AAOpt 2024: Utilizing technology to diagnose inherited retinal diseases

Raman Bhakhri, OD, FAAO, discusses his presentations at the 2024 American Academy of Optometry, one entitled "An Update on Inherited Retinal Disease," with the other being a joint session with the Academy of Ophthalmology on anterior segment herpes simplex and zoster. He highlights the complexity of diagnosing inherited retinal diseases, emphasizing the use of advanced technologies like optical coherence tomography and autofluorescence, and the importance of genetic testing. Bhakhri notes that while optometrists can manage these diseases, referrals may be necessary for specific treatments. He also stresses the significance of recognizing signs and symptoms, using bacterial anterior segment exams, and the importance of vaccinations, particularly for zoster, to reduce the risk of shingles.

Video transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Emily Kaiser Maharjan:

Hi everyone. I'm here with Dr Raman Bhakhri to discuss this 2024 American Academy of Optometry presentations. He's presenting on inherited retinal disease, and he's also participating in a joint session between the optometry and ophthalmology academies, and should be super exciting. So thanks so much for taking the time to be here, Dr Bhakhri.

Raman Bhakhri, OD, FAAO:

Happy to be here.

Kaiser Maharjan:

Of course. So let's start with inherited retinal diseases. What can you tell me about the update that you're giving in Indianapolis?

Bhakhri:

Sure thing. So with inherited retinal diseases, there just lots of them, and it's really hard to figure out which one a patient has. Some of them have similar presentations and the same gene mutation. Some of them have similar presentations and different gene mutations. So myself and my co-lecturer, Dr Shawn Yu from the West LA VA, we go over some of the more common inherited retinal diseases, what to look for in terms of standard stuff. Some of the more unique things are the things that we're trying to point out to the attendees as well. We also go over how to basically identify using different types of technology. There's always updates in technology, whether it be OCT, fundus autofluorescence. So we go over that with pretty much every disease that we go through in the presentation, and then we wrap it up with the importance of genetic testing. It's really opened up how we go about diagnosing inherited retinal disease.

Kaiser Maharjan:

Fantastic, and can you tell me a little bit more about the diagnostic tools and tech that you find really useful?

Bhakhri:

Sure, I think 2 of the big tools that we use, and almost every practitioner has access to it now, which is fantastic, the first one would be OCT. There we get basically, it's like a histology slide, and it's live, and we get an idea of what's going on or not going on. Whether it be at the level of the inner retina, most from our outer retinal, but we get an idea of what's going on. So that's always great. And then the next test we do is fundus autofluorescence. There, we're looking specifically at the RPE, we know that the RPE sits right below the photoreceptors, and pretty much almost every inherited retinal disease, one or both of those layers are involved. And so when you put that together with OCT, again, you have an idea of what the condition could be.

Kaiser Maharjan:

Fantastic, and in the case of inherited retinal diseases, do you often find that you refer those out to a retinal specialist, or do you tend to keep them in your chair?

Bhakhri:

I tend to keep them in my chair. I think inherited retinal disease is something that optometry can handle. If there is a need for referral, whether it be laser procedure or some type of injection, absolutely, we should make that referral. But it is something I feel like that's within our scope, is to diagnose these conditions. Unfortunately, I mean, treatment, it's just not there for inherited retinal disease. There's tons of research going on. Myself and Shawn will go over that, but it's something we can keep in our own chairs.

Kaiser Maharjan:

Yeah, and so kind of in that same vein, we're going to pivot over to that joint session between the American Academy of Optometry and the Academy of Ophthalmology. This talk is on anterior segment herpes simplex and zoster. But can you tell me a little bit about why this is an important topic to discuss jointly?

Bhakhri:

Sure, it's a diagnosis or a condition that's seen by both professions and both of us treat it. And so it just made sense for us to basically join forces on this one and go over things that we both look for, how we treat some of their stuff that might bedifferent from us. Honestly, it doesn't, though. And then when you do need to make the referral, sometimes herpes just goes out of control in the eye, whether it's simplex or zoster, and it gets to a point where we might need our friends in ophthalmology to help us out.

Kaiser Maharjan:

So across all of your talks, what are some key takeaways that you really want to drive home to optometrists?

Bharkhri:

Sure, I think the key point across at least the inherited retinal disease talk is just looking for subtle things in a retinal presentation, and you do that with the technology we had mentioned earlier: OCT and FAF. Just looking at a fundus photo usually is not enough to make a diagnosis. You need that additional testing. And then for the herpetic lecture, it's a bunch of different things: recognizing signs and symptoms, and you do that with interior anterior segment exam. But then it comes into treatment options. We have different treatment options, whether it's topical or oral. And then the big thing, one of my co-lecturer's mentions is the vaccinations, especially for zoster. Anyone over the age of 50 should really consider getting vaccinated for shingrix or for zoster with shingrix, and that drastically, I mean, drastically, reduces the chances of you picking up shingles later in life, which, again, no one wants shingles.

Kaiser Maharjan:

Oh, no, absolutely not. Well, thank you again, Dr Bhakhri for taking the time to chat with me today. I really appreciate your time and your expertise.

Bhakhri:

Anytime.