Volk’s Pictor Plus earns its keep!
It’s been a hectic but rewarding first two days in Uganda for me and the Vision 2020 team. Due to some issues with the benchtop systems, Pictor Plus ended up being our only fundus camera and it has proved to be up to the task. We’ve screened upwards of fifty patients, diagnosed a host of vision issues and even made history–not bad for just two days on the ground!
Screening has been carried out by the Mulago Hospital staff assisted by the Royal Free Hospital Team. In just one morning clinic, we screened thirty patients, carrying out both fundus and OCT photography on each. This patient throughput is similar to that achieved in a London hospital. As patients wait for days, camping outside on the hospital grounds to be seen, it’s imperative we see as many as possible while we’re here, as well as training and mentoring the local staff.
Part of the reason we’ve been able to achieve such high throughput in challenging conditions has been the ease of managing patients with the Pictor Plus. With a bench top system, you have to get the patient to the chin rest with no flexibility at all in positioning. The Pictor Plus can be used on patients sitting on a regular chair, with the practitioner free to position both the Pictor Plus and the patient’s head and gaze. All three team members using it (an ophthalmologist, a retinal nurse and an orthoptist) have all expressed how much they love the ease of use and prefer it to a typical benchtop system.
Screening consisted of an initial Pictor Plus exam and review by an ophthalmologist. In general, we took four fundus images of each patient with Pictor Plus, disc-centered and macula-centered, of each eye. The Pictor Plus’ eyecup provides stability to the camera, reduces stray light and generally helped team members get good images. Images were then transmitted wirelessly into the Spectra Retineye screening software provided by UK-company Health Intelligence. After being acquired, the images were graded by an ophthalmologist on the team prior to, in most cases, OCT examination.
With our first screening exam, we made ophthalmic history in Uganda. Both the formal screening and the OCT exam were firsts for the entire country. This landmark has even attracted the attention of the national press. When you think that this technology has been available for decades, and about the volume of these exams that have been conducted in our developed countries, it is truly humbling to realize the impact of this trip.
The first exam indicated focal laser treatment which was then carried out using a Quantel laser and Volk Optical HR Centralis lens. Over the course of the clinics, patients exhibited a range of pathologies. We saw all stages of diabetic retinopathy, as well as serious conditions such as BRVO (Branch Retinal Vein Occlusion) and CRVO (Central Retinal Vein Occlusion). In addition, we examined two patients who had pathologies suggesting they were HIV positive.
On Thursday, we will have a pediatric consultant with us, trying out the camera on the children’s ward. They have 300 births a day here, so no shortage of patients. We will be screening for evidence of retinoblastoma and other eye disease.
From there, I travel to the Mbarara rural clinic. I’ll be sending more updates as time allows.