Time-lapse video using a series fundus photographs during treatment of wet ARMD

Author: Simon Berry

Affiliation: Simon Berry Optometry, Durham, UK,  Sunderland Eye Infirmary, UK.

Date: 15th April 2010

Background: This case history is written to provide further background information regarding the patient whose fundus photographs were converted to a time-lapse video. It will also describe some of the technical aspects of the conversion and explain how it was done. The patient was recruited from my optometric practice.

The Patient: 81 year old male.

Clinical History:  The patient first came to our practice in 2003. During the initial history he mentioned that he had "dry" ARMD in his left eye and that it was first diagnosed sometime in the 1980s. This was confirmed clinically. He was asymptomatic and had good visual acuity. The left visual acuity was measured at 6/6-.

We continued to see him on a yearly basis and the visual acuity in the left eye remained relatively stable. We first obtained a fundus photograph in May 2008 when he was still asymptomatic although the visual acuity had dropped slightly to 6/9-. This is slide number 1.

He came into our practice on 6th November 2008 complaining of a distortion of his central vision in his left eye. The visual acuity had only deteriorated fractionally and measured 6/12. Nothing was obvious clinically but because of the strength of symptoms I referred him to the macula service at Sunderland Eye Infirmary. He was assessed with OCT and fluorescein angiography and despite the symptoms, no pathology was found. The fundus photographs around this time are labeled as slide number 2.

He attended again on 8th May 2009 describing a large blot on his central vision. He had a large macula haemorrhage in his left eye and the visual acuity had dropped to 6/60. He was again referred to the macula service where he was diagnosed with wet ARMD and received a course of ranibizumab treatment. During this time I took consecutive fundus photographs which have formed the basis for the time lapse video.

The visual acuity in his left eye naturally fluctuated during the course of treatment. After the first course of ranibizumab treatment the visual acuity had improved to 6/12. On a subsequent clinic visit this deteriorated to 6/36 and a further course of ranibizumab was initiated. At the time of writing the patient continues to be reviewed in clinic and we continue to take fundus images, although not as often. Further slides will be added to the video in the future.

Technical Information:  The fundus camera used was a Nidek AFC-210. The image collecting software used was NAVIS Lite. The manipulation software used was Adobe Photoshop CS3 and the video was put together using Fina Cut Pro.  Most images apart from 01 and 02 were taken without dilating the pupil. This is the reason why some slides appear to be darker than others.  As the video was put together using Photoshop and Final Cut, each image was saved as a separate frame and moved so that the retinal veins coincided as closely with the previous image as possible. For this reason the edges of the frames do not always match. All of the images were reduced in resolution for the web. A full resolution version available soon.  Please register and you will be informed as soon as its available.

Notes on Timeline: The images were taken when it was convenient for the patient. On occasions there were images taken a day apart because the patient had a ranibizumab injection on that day, and other images were taken a week apart. No attempt was made to standardise the time between photographs because it was felt that it was more important to obtain as many photographs as possible whilst the patient did not feel too inconvenienced by the process.

Video time-lapse 1

Slides 1 to 3 of the video show significant clinical change and so have a one second delay before moving to the next slide. Slides 4 to 29 are shown without a delay so that the full impact of the ranibizumab treatment and the course of the disease can be appreciated.  (For those without flash player (iPhone, iPad etc) an alternative version is available at the bottom of this article.

Video time-lapse 2

All frames are shown for 1 second showing the VA and ranibizumab injections.

Author Statement

Mr Berry is happy to answer questions and discuss any comments submitted underneath this article.

Mr Berry has no conflicts of interest to declare.

Hi Resolution CD

We are working to produce these videos hi resolution and make them available on a CD.  Please register and you will be notified when they are available. Click HERE

Time line

The time line below is presented in a graphical format but it should be noted that this is simply a more visually appealing way of representing the available data. No useful clinical conclusions should be made from the shape of the curve.

Dataset

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