Ellex Medical Lasers Limited’s Eye Prime diagnostic ultrasound technology enables clinicians to view fine and intricate structures in the eye that can’t be seen with other current available offerings. It offers increased depth of field as well as real-time dynamic imaging, which facilitate enhanced viewing.

“The device’s 6-element annular array, available in 12 MHz and 18 MHz transducers, allows physicians to select precise settings for the disease condition they want to examine,” says Nancy London, ultrasound clinical applications specialist for Ellex. The Agile Focus feature permits users to focus the beam to the precise area of interest in the posterior segment and orbit.

“Images are better with this device because it has higher frequencies than the other instruments I use,” says Yale L. Fisher, MD, an ophthalmologist with Vitreous Retina Macula Consultants of New York, in New York, New York, who notes that he does not receive compensation from Ellex. “The ability to move the ultrasound beam so that the narrowest part of the beam profile is located in the area of greatest interest is very useful,” adds Dr. Fisher, “especially for vitreoretinal interface areas and the orbit. Annular array multisegment transducers permit ‘live’ movement and placement of the ultrasound beam focus, allowing improved image quality in areas of special interest.”

According to Timothy Fuller, MD, ocular oncologist and medical retina specialist with Texas Retina Associates in Dallas, Texas, the device’s most compelling advantage is its higher resolution. “The ability to better differentiate between the layers of the eye, including the sclera, choroid, retina, and vitreous, helps to make a timely diagnosis,” he says.

HOW IT WORKS

The ultrasound device works like most other ophthalmic ultrasound systems, but the difference is in its ability to select a particular probe for the pathology being examined as well as being able to specifically focus on a tiny area of interest while live scanning. The software allows time gain control (TGC) settings to be selected, with the 12 MHz primarily set on “vitreous,” and the 18 MHz primarily set on “retina,” London says. There are also 2 custom TGC settings, in which a user performing a study in optic nerve lesions, for example, can make changes in the software for a specific focus and detail in that area.

“The ability to choose between the 12 MHz and 18 MHz probe allows for better tailoring of imaging depending on the suspected diagnosis,” Dr. Fuller says (Figure 1). For example, sometimes with choroidal melanoma it is difficult to tell whether there is extraocular extension of the tumor. “The additional resolution can aid in surgical planning for plaque brachytherapy and allow for more appropriate and informed patient counseling.”

Eye Prime also offers 2 ultrasound biomicroscopy probes — including 35 MHz to look at and evaluate the ora, ciliary body, iris lesions or cysts, cyclodialysis cleft, and peripheral tears, and 50 MHz for anterior-segment applications, which will provide the ability to evaluate sulcus to sulcus, uveitis-glaucoma-hyphema syndrome, dislocated haptics, and the angle. “The 50 MHz is equivalent to OCT anterior-segment imaging,” says David Lubeck, MD, chief medical officer of Ellex. “The new posterior B-scan technology allows for a wider field to evaluate the far periphery, which helps the examiner and also increases patient comfort.”

CLINICAL APPLICATIONS

Eye Prime’s applications are similar to those of other ophthalmic ultrasound systems. “If you can’t use light to see into the eye, then sound via ultrasound is required,” London says. Eye Prime offers a more precise look at various ocular conditions. A study of a choroidal tumor with the 18 MHz probe will allow an oncologist to discern the layers, from a potential overlying retinal detachment down to the inner sclera, where extraocular extension may occur, London says. Determining whether a lesion has metastasized to the extraocular muscles or optic nerve is evident with the instrument’s high resolution. Details in the vitreous, exquisite separation of vitreous from the retina, and blood flow within a tumor can be visualized with ease. The anterior transducers will also allow a retina surgeon or oncologist to image the iris or ciliary body lesions and their extent beyond the iris, which is unseen by OCT. Another anterior application for a retina practice is the ability to image a displaced intraocular lens, which may cause hyphema in the anterior chamber.

USER FRIENDLINESS

The ability to preset the TGC and select the transducer for the specific pathology should save time in a busy practice. The instrument automatically saves more than 250 frames in movie sequence, so users can return to the device later if desired to adjust contrast or gain, measure the lesion, or prepare special images for publication or presentation, London says. Using the reporting feature is as simple as clicking on desired images and hitting a “save” icon. The DICOM feature will seamlessly transfer images and reports to an in-office medical record.

When examining 12 patients with the Eye Prime ultrasound, Albert O. Edwards, MD, PhD, MBA, affiliate associate professor in the Department of Ophthalmology at Oregon Health Sciences University in Portland, Oregon, noted several benefits. “The probes’ design provided for a more comfortable examination for patients,” he says. “The snap-on connections should extend the probes’ life and address a major limitation of other systems we’ve used by allowing the cords and probes to be replaced separately. The software autosaves images at the end of the scan and is intuitive, saving time for the ultrasonographer. The system provides superior quality images, especially the ability to focus on specific anatomical findings.” RP