Win a Coolpix camera

It is difficult to put a finger on one specific reason why non-mydriatic imaging has become so important to the optometric profession. Perhaps the overriding reason is that, as well as adding so much to the practice and to the care of your patients, it is fun.
I don't mean to belittle the profession by using the 'fun' word, but it is hard to get excited when doing a visual field, and your patients are not exactly impressed by the print-out of the results. Show them their fundus image and it is a different story.
The 'wow' factor aside, I think that it is sensible to categorise the reasons for the growth in digital imaging, not necessarily in any particular order of importance, mainly because most optometrists have different priorities depending on their patients' needs, their catchment area, their practice 'philosophies' etc.
So, why have so many invested so much in one single device?

Diabetic retinopathy
Certainly, the potential government funding for diabetic retinopathy has significantly raised the profile of the non-mydriatic camera.

Litigation
I have no wish to seed a wave of panic among the profession, but we are seeing more cases of litigation where perhaps routine ophthalmoscopy has inadvertently missed pathology. Imaging enables the practitioner to store and easily retrieve patient images for review in the event of a dispute. Perhaps a less obvious use of the technology is the ease of which a second opinion can be sought.

Patient education
This is not to be underestimated; we are as a nation becoming far more self-aware and curious about our bodies and any problems that they may have. One of the features of the Kowa software, for example, is the ability to display a schematic eye next to your patient's fundus. This makes the anatomy explanation so much easier.

Keeping up with the Joneses
A perfectly valid reason to invest in a system is to protect your patients from migrating to a competitor. If you are failing to attract new patients or losing existing patients to a nearby practice that has made the investment Ð then you may have little option but to make the investment. It is well known that the cost of attracting a new patient is hugely more expensive than retaining an existing one.

Patient care
There are several aspects to changing your management of patients with the information from an imaging system, the most obvious of which is the ability to compare images across a period of time to positively assess any possible change in condition. The measuring and 'merge/subtract' features in the Kowa software can be invaluable in helping quantify change. If change or a pathology is detected and a second opinion from a colleague or the local ophthalmologist is necessary, then it is far easier to pop a disk in the post or to email the image rather than to start a chain of hospital or other appointments.

Revenue generation
While cold, hard commercialism may not be at the forefront of your mind, when making a significant investment of £15,000-20,000, some measurable return on that investment may be welcome. To charge or not to charge, that is the question. Many practitioners will charge £10-15 for retinal imaging, but not make a charge for voucher patients or children. Assuming that you lease purchase the non-mydriatic camera, then the break-even quantity of chargeable patients per week can be as low as 15 for a five-year lease.
Show off your skills
Showing off our skills really is a valid reason. There is no doubt in my mind that to show and fully explain the pathology to a patient helps justify the examination fee and reinforces your position as a knowledgeable and qualified practitioner.

See more
Several non-mydriatic camera users have commented that they see far more than with their direct ophthalmoscope. After all, what is a non-mydriatic camera? It is basically a very expensive indirect ophthalmoscope with a camera attached.

Keeping it simple
This is so important. Not only should your camera be easy (and fast) to use, but so should the software Ð there is nothing worse than taking that one in a million image and discovering that you have not saved the image or set the system to capture mode.
Make sure the software is really intuitive Ð you need to focus on your patient, not spend the entire session clicking a mouse. Do not be afraid, a good software package will not allow you to forget to save an image and should not let you accidentally delete a patient or an image.

So why have a competition?
As evident in optician's previous competition, there is a whole range of interesting and excellently produced images out there. This is an opportunity to show them off and possibly win a great prize as well.
There will be four winners based on the four main categories of judging:

Unusual condition: merit will be given to an image which captures a lesion or presentation of particular interest for its unusual or rare nature
Photographic technique: this will be given to the photograph judged to be of the highest quality or representing an image that might be technically difficult to capture in normal practice
Clinical management: this will be awarded to the entrant whose photograph is described as having influenced the clinical management of a patient, so showing how imaging is an important part of clinical intervention
Image manipulation: this will be awarded to the photograph showing best use of image software to highlight or enhance a presenting lesion.

The overall winner will be judged to have best reflected all four of the sub-categories.

The prizes
There will be a high specification Nikon Coolpix digital camera for the overall winner, plus two other Coolpix cameras and two Kowa professional Spotting Telescopes for each of the four sub-category winners.
The judging panel comprises experts from the optometric, academic and photographic worlds. The winners will be announced in September.

How to enter
Email your competition entries to william.harveyrbi.co.uk, or post them on CD to optician/Keeler Photographic Competition, Quadrant House, The Quadrant, Sutton, Surrey SM2 5AS. Include your contact details with your entry.
Please remember to maintain patient confidentiality at all times in your submissions. As well as those shown here, interested readers may see some early submissions as well as some from our last competition on the gallery at www.optometryonline.net This will be updated regularly throughout the period of the competition.

Colin West is product manager for the Kowa nonmyd (see p21 for a review of this equipment)