Ultrawidefield retinal imaging device offers a range of image modalities.

Optos has equipped California — its newest optomap retinal imaging device — with new hardware and software technology that enables practitioners to see, discover, and effectively treat more ocular pathology. California, which is specifically designed for ophthalmologists who have a need for multiple imaging modalities, includes a new ultrawidefield (UWF) optomap imaging modality that provides indocyanine green (ICG) angiography while retaining composite color, red-free, autofluorescence (AF), and fluorescein angiography (FA) options.

“It encompasses all needed fundus imaging modalities, can show retinal structures and circulation across the retina, and has a smaller footprint than earlier UWF devices,” says Szilárd Kiss, MD, chief of the retina service, director of clinical research, director of compliance, and associate professor of ophthalmology at Weill Cornell Medical College, and associate attending physician at New York-Presbyterian Hospital, both in New York, New York.

LARGEST FIELD OF VIEW

The optomap technology gives physicians the ability to quickly and efficiently see and document pathology from ora to ora. “No other imaging device captures as much of the retina as Optos devices,” says Leslie Amodei, vice president of global marketing for Optos, Inc., based in Marlborough, Massachusetts. “The optomap images (produced by Optos UWF systems) capture up to 200° of the retina in a single image.”

Field of view is important, Amodei notes, because a peer-reviewed study showed that 66% of pathology was found outside of the area visualized by conventional imaging methods.¹ In addition, 40% of peripheral lesions identified by optomap in individuals with diabetic retinopathy suggested a more severe grade and were found to be associated with a 5-fold risk in progression to proliferative disease.^2,3 Also, optomap FA resulted in 51% more decisions to alter treatment in patients with vasculitis⁴ and 48% in patients with uveitis.⁵

Images obtained by optomap are presented in ProView, which solves the problem of accurately representing the 3D structure of the eye in a 2D image, displaying images in a consistent, measureable geometry that accurately represents the retina’s anatomical features, according to Amodei. “Optos is the only company that has been able to accomplish this,” she says.

EXCELLING IN IMAGE ACQUISITION

Another benefit of California is its automontage feature, which produces montaged images by detecting the centers of the fovea and optic nerve head in a series of upsteered images. It then registers and combines the images to produce a single montage image which shows approximately 95% (225°) of the retina.

“The California software upgrade has become essential in managing images in house and distributing them to referring physicians and patients,” Dr. Kiss says. “Both technicians and photographers can quickly and easily learn how to acquire images with its modern touchscreen user interface. If a patient is not properly aligned, a light within the machine will change from green to red.”

HOW PATIENTS BENEFIT

Optos devices do not use white light when capturing images, so patients are spared the bright, uncomfortable bursts of light that accompany conventional imaging. Also, image capture is much faster with optomap — less than 1 second — which both patients and doctors appreciate. In addition, the table and device are adjustable so image capture is more comfortable for patients of all shapes and sizes; patients in wheelchairs can also be accommodated.

Dr. Kiss also uses optomap images to educate surgical patients and their families. “We show them a photo of a normal patient without disease and then show them their image, to show where the pathology is,” he says. “After surgery, I show them where the surgery occurred. This enhances the physician/patient relationship.”

“All of my patients receive optomap images,” says Dr. Kiss. “I can’t think of practicing without it. With California, you have one machine that can do everything from A to Z.” RP

REFERENCES

1. Kehoe PH. Widefield patient care. Poster presented at European Academy of Optometry and Optics meeting, Berlin, Germany, May 19-22, 2016.
2. Silva PS, Cavallerano JD, Haddad NM, et al. Peripheral lesions identified on ultrawide field imaging predict increased risk of diabetic retinopathy progression over 4 years. Ophthalmology. 2015 May;122(5):949-956.
3. Silva PS, Cavallerano JD, Sun JK, Soliman AZ, Aiello LM, Aiello LP. Peripheral lesions identified by mydriatic ultrawide field imaging: distribution and potential impact on diabetic retinopathy severity. Ophthalmology. 2013;120(12):2587-2595.
4. Leder HA, Campbell JP, Sepah YJ, et al. Ultra-wide-field retinal imaging in the management of non-infectious retinal vasculitis. J Ophthalmic Inflamm Infect. 2013;3(1):30.
5. Campbell JP, Leder HA, Sepah YJ, et al. Wide-field retinal imaging in the management of noninfectious posterior uveitis. Am J Ophthalmol. 2012;154(5):908-911.