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Me, Myself, and Eye

Posted By Timothy Bennett, Friday, July 24, 2015
Updated: Friday, July 24, 2015

 

As a life-long photographer, I’ve taken my share of selfies over the years. I’ve even attempted a few with the equipment I use for diagnostic ophthalmic photography. Part 1 of this blog explored the fun side of taking selfies with ophthalmic instruments.This post explores the more serious side of eye selfies. 

Surprisingly, the ability to take eye "selfies” has helped me identify and track pathology in my own eyes. Two years ago I suffered an idiopathic retinal tear with avulsed bridging vessel and persistent vitreous hemorrhage. This was successfully treated with vitrectomy. Like many patients, I developed a cataract after the vitrectomy. I also began to notice some distortion that corresponded to progression of an epiretinal membrane (ERM) in the same eye.

Any time I noticed a change in vision I would repeat an OCT on myself. Over the course of six months I tracked an increase in thickness of about 100 microns. The cataract also progressed and I was scheduled for cataract surgery. Two weeks prior to surgery I noticed a very subtle change in vision and sat down at the OCT like I’d done several times in the past. The OCT detected some cystoid macular edema (CME) from the ERM. Picking up the CME prior to cataract surgery was very beneficial. Preexisting CME can be exacerbated by cataract surgery, so my surgeon began a course of treatment that reduced the edema. My OCT selfies likely helped us avoid more severe or persistent edema by catching it in advance.

Cataract surgery went as planned, but within a few hours of my procedure I began to notice a new visual abnormality: a paracentral gray scotoma. Upon arriving at the clinic the next day for my post-operative check, I immediately did an SLO/OCT selfie and identified an unusual finding that corresponded directly to the scotoma.

SD-OCT demonstrated an area of hyper-reflectivity in the middle retinal layers just temporal to the fovea (green arrows) and the IR reflectance image showed a distinct dark gray lesion. Fortunately, the scotoma began to fade within a few days and so did the lesion. The jury is still out on the exact cause of the lesion but the selfies have enabled us to track improvement of my condition and possibly publish a case report. We believe it may be a case of paracentral acute middle maculopathy (PAMM), a recently described variant of acute macular neuroretinopathy (AMN). It's rare enough, that I was able to present it at the OPS Rare Case Symposium in Ann Arbor.

As you can see, image quality can be quite good with a little practice. So good in fact that I’ve received a bill from my institution for OCT images that I’ve performed on myself! Here is a double selfie video of a Spectralis IR fundus image showing how easy it is to capture my own epiretinal membrane.

"

There is a belief that taking selfies can be a sign of narcissism rather than simple self-expression. There is also some concern it can be addicting and unhealthy. Maybe this is true and I should stop taking selfies of my own eyes. After all I keep finding abnormalities! But there is a growing trend in telemedicine where patients can take and forward selfies to their doctors to help diagnose or triage the urgency of their condition. 

Ophthalmic Photographers taking diagnostic selfies: obsessive, silly, or beneficial?

Tags:  2015  Ann Arbor  blog  education  Educational Meeting  Ice Breakers  Interactive  Kellogg Eye Center  Meaningful Use  Mid-year  PDC  Selfies  Tips 

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Permalink | Comments (7)
 

Comments on this post...

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Elizabeth L. Affel MT MS OCT-C CDOS ROUB COA says...
Posted Friday, July 24, 2015
Tim,
This is great! But it is a shame you have been going through so much with your own eyes!
Libba
Permalink to this Comment }

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Timothy J. Bennett CRA OCT-C says...
Posted Friday, July 24, 2015
Thanks Libba. Ironically, I just had a vitrectomy with membrane peel this morning. Fingers crossed this will be the last!
Permalink to this Comment }

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Alan Frohlichstein says...
Posted Friday, July 24, 2015
Selfeye?

I trust the surgery went well.

Alan
Permalink to this Comment }

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Elizabeth L. Affel MT MS OCT-C CDOS ROUB COA says...
Posted Friday, July 24, 2015
So do I! I hope they let you take the rest of the day off to recover!
Permalink to this Comment }

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Adeline Stone COT CRA CDOS says...
Posted Friday, October 16, 2015
this is taking selfies to the next level ;)
Permalink to this Comment }

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James Soque CRA OCT-C COA says...
Posted Thursday, January 28, 2016
Not over yet, is it? What is your BCVA this month, 6 months out?
Permalink to this Comment }

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Timothy J. Bennett CRA OCT-C says...
Posted Monday, February 08, 2016
Thanks for asking Jim. I'm currently at 20/30 in that eye. I've done as well as 20/20 with some distortion for a period of time, but things are still settling down. No plans to do a refraction just yet, but I'm guessing I'll land at 20/25 when all is said and done (I hope). Trying to get the steroid induced glaucoma under control right now....
Permalink to this Comment }

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