Is there a risk of retinal damage with retinography (retinal photography)?

Risk of Retinal Damage with Retinography

Retinography (retinal photography) poses minimal risk of retinal damage when performed properly, with phototoxicity being the primary concern that can be effectively mitigated through appropriate preventive measures.

Potential Risks and Mechanisms

Retinal photography uses light to capture images of the retina, and the primary concern is phototoxicity from excessive light exposure. The American Academy of Ophthalmology has identified several factors that influence this risk:

• Photosensitizing medications: Tetracyclines, retinoids, amiodarone, hydrochlorothiazide, furosemide, allopurinol, and benzodiazepines can increase phototoxicity risk 1
• Age-related factors: Decreased production of antioxidants and accumulation of endogenous chromophores after middle age 1
• Duration of exposure: Prolonged exposure during examination increases risk 1
• Pre-existing retinal conditions: Patients with retinal pathology may have increased susceptibility 1

Evidence of Safety

Multiple studies support the safety of retinography:

• Research on Boston Keratoprosthesis surgery demonstrated that modern surgical microscopes with appropriate filters block the most damaging wavelengths of light, presenting a low risk of photochemical damage to the retina 2
• Studies evaluating retinography in diabetic patients have not reported retinal damage as a complication, focusing instead on diagnostic accuracy 3, 4
• Even portable retinography has been safely used in hospitalized COVID-19 patients without reports of retinal damage 5

Prevention Strategies

To minimize any potential risk of phototoxicity during retinography, the American Academy of Ophthalmology recommends:

• Minimize exposure time: Reduce the duration and number of light flashes 1
• Use appropriate filters: Blue-blocking filters that remove at least 94% of blue light (400-500 nm wavelength) 1
• Optimize wavelength: Use longer wavelengths (red light) rather than shorter wavelengths (green or blue) when possible 1
• Utilize newer technologies: Faster acquisition times reduce exposure duration 1
• Monitor for symptoms: Watch for visual discomfort, temporary scotomas, and decreased visual acuity 1
• Provide eye protection: For both patients and operators 1

Special Considerations

Patient Factors Requiring Extra Caution

• Patients taking photosensitizing medications
• Elderly patients
• Patients with pre-existing retinal conditions
• Patients with a history of photosensitivity reactions

Technical Considerations

• Non-mydriatic cameras may require less light exposure than traditional fundus cameras
• In some cases, pupillary dilation may improve image quality and reduce the need for repeated exposures, particularly in older patients 4
• Modern digital retinography systems typically have built-in safety features to limit light exposure

Monitoring and Management

If a patient reports visual symptoms during or after retinography:

1. Immediately discontinue the procedure
2. Document symptoms thoroughly
3. Consider follow-up with OCT or visual field testing if symptoms persist
4. Most patients with retinal phototoxicity have excellent prognosis with complete visual recovery within a few months 1

Conclusion

When performed according to established guidelines with appropriate equipment and technique, retinography carries minimal risk of retinal damage. The benefits of early detection of retinal pathology through retinography far outweigh the potential risks when proper precautions are taken.