuous naevus.

Whilst Anna’s result was good, the team at CFEH have identified and measured at least two lesions outside the range of normal.  In both cases the ophthalmic team has made a provisional diagnosis of choroidal melanoma and recommended urgent referral to a retinal specialist.  Uveal melanoma is a life-threatening cancer of the eye, requiring urgent referral to a specialist for appropriate management.

Precise measurement of suspect ocular lesions is critical, and CFEH’s assessment can identify whether such lesions are simply small naevi requiring ongoing monitoring, or fall within a ‘suspicious’ category of uveal melanoma requiring referral to a retinal specialist.  Says Michael Kalloniatis “Based on US studies, we can predict that in Sydney alone the incidence of uveal melanoma is approximately 20 per year. Photo documentation and quantification of the size of pigmented lesions is required to identify those that require further assessment by retinal specialists.  Early detection is critical as uveal melanoma size directly determines survival rates.”