Tag Archives: angiography

The Value of Maintaining Certification

Along with holidays and festive celebrations, the end of the calendar year often marks the deadline to complete any recertification requirements in order to maintain your professional credentials.  I recently completed my OCT-C (Optical Coherence Tomographer-Certified) recertification in December, and just received my updated certificate in the mail. That will hold me for another three years. At the end of 2017, my other professional credential, the Certified Retinal Angiographer, will be up for recertification. It will mark my 30th year of proudly holding the CRA.

I’m not alone when it comes to maintaining these voluntary certifications. Johnny Justice Jr. continues to set an example by maintaining the CRA credential that he originally obtained in 1979 (the first time it was offered). That’s amazing to me.  Several others from that inaugural group of CRA recipients, including Peter Hay, Phil Chin, Tom Egnatz, and Chuck Etienne, also maintain their CRA after all these years.  None of them have anything to prove at this point in their careers, especially Johnny. He is a pioneer in the profession and was the driving force and founding member of the Ophthalmic Photographers’ Society. He is a well-known author and lecturer, and is universally considered the “Father” of our profession. He certainly doesn’t need the CRA to gain employment, or practice in his chosen profession. He proudly maintains his CRA out of respect for the credential, and what it means to the profession that he helped to create. It clearly has value to him after all these years and all his accomplishments.

In a highly technical field such as ophthalmic imaging it may seem surprising there are no licensure or certification requirements. Certification is strictly voluntary to perform in these roles. It is estimated that less than half the people working as ophthalmic photographers, assistants, or technicians are certified. It’s not easy to obtain certification, and it shouldn’t be. After all it’s meant to identify individuals who have demonstrated a designated level of competence in their field. It takes knowledge, skill, and experience to successfully complete the examination process for certification. Anyone who has completed this process knows the significant effort that is required.

So why get certified if it isn’t required, universally recognized, and takes significant effort? It’s about value. The benefits of certification are often tangible: increased job satisfaction, enhanced job mobility, increased earning power, and a competitive advantage for advancement or the best employment opportunities. But the benefits don’t stop with the certified individual. They also extend to the employer, ophthalmologists, insurers, and most importantly, our patients and their families. All of these groups benefit from knowing they are dealing with a recognized professional.

Certification also helps establish a professional identity and recognition by your peers. It certainly did that for me. In fact, I worked in the field for nearly ten years before initially pursuing certification. I decided it was time to move on in my career and needed certification to gain access to the best jobs. It worked, as my next employer required the CRA as a condition of employment. But I was pleasantly surprised by the additional benefits that certification provided. Although I was very skilled in the technical aspects of photography and had worked at one of the most prestigious institutions in the world, no one outside my place of employment knew my name. That all changed when I obtained my CRA. I suddenly had the respect of my peers and began receiving invitations to play a role in professional activities in the OPS and beyond.  Certification seemed to be “the price of admission” to important networking opportunities that lead to leadership roles in the OPS and JCAHPO. From there came many opportunities to share my knowledge through lectures and publication. And it all started with certification.

But the process doesn’t end when you first receive your credentials. Certification is much more than a one-time achievement. It is a dynamic, career-long commitment to continued education, assessment, and professional development. There is incredible value in attaining, and also maintaining, your certification.

Book Review

Optical Coherence Tomography and OCT Angiography: Clinical Reference And Case Studies

Darrin A. Landry, CRA, OCT-C
Amir H. Kashani, MD, PhD

Bryson Taylor Publishing, 2016
ISBN–‐13:978–‐1523976867
ISBN–‐10:1523976861
www.BrysonTaylorPublishing.com

In the early days of retinal angiography, photographers often worked very closely with ophthalmologists, learning together as they explored the diagnostic uses of fluorescein angiography and unraveled the complexities of interpreting the fascinating images they were capturing. This spirit of scholarly collaboration between imager and physician continues today in a new book: Optical Coherence Tomography and OCT Angiography, Clinical Reference And Case Studies by Darrin Landry and Amir Kashani. These authors are both well respected in their respective fields as educators and authors. Together they have created a timely textbook that will appeal to members of both professions.

Before receiving an advance copy of this book for review, I anticipated that the content would focus almost exclusively on OCT angiography.  I was pleasantly surprised to find that although the book features OCT-A prominently, it is much more than a text on this new state-of-the-art technology. It appropriately places OCT-A in the context of multiple imaging modalities to assist in diagnosis of a variety of retinal conditions.

The authors have produced a book that is part tutorial, part clinical atlas, and a collection of over forty cases that “puts it all together” using multiple imaging modalities with clinical descriptions. The book is divided into three sections:

Section 1. OCT and OCT Angiography

The introductory section will be particularly useful to imagers as it includes a basic overview of OCT and OCT-A technology, followed by a discussion on pattern recognition, normal anatomy and layers of the retina, how to move the scan pattern, recognizing artifacts, EDI/FDI and a basic primer on OCT-A. The OCT-A primer explains how this technology scans through the z-axis and detects motion to identify the retinal vasculature including the deep retinal plexus.  It includes a discussion of artifacts specific to OCT-A . This section will be especially helpful to those new to OCT and OCT-A, and anyone preparing for certification as an OCT-C.

Section 2. Atlas of Images and Disease Pathology

This section is an atlas of retinal OCT findings organized in anatomical order from the vitreous to the choroid. For each condition, the text includes a brief discussion of the disease process, clinical findings, and appearance in multiple modalities. For each condition, there are multiple image examples providing a full spectrum of potential findings for that disease. For instance, there are over twenty different examples of epiretinal membrane. Novice imagers will find this variety especially helpful in learning to recognize different manifestations of a single condition. In addition to common retinal findings the book also includes good examples of less recognized conditions such as outer retinal tubulation (ORT) and reticular pseudodrusen. As expected, retinal vascular diseases include OCT-A examples along with SD-OCT and other imaging modalities including fluorescein and ICG angiography. Experienced imagers will recognize many of these conditions, but the addition of OCT-A will give them another viewpoint and expand their understanding of each disease.

Section 3. Case Studies

The final section of the book is a series of over forty cases where the authors combine a brief medical summary with appropriate imaging modalities for clinical correlation. This format fits well with the current trend of “case-based-learning” in medical education. In many of these cases, OCT-A dovetails nicely with other imaging modalities to increase our understanding of a disease process or help confirm a diagnosis. This quote from the book’s Preface describes the format well “These images are presented in the context of additional imaging modalities to aide the reader in making useful correlations.”

In conclusion, this timely book is well organized and thorough, without becoming unwieldy. It is easy to navigate between sections if you want a quick reference on OCT anatomy or to look for examples of specific retinal conditions and how they may appear on OCT, OCTA and other imaging modalities. With over a thousand images and forty cases, to say that this book is generously illustrated would be an understatement. It is an impressive collaboration between an ophthalmic imager and a retinal specialist that should appeal to a wide audience that would include ophthalmic imagers, retinal technicians, residents in training, and clinicians wanting a reference for clinical correlation between modalities.

From a personal standpoint, I think it’s great to have an ophthalmic imager making a significant contribution to the ophthalmic literature. Darrin’s collaboration with Dr Kashani serves as a model for what imagers can accomplish when we collaborate with physicians on a professional level.  The spirit of collaboration between professions is echoed several times in the book including this statement from the Introduction, “Constant and close communication between the physician and imager is very essential.”

Reviews like this often end with a cliché that suggests that everyone in the profession should “add this book to your collection” or “keep a copy on your bookshelf”. I’ve tried to avoid those clichés, but honestly, I am happy to have this book in my collection and plan to keep it handy in clinic for reference, especially as we integrate OCT-A into our own diagnostic armamentarium.