The Monaco ultrawidefield (UWF) imaging device (Optos) with integrated optical coherence tomography (OCT) produces a 200-degree single-capture optomap fundus photograph in less than half a second. It also provides cross-sectional 12 mm × 9 mm macular OCT images.

“In any business, time and space equal money, and by combining a high-resolution OCT with fundus photography, you certainly save both by not having to purchase multiple devices and minimizing patient movement,” says Nikolas J.S. London, MD, FACS, director of clinical research, Retina Consultants San Diego in Poway, California, who uses the device. “Furthermore, Optos is possibly the gold standard for widefield imaging.”

Monaco also enables a rapid multimodality image overview featuring color, autofluorescence (AF) optomaps, and posterior-pole OCT scans in as little as 2 minutes. “This unique view of 3 different image modalities provides information that may help a physician detect pathology more quickly,” says Leslie Amodei, vice president of global product marketing for Optos. Monaco helps to facilitate pathology examination by correlating the optomap images and OCT scans and showing color, AF optomaps, and OCT images in a single, comprehensive view.

Dr. London has found that the combination of UWF photos and OCT provides an immense amount of data, and greatly reduces the chance that pathology is missed. “This is particularly useful in a busy clinic where you may not have time to shuffle patients between several different cameras,” he says.

Having optomap ultrawidefield photography combined with OCT is also advantageous because optomap has been shown to enhance disease management, Amodei says. According to an internal study, optomap revealed that 66% of pathology is outside of the area visualized by traditional small field imaging.¹ Another study showed that optomap-assisted ophthalmoscopy identified 30% more retinal lesions than traditional binocular indirect ophthalmoscopy.²

HOW IT WORKS

Like Optos’s California and Daytona UWF imagining devices, Monaco uses scanning laser ophthalmoscope technology combined with an ellipsoidal mirror to capture an optomap UWF image and cross-sectional 40-degree spectral domain OCT scan.

By using UWF and OCT imaging, Monaco can detect and monitor a wide variety of retinal pathology, including age-related macular degeneration (AMD), choroidal melanoma, choroidal nevus, diabetic retinopathy, glaucoma, retinal vein and branch retinal vein occlusion, retinal detachment, retinal toxicity, retinitis pigmentosa, central serous chorioretinopathy, Stargardt disease, and uveitis. It is also a useful tool for postsurgical evaluations.

Dr. London finds the device useful for all of his patients, most of whom have vision abnormalities. “My clinic runs much more efficiently by simply having imaging with color photos and spectral-domain OCT as a routine part of a workup prior examining a patient,” he says. “I have all the data I need to care for each patient and there is minimal time wasted transferring patients back and forth between clinic rooms.”

EASE OF USE

Monaco is user friendly and easy to train on. To capture an image, the patient sits comfortably in front of the device. As the patient looks into the device, a blue target will appear. The operator will then adjust the device to the correct orientation and capture the image or sequence of images.

Dr. London can attest to Monaco’s user friendliness. “It is extremely easy to capture images, and the user interface is intuitive and easy to use in the review software,” he says. “No focusing is required when taking images — roughly position the patient’s head and then give direct feedback to guide the patient into the perfect position.”

Monaco also features OptosAdvance Image Management, which facilitates image review and consultations and includes measurement and auto-montage capabilities.

PATIENT BENEFITS

The Monaco nonmydriatic, noncontact technology can capture an UWF optomap and OCT scan in as little as 90 seconds, making the experience both quick and comfortable for the patient. “Monaco can also capture an optomap image through cataracts 85% of the time³ as well as for patients with 2 mm pupils, helping to ensure that these patients, who may otherwise have been difficult to image, can be thoroughly evaluated,” Amodei says.

Any optomap image captured with Monaco can potentially benefit a patient because of earlier detection and diagnosis, particularly given that early signs of disease often manifest in the periphery. In fact, optomap AF revealed peripheral abnormalities outside of the area captured by traditional small field imaging in 97% of AMD patients.⁴

“Once patients are diagnosed, they can be monitored more effectively because disease progression can be assessed by comparing new optomap images and OCT scans with those from previous evaluations,” Amodei says.

A study by Horton et al found that optomap images reduce the ungradable rate over traditional small field imaging by 81%,⁵ and another by Silva et al found that it reduces image evaluation time by 28%.⁶ Also, Tornambe reported that implementing optomap can result in physicians seeing an average of 1.5 additional patients per day.⁷ RP

REFERENCES

1. Data on file with Optos.
2. Brown K, Sewell JM, Trempe C, Peto T, Travison TG. Comparison of image assisted versus traditional fundus examination. Eye Brain. 2013;5:1-8.
3. Chen WS, Friberg TR, Eller AW, Medina C. Advances in retinal imaging of eyes with hazy media: further Studies. Invest Ophthalmol Vis Sci. 2011;52:4036. Presented at The Association for Research in Vision and Ophthalmology, 2011.
4. Friberg TR, Chew EY, Domalpally A, Sadda SR, Clemons TE, Danis RP; AREDSII - OPERA Study. Peripheral retinal findings in color images in age-related macular degeneration - OPERA, an AREDS 2 ancillary study. Invest Ophthalmol Vis Sci. 2014;55:4017. Presented at The Association for Research in Vision and Ophthalmology, 2014.
5. Horton MB, Silva PS, Lewis D, Cavallerano JD, Aiello, LP. Identification of diabetic retinopathy (DR) and reduction in ungradable image rate with ultrawide field imaging (UWFI) within the Indian Health Service (IHS) teleophthalmology program. Invest Ophthalmol Vis Sci. 2015;56:1424. Presented at The Association for Research in Vision and Ophthalmology, 2015.
6. Silva PS, Cavallerano JD, Tolls D, et al. Potential efficiency benefits of nonmydriatic ultrawide field retinal imaging in an ocular telehealth diabetic retinopathy program. Diabetes Care. 2014;37(1):50-55.
7. Tornambe PE. The impact of ultra-widefield retinal imaging on practice efficiency. US Ophthalmic Review. 2017;10(1):27-30.