Retinal angiography, also know as ophthalmic photography, is a sub-field of biomedical photography that records the structure of the eye using specialized equipment. According to the Ophthalmic Photographer's Society:1
Ophthalmic photography is a highly specialized form of medical imaging dedicated to the study and treatment of disorders of the eye. It covers a very broad scope of photographic services incorporating many aspects of commercial and medical photography. But it is through the use of highly specialized equipment used to document parts of the eye like the cornea, iris and retina, that ophthalmic photography takes on its true identity.
The retina is the “film” of the eye. Images passing through the clear structures of the cornea and lens are focused there to give us our view of the world. Special instruments called fundus cameras, when used by skilled photographers, can document the condition of this miraculous anatomical structure.
When fundus photography is performed after the injection of a fluorescent dye into the bloodstream via a vein in the patient’s arm, the procedure is called Fluorescein Angiography. With special colored filters, only the dye is photographed as it travels through the vessels in the retina. These studies, performed by ophthalmic photographers and interpreted by ophthalmologists, are used in differentiating one retinal disease from another and in determining appropriate courses of treatment.
Certified Retinal Angiographer (CRA) is a designation given exclusively by the Ophthalmic Photographer's Society (OPS). The certification program was established in 1978 and there are currently 600 CRAs in North America. Most CRAs work as ophthalmic technicians and ophthalmic photographers. According to the Ophthalmic Photographer's Society:2
Certified Retinal Angiographer (CRA) designates an individual who has met the BOC [Board of Certification] standards of competence in fundus photography and retinal angiography.
The CRA is able to identify the anatomy of the ocular fundus and the structures through which the fundus is imaged. The CRA is skilled in single frame and sequential stereo fundus photography, and in rapid sequence fluorescein angiography. The CRA has an understanding of capture, processing and printing of retinal fluorescein angiograms in both digital and film media.
There is very little labor market information specifically related to ophthalmic photography. The closest job title is ophthalmic laboratory technician, which is a more general job and frequently does not involve ophthalmic photography. In Texas in 2002 there were 2,650 ophthalmic laboratory technicians. There are expected to be 2,950 in 2012. Between job growth and job replacement there are expected to be 90 openings each year 2002-2012.3
Nationally, the ophthalmic technician and biomedical photography positions have similar salary ranges of $25,000 to $55,000. According to salary.com, the median salary for biomedical photographers is $39,693 and the median salary for ophthalmic technicians is $37,367.
In a December 2005 study of their membership, OPS found that 19% of the respondents worked in university hospitals, 52% in private practice, 24% in hospitals and medical facilities, and the reminder were either independent contractors or other.
In 2004 the Ophthalmic Photographer's Society commissioned an extensive study which describes the “critical tasks required for competent, entry-level retinal angiographer practice.”4 The study was conducted to support the relevance and validity of the Society's certification. Findings include an extensive analysis of job tasks and the relative importance of each task.
Based on this research and other data from OPS as well as job announcements for ophthalmic photographers, the knowledge, skills and abilities are as follows:
CRA candidates are tested on the following subjects:
OPS assigns 44% of the CRA candidate's certification score to fundus photography (22%) and fluorescein angiography (22%).
CRAs screen patients in terms of visual acuity testing, lensometry for clinical optics testing, keratometry for contact lenses, stereo acuity testing, automated refractometry for clinical optics testing, pupil assessment; gross external examination and eye drop installation.
They also apply electron or schioty tonometry, refractometry and/or retinoscopy for clinical optics testing, visual field testing (automated and/or non-automated), specular microscopy; fundamental photography, potential acuity testing(a-scan ultrasonography and introcular lens calculation).
CRAs also engage in patient education and counseling and conduct basic maintenance, and inventory control.
CRAs demonstrate proficiency in: history taking, ophthalmic patient services, lensometry, instrument maintenance and repair, special instruments and diagnostic techniques, advanced general medical knowledge, ocular motility, clinical optics, visual fields, contact lenses, advanced ocular pharmacology, advanced tonography and advanced colorvision.
Responsibilities include organizing and prioritizing work to ensure completion in a timely manner. Ophthalmic photography requires the analytical ability to understand and apply complex ophthalmic procedures, follow detailed instructions from the ophthalmologist and interpersonal skills necessary to relate to patients in a sympathetic and tactful manner.
Ophthalmic photographers are not required to have certification and most learn on the job and through continuing education programs. The Bureau of Labor Statistic's Occupational Handbook observes, “Most medical, dental and ophthalmic laboratory technicians learn their craft on the job; however, many employers prefer to hire those with formal training in a related field.”5 No data were provided to support this claim.
The field of biomedical photography is considered very competitive and is still a relatively small field. However, the job market is expected to expand and ophthalmic photography is identified as a particularly promising field.6 There is no Texas labor market information specific to biomedical photography.
Although the field of ophthalmic photography is small and future growth is difficult to judge, there is interest in OPS in increasing the formalization and recognition of the field.
There is currently no program at the community or technical college level specifically designed to prepare students to become a CRA. The closest related programs are the photography programs the at Rochester Institute of Technology and Brooks College in Santa Barbara, California. The Joint Commission of Allied Health Personnel in Ophthalmology does offer ophthalmic technician programs but only a small portion of their curriculum addresses ophthalmic photography. According to the OPS Education Chair, the society is currently compiling a list of related programs.
The OPS offers continuing education programs through annual conferences and through sponsorship of short courses offered by a number or associations and institutions.
Despite the fact that fluorescein angiography has been in use for four decades, according to OPS, there is very little formal education in the subject.
There is an ophthalmic technician program offered at El Paso Community College that is geared exclusively toward dispensing opticians and does not include any photographic or angiographic components. There appears to be no biomedical photography program at any Texas community or technical college.
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Crime Scene Technicians (CST) are essentially functional generalists who collect and maintain physical evidence from crime scenes. The technology of crime scene investigation is very advanced; however, the technology (hardware, software and forensic analysis) is located in the “Forensics Laboratory” rather than in the field.