Digital retinal Screening

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The Chicago Neuroscience Institute (CNI) utilizes state-of-the art retinal imaging technology to screen for retinal pathology and to further neurological assessment in some cases. CNI forwards the digital images through a telemedicine portal to a renowned ophthalmologist/retinal specialist for interpretation. The  interpretive report is generally received back within 24 hours of submission. 

The study protocol  implemented by the Institute allows for digital recording of retinal integrity, expert interpretation and an  objective basis for comparative reevaluation. Digital retinal screening provides valuable information about the health and integrity of the optic nerve, macula, and small blood vessels in the retina. It provided an effective method for detecting eye (retinal) complications associated with diabetes. The eye provides an accessible “window” for detecting and characterizing small vessel (microvascular) disease which often parallels small vessel changes in the brain.

Digital retinal screening refers to the use of a special microscope and camera to image and photograph the back of the eye, an area referred to as the retina. The images reflect the health of numerous tissues including the optic nerve, macula, retina and small blood vessels. Retinal imaging is used to diagnose systemic and eye conditions. The integrity of small blood vessels in the back of the eye often represents small vessel changes in other regions of the body including the brain. Retinal images also reveal abnormalities which may threaten normal vision. 

Retinal images offer an objective baseline for future comparison which supports disease monitoring and provides measures of treatment outcome. Imaging data can be sent to a remote expert for interpretation. In some cases artificial intelligence (AI) may be used in addition to expert interpretation to improve the diagnostic process. Advantages of digital retinal screening include rapid diagnosis, remote expert review, and objective medical record documentation. 

The digital retinal screening at the Institute includes assessment for: 

• diabetic retinopathy 
• diabetic macular edema 
• choroidal nevus 
• increased cup/disk ratio (glaucoma) 
• vascular tortuosity 
• abnormal pigmentation  

Research has demonstrated that the integrity of small blood vessels in the retina often parallel the integrity of small vessels within the central nervous system including the brain.

The retina shares many of the tissue characteristics and features of the brain. Small vessel disease in the eye often parallels abnormal brain MRI findings consistent with small vessel disease, such as, white matter lesions, atrophy and micro-strokes. Small blood vessel compromise in the brain increases the risk for cognitive impairment, poor balance, dementia, stroke, and movement disorders. Regular retinal screenings can lead to early detection and intervention for microvascular disease, thus leading to better treatment outcomes and improved neurological health.  

Small blood vessels represent the final pathway of the delivery of nutrients and oxygen to nerves within the brain. Nerves which do not receive adequate blood flow from small blood vessels will suffer damage or cell death that alters function. Microvascular disease is subsequently a common contributing factor to chronic and degenerative neurological disorder in older people. The majority of adults over age 60 demonstrate some degree of age-related small vessel ompromise on brain MRI studies. 

Digital retinal imaging can be used to screen for diabetic retinopathy and to help detect the presence of small vessel disease, often referred to as microvascular disease (MVD). The circulatory system is comprised of large, medium, and small caliber blood vessels. Most diagnostic and therapeutic procedures focus on diseases of large vessels. The acronym MVD refers to disorders which compromise small blood vessels.  Small blood vessel disease is harder to detect and more difficult to treat than large vessel disease; therefore, prevention, early detection and timely intervention is crucial. The health and integrity of all bodily tissues is dependent on adequate large and small vessel blood flow. MVD can result in cell injury (ischemia) or cell death (infarct) in any tissue, even in the absence of large vessel disease. Retinal imaging provides a unique opportunity to detect the presence of her risk for small vessel (microvascular) disease. 

The cause of microvascular disease is not completely understood. What is known is that many of the risk factors can be reduced or eliminated by lifestyle changes. Therefore it is important to consider diagnostic methods such as digital retinal imaging to detect early stage involvement. Risk factors for microvascular disease include:

• aging atherosclerosis
• tobacco use (smoking)  obesity
• diabetes high cholesterol
• sedentary lifestyle high blood pressure
• insulin resistance estrogen deficiency
• arteriosclerosis  autoimmune disorder

The attending healthcare provider will have you sit comfortably in front of the imaging system with your chin and forehead resting on a guide. The eye camera will be focused on one eye, then the other. There will be a brief flash when an image is taken, similar to flash photography. The entire retinal imaging procedure will take a few minutes.