Optos’s next-generation ultrawidefield (UWF) scanning laser ophthalmoscopy and spectral-domain retinal imaging solution, the MonacoPro, was designed to enhance diagnostic precision and streamline workflow. The device, unveiled in 2025, builds on the earlier Monaco system by adding significant upgrades—including improved OCT resolution, new analytical tools, and expanded imaging and data capabilities—to the largest reference database available in the United States.
“For more than 3 decades, Optos has built its technology on a simple, proven principle—the more of the retina you can capture in a single image, the more insight you can provide to support patient care,” said Dana Keane, MS, CCRA, CCRP, vice president of clinical affairs at Optos in Marlborough, Massachusetts. She noted that Optos’s optomap feature can capture up to 80% of the retina. An optomap image is the first image obtained, and in the case of the MonacoPro, it serves as a baseline for future OCT scans.
The MonacoPro’s 200° UWF imaging allows assessment of the peripheral retina, where many diseases are believed to manifest before threatening sight. The combined UWF and OCT imaging can detect 29.4% more macular pathology compared with UWF imaging alone.¹ MonacoPro pairs these capabilities with advanced review tools and resources, providing eye care professionals with a comprehensive platform for both visualization and interpretation of the retina in remarkable detail, Keane said.
“The difference between the old device and the new one was like night and day,” said William Blase, MD, MSc, FACS, medical director of California Eye Professionals and a practicing ophthalmologist in Riverside County, California, who uses the MonacoPro in his practice. “The images are far sharper and better delineated. We can perform a much more thorough retinal evaluation.”
Figure 1. The MonacoPro combines 200° ultra-widefield imaging, spectral-domain OCT, and new software tools to support faster, more confident diagnoses. Image courtesy Optos.
Identifying Concerns
The MonacoPro includes the new AreaAssist tool, which enables users to automatically measure areas of concern and adjust the sensitivity of the selected area by simply clicking and dragging the mouse. “By automating and simplifying these processes, AreaAssist removes the need for time-consuming manual tasks and improves workflow,” Keane said.
The tool allows Dr. Blase to identify suspicious areas such as hemorrhages, dry macular degeneration changes, pigmentary changes, or peripheral lesions. “We can map and delineate a lesion, file it, and compare it to subsequent scans on future visits,” he said. “It’s an extremely helpful tool that gives physicians greater confidence in identifying concerning areas and avoiding missed findings.”
Enabling a Quick Diagnosis
The MonacoPro’s multimodal imaging capability enables clinicians to obtain a comprehensive assessment and make a prompt diagnosis. The optomap’s red-green color image provides three-in-one imaging with an integrated color image, a red-free sensory image, and a choroidal (red channel) view, allowing visualization of pathology in two planes. The optomap’s green autofluorescence provides functional assessment, helping clinicians identify areas of the retina that may be stressed by underlying disease.
Spectral-domain OCT supports assessment of the optic nerve, macula, and individual lesions for glaucoma, fluid buildup, and retinal thickening or thinning. These images are supported by one of the largest reference databases available, according to Optos. All image types can be obtained quickly, without dilation, through pupils as small as 2 mm, and by technicians with minimal training.
Clinical Applications
The MonacoPro is designed to support evaluation of retinal and choroidal conditions as well as systemic diseases such as diabetes, hypertension, and neurologic disorders, Keane said. Optomapimaging has been shown to aid in the detection and diagnosis of more than 350 diseases. The extensive reference database also makes the MonacoPro a valuable tool for glaucoma management.
With the ability to capture up to 6 modalities in as little as 60 seconds, the MonacoPro is well suited for large population screening. In primary eye care, where patients may want retinal assessment before a routine exam, its image quality and reference database enable comparison with age-matched normals to identify potential pathology.
In settings where patients have known glaucoma, diabetes, or other chronic conditions, OptosAdvancesoftware enables accurate measurement and historical overlay to assess disease progression and treatment effectiveness.
“The device limits unnecessary referrals to subspecialists and reduces delays in patient care,” Dr. Blase said. “By identifying true glaucoma-related changes, it can enable physicians to expedite treatment.”
User-Friendly Features
Optos systems are designed for accessibility and ease of use across patient populations, including children and individuals who use wheelchairs. The device is ADA compliant and includes user-friendly features that facilitate image capture for patients who are photophobic, unable to follow verbal directions, or have limited mobility, Keane said.
An integrated chinrest offers stability but can be removed to accommodate children or patients with deeper-set eyes or posture challenges. The flexible face pad also ensures comfortable imaging for patients with varying facial structures.
With its combination of UWF imaging, OCT integration, and intelligent review tools, the MonacoPro represents the next step in comprehensive retinal evaluation. By improving image quality, enhancing diagnostic confidence, and streamlining workflow, the system supports clinicians in delivering more efficient, informed, and patient-centered care. RP
Reference
LP Aiello, Jacoba CM, Ashraf M, Cavallerano JD, Tolson AM, Tolls D, et al. Integrating macular optical coherence tomography with ultrawide-field imaging in a diabetic retinopathy telemedicine program using a single device. Retina. 2023;43(11):1928-1935. doi:10.1097/IAE.0000000000003883.