Features

All the judges have returned their verdicts and we are proud to announce the winners of our anterior eye photography competition. This is the first competition of its kind we have run and so the outcome was impressive.

We had around 40 entrants in total, and of those several sent in many individual entries (which was well within the rules) of exceptional range and quality.

The majority of entries were of unusual conditions, though there were also some excellent photos showing good clinical management, including contact lens related presentations.

The judges were: Bill Harvey, Optician clinical editor; Ron Loveridge, professional services manager, CIBA Vision (UK); Anne Bolton, head of medical imaging, Oxford Eye Hospital, Radcliffe Infirmary, University of Oxford; and Dr James Wolffsohn, director of undergraduate studies and senior lecturer, Neurosciences Research Unit, Aston University.

Clinical Management
Winner:  Tim Wooley
Prize: £200 Camera


This was judged as the photo or photos that were thought to best illustrate how an image or images help in the management of any particular presentation, including 'before and after' images.
One good example came from Deacon Harle (Institute of Optometry) whose removal of a foreign body could have won had the resolution of the images been higher (Figures 1a and b).


Several of the contact lens related presentations fitted well into this section as the image influenced subsequent management.

 





Paul Hutchence (Lancaster) sent some nice images of presentations where the severity of the signs influenced the subsequent course of action, including severe contact lens related
neovascularisation (1c), an infective keratitis ulcer (1d) and an atypical lid ulcer subsequently confirmed as a sclerosing basal-cell carcinoma.



One judge described the neovascularisation image as 'a very good image purely on its own merits. The illumination is even and the highlight has been placed in the pupil rather than on the sclera where it would have caused flare.


It has been taken with high magnification so it is harder to get a crisp image and this one is very well focused as you can see the tiny capillaries on the corneal surface extending beyond the limbus'.

The majority decision, however, awarded the prize to Tim Wooley (Maidstone), whose 'mini-portfolio' showed 'an excellent breadth of photographic and imaging skill' to 'enhance his clinical decision-making'.


Notable examples included contact lens related images, such as the GPC
on lid eversion shown in Figure 1f, and the
excessive lens deposition shown in Figure 1g.




A corneal section to view an inferior corneal cone (1h), the use of 3D imaging to assess a lid neoplasm (1i) and a view through a gonioscopy lens, all show excellent clinical skills and are worthy of the prize.



















Unusual Conditions
Winner: David Gould (Lancashire)
Prize: £300 camera

There are too many entries to give a fair reflection of the excellent skills out there in this short review and Optician does intend to put further examples up on the website at some stage. In the meantime, our old friend Kirit Patel (Radlett) and his 'Christmas tree cataract' is worth showing here (Figure 2a).



A much more common presentation but beautifully photographed was the pterygium sent in by Michael Gatoff (Hanley) in  Figure 2b.













The unusual lid wart (2c) and the excessive dimpling sub lens bubbles (2d) sent in by Brian Tompkins (Northampton) were also noteworthy.








Lewes-based Paul MacDonald's shot of a Weiss' ring (2e) was also liked by our judges.









Dr Dan Rosser (Norfolk) sent an image of Stevens-Johnson syndrome, rarely seen by optometrists but remarkable for the extent of its effect (2f).





Graeme Clark (Orkneys) deserves a mention for his unusual presentation of a progressive benign conjunctival haematoma (2g) which could easily have been selected for the last category.




But overall the judges liked the entry from David Gould (Lancashire) showing an insect tangled in the upper lash margin (Figure 2h), 'the cause of my patient's itchy eyelid. I am no insectologist, and the species remains unknown to me, but he appeared to be waving at me when I switched on the slit lamp'.

Overall Winner

Dan Rosser (Norfolk)
Prize: £500

For a range of conditions showing ' superb detail and photographic skill', the winner was selected unanimously by our judges.

Dan Rosser used a Coolpix 950 attached to Haag Streit BM900 (in most cases with bespoke eyepiece adapter).


Among the unusual conditions he included: traumatic angle recession viewed through four-mirror gonioscopy lens (Figure 3a);








Fuch's corneal dystrophy, Descemet's membrane fold seen in direct illumination (3b);















Haab's striae, with splits in Descemet's membrane secondary to enlargement of the globe in congenital glaucoma (3c);
 

Irdo-corneal-endothelial (ICE) syndrome showing corectopia secondary to contraction of abnormal corneal endothelial cells which have migrated across the anterior chamber angle and iris (3d);













Kayser-Fleischer ring (3e);











Vogt's striae (3f);

















Krukenberg's spindle (3g);
















and rubeosis (3h).
















Clinical management was well represented by a nice 'before and after sequence' showing the allergic response to levobunanol and resolution upon switching to latanoprost (3i and j).

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