This document discusses updates to the EyePACS photography certification process including a new website for practice cases and test questions. It provides tips for taking high quality external photos and avoiding small pupil artifacts. Recommendations are given for optimizing photos taken before and after pupil dilation. Recent winners of a photography volume and growth award are also recognized.

1. EyePACS Learning Community
October 24, 2011
Photographers’ Corner:
New Approaches to Old Problems
Harry Green, OD, PhD
Nancy Nguyen, OD
Jorge Cuadros, OD, PhD
Barbara Shayesteh
UCB Digital Health at 510-642-5456

2. Items to discuss
 Changes to the photography certification
process
 New Compact Flash adapters
 Optimizing External Photos
 Review of retinal landmarks
 Small Pupil Artifacts – avoiding the dreaded
shadow
 Photograph quality before and after the decision
to dilate
 Awards

3. Photography Certification
 New certification website:
 http://photographer.eyepacs.com
 Separate from the main www.eyepacs.org site where actual
patient cases are uploaded
 Two parts:
 Practice Case Module
 Test Questions Module
 To start a new photographer certification:
 Accounts to the certification site are by email invitation
 Email ucb.digital.health@berkeley.edu with photographer’s
full name and email address

4. Practice Case Module
 Capture retinal photos of non-patients (i.e., other clinic
staff) and upload photos on a case by case basis onto
the EyePACS photographer certification website
 Cases are graded for:
 Good focus
 No artifacts
 Correct view for all 8 photos (fixation target is moved
appropriately)
 Start by submitting 3-5 full cases
 These will be evaluated and feedback provided
 If not of sufficient quality, more test cases will be requested
 If of good, consistent quality, can then proceed to Test
Questions

5. Test Questions Module
 Consists of 10 multiple choice questions that cover the
basics of effective Digital Retinal Imaging
 To pass the test, candidates must correctly answer all
questions.
 If a candidate fails the test, he or she is advised to
review the 'Test Review' page that provides the correct
answer and explanation for each question the
candidate missed.
 The candidate will then be given the option of retaking
the test.

6. Compact Flash to MicroSD Adapters
 The Why
Bending the pins in the
compact flash reader
inside the camera back

7. Compact Flash to MicroSD Adapters
 The Why
Bending the pins in the
compact flash reader
inside the camera back
 The How
MicroSD to Compact
Flash adapter
MicroSD card very
small

8. Compact Flash to MicroSD Adapters

9. Compact Flash to MicroSD Adapters
 The Why
Bending the pins in the
compact flash reader
inside the camera back
 The How
MicroSD to Compact
Flash adapter
MicroSD card very
small
 The When
Ready to ship

10. Tips for External Photos
 What is important for the external photo:
 Pupil margin in sharp focus
 Iris details in sharp focus
 The eye should take up 2/3
of the screen as pictured
 Bright red reflex to helps indicate presence of cataracts
 CR-Dgi: pull tab all the way “out” for “out”side photos
 CR-1: pull tab “down and out” for “out”side photos

11. Retinal Landmarks To Look For
Vessels
Optic Nerve
Macula

12. Alignment and Gaze Direction
Internal Field 1 Internal Field 2 Internal Field 3

13. “The Shadow” – Small Pupil Artifacts

14. “The Shadow” – Small Pupil Artifacts
3 MUST HAVE elements
1. Optic Nerve visible and in adequate focus
2. 50% of the retinal area visible and in adequate
focus
3. MACULA

15. “The Shadow” – Small Pupil Artifacts
External Internal 1
Internal 2 Internal 3

16. The Shadow – Small Pupil Artifacts
Solutions:
Make sure the room is completely dark
Wait longer between photos (30-60sec)
Small pupil “s.p.” knob
Ask patient to wiggle their toes
Increase flash
911
Dilation
Shadow
Overall dark + shadow

17. Benefits of Dilation

18. September 2011 Winners
Volume
East Valley Community HC 198
Golden Valley HC - Modesto 100
Golden Valley HC - Merced 92
Growth compared to August 2011
 Lifelong Medical Care showed the
highest increase over July’s screenings.