Digital Retinal Photography: A Golden Standard?
Affecting the performance of multiple systems within the human body, diabetes is known to impair patients’ vision significantly. Particularly, due to the increased blood sugar levels, a diabetic patient is exposed to the threat of the retina is damaged, which, in turn, may cause the rapid development of retinopathy and the resulting loss of vision (Padhy et al., 2019). Since the destruction of the retina occurs at a very fast pace, using tools that will allow detecting it in a patient and introducing appropriate measures immediately is crucial, which is why they use of digital retinal photography (DRP) as a diagnostic tool is vital. However, the role of the DRP must not overshadow the application of other methods that allow for a more accurate diagnosis and a more precise measurement of the extent of the threat.
In its essence, DRP is the process of scanning the back of an eye, including the retina, the optic disk, and the blood vessels, for any abnormalities or dysfunctions. Thus, applying DRP as the method of capturing the presence of a threat and undertaking measures for counteracting it is vital to the patient’s well-being (Unnikrishnan et al., 2018). Specifically, DRP provides a wider view of the retina due to the application of digital technologies that offer greater opportunities for navigating the patient examination process (Rhee et al., 2020). Thus, DRP must be acknowledged for the improvements that it has introduced into the early management of retinopathy, particularly, in diabetic patients, who are especially prone to the disease.
However, the DRP technique also has noticeable disadvantages. For instance, despite the presence of digital technologies in the described method, the DRP technique does not provide an entirely accurate account of the changes in the patient’s retina. Therefore, it cannot be viewed as a standalone tool for testing the development of retinopathy in diabetic patients and, instead, should be used as an auxiliary tool (Zapata et al., 2020). Indeed, as the existing studies indicate, the use of DNP implies several important limitations, both in terms of quality of diagnosis and the associated costs.
Specifically, DNP is not included in digital care plans, which means that it will not be covered by insurance. Although the current fee for DNP is quite affordable, the absence of insurance coverage still represents a significant concern. In addition, different DNP tools perform the assessment of the retina at different levels of accuracy (Andriesen et al., 2017). Therefore, the outcomes of the assessment are likely t require additional assessment and a more precise diagnostic tool. Finally, the low resolution of the obtained images does not allow making DNP the golden standard for diagnosing retinopathy in patients. Instead, it must be used as the first assessment tool in conjunction with other assessment techniques and followed by a more detailed and accurate assessment approach, such as a comprehensive eye exam combined with optical coherence tomography (OCT). Since OCT allows scanning different layers of the retina and defines its thickness, it offers a much more accurate assessment, which makes DNP less efficient by comparison (Sanborn and Wroblewski, 2018). Nevertheless, as the means of controlling the development of diabetic retinopathy, the specified tool I quite efficient t indicating changes at the early stages, which is why it needs to be included in the traditional set of tools. Thus, even though DNP cannot be regarded as the golden standard for identifying retinopathy in diabetic patients, it still should be incorporated into the diagnostic toolkit.
Case Study: Locating Treatment Options
Addressing the first complaint of the patient, specifically, the issue of left eye background retinopathy, one should admit that there is currently no treatment that could cure or, at the very least, reverse it. In addition, to reduce the extent and scale of the disease development, scatter laser surgery can be recommended (Opara et al., 2020). The described method allows shrinking blood vessels that create vision problems, thus improving the patients’ well-being (Gerull et al., 2018). Although scatter laser surgery does not imply curing retinopathy, it will delay the process of disease development, allowing the patient to adjust to changes and develop a healthier lifestyle and a more effective approach toward managing key threats to her health.
Additionally, regular checkups will be crucial for controlling the changes and delaying the progression of the disease as effectively as possible. Monitoring changes will be essential in keeping the patient’s well-being and ensuring that their disease is not going to disrupt their life. Moreover, the specified approach will help the patient to transition to a new lifestyle that will simply be adjusting to changes in her vision and the related management of key daily and work-related routines. Finally, medical treatment will involve antihypertensive drugs, as well as antiaggregatory and lipid-lowering medications, which will contribute to the development of macular edema and the resulting loss of vision that background retinopathy may entail (Spector and Kim, 2019). Thus, the threat of further impairment and vision deficit will be minimized.
Similarly, the problem of proliferative retinopathy must be addressed accordingly. Implying not only a gradual decline of vision but also the threat of vitreous hemorrhage, as well as further retinal detachment, the specified disease will require focal laser treatment. Since proliferative retinopathy involves the formation of a new vessel on the retina, known as neovascularization, the removal of this tissue will be crucial in ensuring that the patient’s vision is not impaired. In turn, focal laser treatment will reduce the threat of blood and fluid leakage, thus preventing the damage to the eye from occurring (Trifonova et al., 2018). Therefore, surgical intervention will be crucial in addressing proliferative retinopathy in the patient’s right eye. Thus, while the left eye is likely to be impaired gradually, the vision of the right eye can be retained at the current rate with the help of timely focal laser treatment.
Finally, it will be critical to ensure that the quality of the patient’s life remains at the same level despite the development of retinopathy. For this purpose, a therapist will have to help the patient to adjust to the new lifestyle and transition to a new mode of functioning seamlessly. Specifically, the vision impairment should not affect the patient’s ability to move, engage in her daily activities, perform key workplace functions, and be socially active.
In addition, both conditions observed in the patient will require a more coherent and careful regulation of sugar levels in her blood. The goal of reducing the amount of blood sugar will be achieved by reconsidering the present lifestyle of the patient and suggesting that she adopt a more proactive one. Specifically, exercises aimed at controlling the levels of blood pressure and ensuring that they are sufficiently high will be needed to reduce the current rates of disease progression and create the basis for further treatment.
References
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Gerull, R., Brauer, V., Bassler, D., Laubscher, B., Pfister, R. E., Nelle, M. and Adams, M. (2018) ‘Incidence of retinopathy of prematurity (ROP) and ROP treatment in Switzerland 2006–2015: a population-based analysis’, Archives of Disease in Childhood-Fetal and Neonatal Edition, 103(4), pp. 337-342.
Opara, C. N., Akintorin, M., Byrd, A., Cirignani, N., Akintorin, S. and Soyemi, K. (2020) ‘Maternal diabetes mellitus as an independent risk factor for clinically significant retinopathy of prematurity severity in neonates less than 1500g’, Plos One, 15(8), pp. 1-8.
Padhy, S. K., Takkar, B., Chawla, R. and Kumar, A. (2019) ‘Artificial intelligence in diabetic retinopathy: A natural step to the future’, Indian Journal of Ophthalmology, 67(7), p. 1004.
Rhee, S. Y., Kim, C., Shin, D. W. and Steinhubl, S. R. (2020) ‘Present and future of digital health in diabetes and metabolic disease’, Diabetes & Metabolism Journal, 44(6), pp. 819-827.
Sanborn, G. E. and Wroblewski, J. J. (2018) ‘Evaluation of a combination digital retinal camera with spectral-domain optical coherence tomography (SD-OCT) that might be used for the screening of diabetic retinopathy with telemedicine: a pilot study’, Journal of Diabetes and Its Complications, 32(11), pp. 1046-1050.
Spector, A. A. and Kim, H. Y. (2019) ‘Emergence of omega-3 fatty acids in biomedical research’, Prostaglandins, Leukotrienes and Essential Fatty Acids, 140, pp. 47-50.
Trifonova, K., Slaveykov, K., Mumdzhiev, H. and Dzhelebov, D. (2018) ‘Artificial reproductive technology–a risk factor for retinopathy of prematurity’, Open Access Macedonian Journal of Medical Sciences, 6(11), p. 2245.
Unnikrishnan, R., Sharma, N., Mohan, V. and Ranjani, H. (2018) ‘Technology in the management of diabetes mellitus’, Journal of Diabetology, 9(1), p. 3.
Zapata, M. A., Royo-Fibla, D., Font, O., Vela, J. I., Marcantonio, I., Moya-Sánchez, E. U. and Labarta, J. (2020) ‘Artificial intelligence to identify retinal fundus images, quality validation, laterality evaluation, macular degeneration, and suspected glaucoma’, Clinical Ophthalmology, 14, p. 419.