To further assist eyecare professionals in detection, management, and treatment planning for retinal disease, Optos has added a blue laser to the standard image generated by red/green lasers to create a single composite red/green/blue (RGB) image on its optomap ultrawidefield (UWF) retinal imaging system, the California FA. optomap UWF images, including the new modality, allow eyecare professionals to capture and document 82% of the retina (a 200° image) in less than half a second.

“Although other retinal imaging devices offer color RGB, the California FA is the only one that can assess such a large area of the retina in all 3 wavelengths,” says Rob Kennedy, chief executive officer at Optos.

optomap color RGB images help eyecare professionals detect and evaluate a variety of retinal diseases, including age-related macular degeneration (AMD), diabetic retinopathy (DR), retinal breaks and detachment, uveitis, pigmented lesions, choroidal melanoma, glaucoma, vein occlusions, and retinitis pigmentosa.

Having access to a 200° UWF image of the retina allows eyecare professionals to visualize and document pathology in the far periphery that might otherwise go undetected, Kennedy says. This is supported by research, including the DRCR Network’s Protocol AA study,¹ which indicates that in DR, predominantly peripheral lesions are associated with a significantly greater risk of worsening disease. Additional research² has indicated that 66% of retinal pathology was found beyond the reach of standard fundus cameras.

The new image modality is captured at the same time as optomap’s color RG image. Therefore, a single capture delivers 2 color UWF images and doesn’t add any time or steps to capture the additional image, Kennedy says.

Steven Bloom, MD, a retina specialist at Bennett & Bloom Eye Centers in Louisville, Kentucky, who uses the California FA and its new modality at his practice, says, “You can see almost everything in 1 picture. Other UWF imaging devices require users to take multiple images that are then montaged into a single image. With Optos’s imaging system, you only need to take 1 photo, which is much crisper and also faster for technicians to capture.”

FOUR IMAGES IN A SINGLE CAPTURE

Each wavelength the optomap captures provides different information about a lesion’s size, depth, and impact. “Having access to more information should empower physicians to make more informed decisions and positions them to diagnose pathology with greater clarity,” Kennedy says.

In addition to now being able to capture color RGB images, Optos’s California FA retinal imaging platform can also capture green (sensory retina/RPE), red (choroid), fundus autofluorescence, fundus fluorescein angiography, and indocyanine green angiography modalities. “Each of these modalities adds value by providing additional information, which can better inform diagnosis as well as treatment decision-making,” Kennedy says.

Each UWF modality offers its own set of advantages. Different modalities are selected based on the anatomy and pathology an eyecare professional wants to evaluate, Kennedy says. For example, optomap color RGB can help discern holes in peripheral lattice degeneration and retinoschisis and reveal improved detail of drusen in intermediate AMD. Additionally, physicians have reported that the RGB modality allows them to better visualize the extent and severity of a macular epiretinal membrane and better grade DR.

optomap color RGB also provides an improved assessment of the optic nerve. Both RG and RGB images provide details on a lesion’s structure.

According to Dr. Bloom, including a blue wavelength in an optomap UWF image is invaluable when capturing a record of a patient’s fundus biomicroscopy. “Being able to see the fundus the same way as it appears when I examine a patient is transformative,” Dr. Bloom says. “This is especially true when examining choroidal nevi and uveal malignant melanoma where the standard color RG image distorts what I see on biomicroscopy. True color images are also best for patient education because patients intuitively better understand what their eye actually looks like.”

Along these lines, Kennedy says physicians can use the images to help patients to better understand treatment and lifestyle change recommendations, and the benefits of making them.

BENEFITS ABOUND

A fuller assessment allows for better monitoring of disease progression, and also increases the likelihood of the best treatment strategy being implemented, Kennedy concludes. Outcomes can be closely followed by eyecare professionals with enhanced understanding. In a variety of diseases, research has shown that early detection can improve the chances of a positive outcome with further treatment.³ RP

REFERENCES

1. Marcus DM, Silva PS, Liu D, et al. Association of predominantly peripheral lesions on ultra-widefield imaging and the risk of diabetic retinopathy worsening over time [published correction appears in JAMA Ophthalmol. 2023 Jan 1;141(1):104]. JAMA Ophthalmol. 2022;140(10):946-954. doi:10.1001/jamaophthalmol.2022.3131
2. Kehoe P. Widefield patient care. 2016. Accessed September 13, 2023. https://www.optos.com/globalassets/public/optos/providers/peer--clinical-papers/kehoe---widefield-patient-care---66.pdf .
3. Fragala MS, Shiffman D, Birse CE. Population health screenings for the prevention of chronic disease progression. Am J Manag Care. 2019;25(11):548-553.