Ophthalmic photography has long played an important role in the documentation and diagnosis of ocular diseases. Ocular photography is used to record medical conditions, track disease progression, and create illustrations for publication and education. The primary role of ophthalmic imaging however goes well beyond documentation in its ability to aid in diagnosis of a broad range of eye conditions. Treatment plans derived from the diagnostic information provided by ophthalmic images have benefited countless patients, as ophthalmologists use images for decision making purposes on a daily basis, and in some cases, rely on photographs as a “road map” to guide therapy.
The history of ocular photography dates back to the late 1800’s when Jackman and Webster described a technique for photographing the retina of a living human subject. The next fifty years witnessed a slow advancement in instrumentation and techniques. Photographic results were mostly inadequate due to slow film speeds, long exposures, and inconsistent light sources. In the 1950s electronic flash and 35mm cameras were adapted to ophthalmic instruments and modern ophthalmic photography was born.
There is a compelling connection between this photographic discipline and our subject, the human eye; a connection that goes beyond the obvious parallels between eye and camera, cornea and lens, iris and aperture, retina and film. We use the visual art of photography to identify problems in another visual system – the eye itself. Optical instruments used to examine or photograph the eye often utilize the optics of the subject eye to help in visualizing the target pathology.
Ophthalmic photography can at times be simple or incredibly complex. Ocular tissues can be opaque, translucent, or transparent and may require different strategies to record these structures photographically. Enhancement of anatomic features is sometimes necessary, and can be achieved by using fluorescent dyes, monochromatic light, or specialized optical devices and techniques to adequately document subtle pathology that would otherwise not be visible.
Creativity and aesthetics have their place in this field and many ophthalmic images transcend their scientific purpose and achieve artistic merit, but it can be heartbreaking when the most photogenic or aesthetically pleasing subjects present themselves because a patient’s vision is severely compromised. Enthusiasm for creative imaging can suffer in the context of tragic loss of vision. This is balanced however, against those times when an imager captures great images that help preserve a patient’s vision. Unfortunately not all images will be of sufficient quality to warrant public display or publication. The challenge for ophthalmic photographers is to provide consistent clinical images of adequate diagnostic quality, even under adverse conditions.
By providing support for education, research, and clinical eye care activities, ophthalmic photographers have been an integral part of the professional eye care community for decades. As new diagnostic imaging and treatment modalities are developed, the role of the ophthalmic imager will evolve and continue to play an important role in the preservation of sight.