SECO 2023: Incorporating confocal scanning laser imaging in practice


Mile Brujic, OD, shares highlights from his SECO 2023 poster presentation on confocal scanning laser imaging and patient care.

Mile Brujic, OD, shares an overview of his poster presentation on confocal scanning laser imaging and patient cases in which this imaging empowered optimal patient care, which he presented during the 100 year anniversary of the SECO meeting, held this year in Atlanta, Georgia.

Editor's note: This transcript has been edited for clarity.


Hi, I'm Mile Brujic, and I'm a partner of a four location practice in Northwest Ohio: Premiere Vision Group. And I've had the honor to be able to be here [at SECO] and share with colleagues through a poster presentation, kind of some interesting cases that we ran into. And I have to share a little bit of the background with you, and the impetus behind the creation of this poster.

This was something that we learned several years ago, when we incorporated confocal scanning laser imaging into our practice. And literally, what we wanted to do is we wanted to get high quality fundus imaging into our practice so that we could capture that and see that over time for patients.

And what we found was we could better care for patients and see subtle changes. But what we also found immediately was there were certain patients where we weren't getting what I would consider the best clinical images. And the reason why was there these massive shadows that were showing up at the bottom of these images, then the reason being is when you look at confocal scanning, they actually get those inferior images from superior light leaving the eye and because of that anybody that has any form of obstruction superiorly will actually block our ability to image that adequately.

And you immediately think of the patient with ptosis. And we saw this direct relationship with how much those lids were drooping—or how low they were—and how much of that field was obstructed. So what we realized immediately was that if we're seeing this on fundus imaging, what does that actually mean from a functional perspective for patients?

At the time, Upneeq was just FDA approved, so we had the opportunity to put it in some of these patients' eyes. And within 10 minutes, you saw a massive improvement in the upper eyelid of these patients. But interestingly, what we then did was we followed up with these patients with fundus imaging right after we installed the drop, and you could see substantial improvements.

So we share with our colleagues here at SECO, case presentations where not only could you see those fundus images change over time with an aging eye where you're seeing ptosis starting to occur, but we also saw immediate changes pre dosing versus post dosing, and how much of a difference in the fundus images that we saw, which directly related to their functional improvements as well, too.

So again, just a little bit of a nugget that I love sharing with colleagues because I think it's phenomenal when we have these technologies that we can repurpose, where we're really fundamentally using them for one function. And now we have it as a screening tool for something else as well. And really the benefits of easy in office treatments through again, a drop that literally lifts these individuals lids and not only provides us better fundus imaging but also better functionality for those patients.

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