Digital Photography in the Diagnosis and Follow-up of Ocular Diseases

Purpose: The aim of the present study was to develop and test new digital imaging equipment and methods for diagnosis and follow-up of ocular diseases. Methods: The whole material comprised 398 subjects (469 examined eyes), including 241 patients with melanocytic choroidal tumours, 56 patients with melanocytic iris tumours, 42 patients with diabetes, a 52-year old patient with chronic phase of VKH disease, a 30-year old patient with an old blunt eye injury, and 57 normal healthy subjects. Digital 50° (Topcon TRC 50 IA) and 45° (Canon CR6-45NM) fundus cameras, a new handheld digital colour videocamera for eye examinations (MediTell), a new subtraction method using the Topcon Image Net Program (Topcon corporation, Tokyo, Japan), a new method for digital IRT imaging of the iris we developed, and Zeiss photoslitlamp with a digital camera body were used for digital imaging. Results: Digital 50° red-free imaging had a sensitivity of 97.7% and two-field 45° and 50° colour imaging a sensitivity of 88.9-94%. The specificity of the digital 45°-50° imaging modalities was 98.9-100% versus the reference standard and ungradeable images that were 1.2-1.6%. By using the handheld digital colour video camera only, the optic disc and central fundus located inside 20° from the fovea could be recorded with a sensitivity of 6.9% for detection of at least mild NPDR when compared with the reference standard. Comparative use of digital colour, red-free, and red light imaging showed 85.7% sensitivity, 99% specificity, and 98.2 % exact agreement versus the reference standard in differentiation of small choroidal melanoma from pseudomelanoma. The new subtraction method showed growth in four of 94 melanocytic tumours (4.3%) during a mean ±SD follow-up of 23 ± 11 months. The new digital IRT imaging of the iris showed the sphincter muscle and radial contraction folds of Schwalbe in the pupillary zone and radial structural folds of Schwalbe and circular contraction furrows in the ciliary zone of the iris. The 52-year-old patient with a chronic phase of VKH disease showed extensive atrophy and occasional pigment clumps in the iris stroma, detachment of the ciliary body with severe ocular hypotony, and shallow retinal detachment of the posterior pole in both eyes. Infrared transillumination imaging and fluorescein angiographic findings of the iris showed that IR translucence (p=0.53), complete masking of fluorescence (p=0.69), presence of disorganized vessels (p=0.32), and fluorescein leakage (p=1.0) at the site of the lesion did not differentiate an iris nevus from a melanoma. Conclusions: Digital 50° red-free and two-field 50° or 45° colour imaging were suitable for DR screening, whereas the handheld digital video camera did not fulfill the needs of DR screening. Comparative use of digital colour, red-free and red light imaging was a suitable method in the differentiation of small choroidal melanoma from different pseudomelanomas. The subtraction method may reveal early growth of the melanocytic choroidal tumours. Digital IRT imaging may be used to study changes of the stroma and posterior surface of the iris in various diseases of the uvea. It contributed to the revealment of iris atrophy and serous detachment of the ciliary body with ocular hypotony together with the shallow retinal detachment of the posterior pole as new findings of the chronic phase of VKH disease. Infrared translucence and angiographic findings are useful in differential diagnosis of melanocytic iris tumours, but they cannot be used to determine if the lesion is benign or malignant.

Valokuvallistettu luonto : I. K. Inhan tuotanto luonnon merkityksellistäjänä

Photographized nature I. K. Inha s work as a signification of nature The dissertation examines, through the work of the Finnish photographer and writer I. K. Inha (formerly Konrad Into Nyström) (1865 1930), the different ways in which the signification of nature is achieved. The principal material consists of Inha s work from 1890 to 1925, from which a number of photographs and texts are considered and upon which the photographization of nature is contemplated. The dissertation addresses the issue of how nature is conceived and how the act of photographizing it can be defined. The methodical context of the study is composed of three thematic baskets that structure the material and which consist of narrations on Finnish national perception, nature conservation and understanding the world. In the first case nature is seen as the natural environment encompassing lakes, seashores, forests, and hills, which at the time were often perceived from a utilitarian viewpoint. By the photographization they generated a pictorial narrative that could be shared. The natural environment was thus turned into landscape by means of photography, following the global pictorial concepts picturesque and sublime, as well as the national canons that had been developed in literature and the visual arts. In the narrations concerning nature conservation, the photographization did not merely occur within the limits of presuppositions, but rather nature was given the opportunity to unfold itself. While the photograph was being established as a basis for supporting nature conservation or to highlight the destruction of nature at the hand of Man, an attempt was made to represent subjects that were difficult to convey in photographs, such as nature s power or the miracle of growth. The thesis suggests, that in the third case the concept of nature broke away from its strict interconnection with the natural environment and led to a contemplation of nature that is perceivable in a person. In this context the photograph and the photographization are interpreted as an attempt to understand a person and his or her very existence in the world, while this same existential wonder is seen as being embodied in Inha s portrait of a rune singer and in his photographs of forest interior and water. Further, the thesis asks whether photographing nature could be interpreted as an action similar to the idea of the phenomenological reduction as a means of bypassing the photographer s prevailing way of being.