Join Me as I Learn to Use the iCam: Lesson 2. Avoiding Small Pupil Artifacts

May 17, 2016

When viewing retinal images, you should notice two main retinal landmarks: the optic disc, which is the bright spot where the blood vessels enter the eye, and the macula, the darker area of the retina that appears next to the optic disc in all the images. It is important to get a clear image of the macula, as this is the area of the retina that contains the highest concentration of cones and is responsible for central, high-resolution vision. The consultant grading the images needs to be able to clearly see the health of the macula in order to properly diagnose the patient. One problem that can obscure the ability to clearly see the macula is a dark shadow that is a result of a patient’s small pupil.

The arrows point to a dark shadow that is obscuring the view of the macula. This shadow is a result of a small pupil.

A few tips and tricks beyond chemically dilating the patient’s eyes can help reduce this shadow. First, make sure that the room is as dark as possible. Turn off the lights, draw the blinds, and turn off or cover any equipment that is emitting a bright light or glow. Secondly, you want to make sure to alternate eyes from right to left as you’re capturing the images. This gives time between each image for the eye to re-dilate after experiencing the camera flash. Failure to alternate between the right and left eye subjects the same pupil to multiple flashes and can result in a constricted pupil.

If a patient’s pupils are still constricted, you can encourage them to sit back and rest their eyes while wiggling their toes. Strangely enough, wiggling your toes is a natural way to dilate your own pupils. If you are having problems with small pupil artifacts, try these suggestions. For more helpful tips and tricks, please feel free to contact us at

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