There is no reason why a patient seen in their own home should expect anything less than a comparable service to someone attending a high street practice. In the past, Domiciliary Optometry may have been viewed by some as a poor relation of high street practice. Seemingly, an Optometrist would visit a patient at home with equipment they'd managed to bring from their practice and conduct an eye exam to the best that a non-ideal environment would allow. For years the sector has worked hard to shake off these outdated stereotypes.
Modern technology has accelerated the quality and expectations of a domiciliary visit. Equipment is becoming ever more portable and ever more workable. The development of the iCare tonometer has allowed for patient friendly and highly portable pressure measurements. Electronic LogMAR test charts assist in assessing those patients with low vision and tablet computers mean comprehensive and secure patient record cards can be created efficiently.
Now there has been a giant leap for home eyecare.
Until recently it has been impractical to obtain usable fundus images in a remote environment, something that has been the norm in high street practices. Previous attempts at portable fundus cameras have been less than ideal with many having a limited field of view, low resolution and often difficult to get the patient to fixate accurately. Attempts at photography often resulted in images which were little more than a red blur, or indeed no image at all.
However, with ever advancing technology, several manufacturers are now producing high quality, portable, non mydriatic cameras allowing the level of clinical care and monitoring in a patient's own home. When connected to a computer or tablet PC these images can be directly uploaded and inextricably linked to a patient record card allowing for accurate year on year monitoring. 5-megapixel resolution and a 45-degree field of view are now standard allowing practitioners to zoom in on lesions for localised assessment; certainly comparable with the often bulkier high street equivalent technology. With an ageing population and an associated increase in ocular pathology this becomes an even more vital tool in the Domiciliary Optometrist's armoury.
As a leading innovator in home eyecare, The Outside Clinic has recently invested heavily in this exciting new technology, currently rolling out Nidek Versacam cameras to all Optometrists, raising the bar in domiciliary care. Should a field Optometrist request a second opinion from a colleague they no longer have to rely on verbal descriptions but can send encrypted images to office based Professional Services Optometrists just as you might request your colleague's opinion in the next door consulting room.
Should the need arise, and with the patient's permission, these images could be securely shared with other medical practitioners involved in their care.
The first image on this page shows a Nidek Versacam in use. Here a touch screen interface and large display means intuitive user controls and the ability to instantly show and discuss images with a patient. At 445g it adds little to the overall weight of equipment, can be used with a patient who is seated or supine and can also be attached to a slit lamp if required. Both colour and red free images can be captured and stored simultaneously at any one of seven fixation points as in the example shown in Figure 1, below.
Figure 1: Example images taken with a Nidek Versacam in a domiciliary environment. Patient: Mrs P, Nottingham.
The Outside Clinic Optometrists will automatically be supplied with any previously obtained fundus photographs on subsequent visits. This ensures they can be confident to monitor the progression or changes of any pathology as well as providing a very useful tool to aid detection. This is all part of their in-house developed, tablet PC record card system. When used in conjunction with direct ophthalmoscopes, portable binocular indirect ophthalmoscopes and portable slit lamps, this provides a comprehensive array of investigative tools ensuring the patient receives the best possible service and care.
“As UK distributors for Nidek we are delighted to be working with the Outside Clinic to introduce an enhanced patient experience. The introduction of Hand Held Fundus Cameras for all Optometrists in the group demonstrates the importance placed on providing a comparable service in the patient’s own home as in a high street practice” said Amanda Danson, Sales Director for Birmingham Optical.
Who knows what equipment will be available to the Domiciliary Optometrist of the future, perhaps even portable OCTs or similar?
It is certainly an exciting time to be involved in Domiciliary Optometry!