Many optometrists today say they couldn’t practise without their OCT, and it seems ultra-widefield
retinal imaging is heading down the same path. Two independents discuss how Optos technology has influenced the way they practise.
To operate a high-performing two-practice optometry business – one on each side of the NSW-Queensland border – Mr Andrew Bowden is cognisant that when he invests in high-end equipment, it needs to at least pay its own way, plus more.
It goes without saying that installing two new Optos Daytona ultra widefield imaging devices came at a substantial cost, but within a month of using the devices at Envision Optical Tweed Heads and Burleigh Waters, he could already see it was paying dividends in terms of commercial and clinical outcomes.
When the Daytona system was installed two years ago, it replaced a retinal camera that captured a 45-degree area. He charged a separate fee for this, but since acquiring Optos technology and its 200-degree imaging capability, the practice could justify increasing this by 50% with no resistance form patients. After recently switching to a three-tiered private billing model, an optomap image is now included in his standard and premium eye exam package (with flexibility for pensioners and similar patients).
“We’ve tracked our retinal photography over the years and could see that it was a nice little profit centre for us. It was the same when we introduced the Optos devices; we could definitely see it was cash positive within the first month just off scan fees alone,” he says.
“It’s always a challenge of trying to find that sweet spot, balancing the practice’s profitability and sustainability alongside the affordability for the patient.”
As a result, ultra widefield retinal scans on the Daytona – called optomap images – has become a virtuous cycle for Envision Optical. The business has seen its retinal scan volumes increase because staff see the value in it, and patients are impressed with the technology, especially after receiving a brochure demonstrating how much more of the retina it can scan compared to traditional retinal photography.
For the optometrist, Bowden says optomap imaging plays a key role in primary eyecare, with an ability to detect retinal tears or lesions in the periphery – often so far out they may have been missed otherwise. He can also easily monitor them over time and provide clear and efficient co-management with ophthalmologists.
It’s because Daytona and Optos’ other devices, Monaco and Silverstone, can capture approximately 82% of the retina, something the company says no other device can do in a single shot. Optos has expanded its technology now with nine imaging modalities available across all its platforms, including the recent addition of optomap colour red, green blue laser (rgb), natural colour and blue fundus autofluorescence.
For Bowden, the colour and autofluorescence modalities are used the most. When speaking to Insight, he’d just seen a patient with a known choroidal nevus.
“When you’re imaging this condition with traditional systems, often it’s difficult to obtain a quality image of it. Whereas with the Optos technology, you’re able to image and monitor it even though it’s a fair way out on the edge of the retina,” he says.
“I get a lot of benefit out of its multi-functionality. Autofluorescence has become invaluable because you can often glance at the colour photo and think it looks good, and then you switch to autofluorescence and you can see pathology hidden there, which helps you make an informed decision around monitoring or referral.”
In cases like the above, Bowden says Optos ultra-widefield imaging has offered a seamless patient experience and is simple to use for his optical dispensing staff. The high resolution optomap scan is exported into the cloud and can be accessed in any of his four consulting rooms.
“The beauty of it is that you’re opening the image as soon as the patient’s walking into the room, and it’s very easy to flick through and perform a serial comparison to check for any changes year-to-year. It’s super easy to use, quick, and you can zoom nicely on areas of interest,” he says.
“In the patient with the choroidal nevus, she could look at the screen as I move around the image and explain what I’m looking for. I was able to clear her for melanoma in her eye.”
Since acquiring the Optos Daytona, Bowden has picked up more cases of Coats disease, an idiopathic ocular condition characterised by retinal telangiectasia, aneurysms, and exudation.
“I’ve had three or four of those in the last 18 months that I’d hardly seen previously because it occurs way out on the edge. But we’re picking up things daily, and when you go back and look with the fundus lens you realise you’re only often seeing the edge of a disease, but it is so comprehensively imaged on the Optos device.”
When a disease is evident on the optomap requiring potential referral, the scope and quality of the images make it simple for Bowden to send a quick de-identified image to the local retinal subspecialist.
With a full appointment book, he says ophthalmologists don’t want to be unnecessarily seeing patients that can be cared for at the primary eyecare level.
“It’s a slightly clunkier version of telehealth and modern healthcare but using the tech to ease that communication has proven a great co-management tool,” he says.
“Overall, the Optos technology ticks all the boxes that I always look for in equipment: is it good for the patient, are we able to extract important clinical information, does it suit us workflow wise? My philosophy has always been, if you just do what’s best for the patient, then invariably, the business side of it takes care of itself, and I feel like we are achieving this with this technology.”
A big asset to the practice
As an independent optometrist in the rural town of Ayr, Queensland, the closest ophthalmologist is about an hour’s drive north in Townsville. That means Ms Helene Holmes, who has operated Helene Holmes Optique Eyes for 27 years, has a heightened need for precise referrals to ensure no one’s time is wasted.
Alongside her OCT, the Optos Daytona Plus is a piece of equipment she could not practise without today, making co-management with ophthalmology straight forward.
A classic example occurred just recently when a patient visited complaining of an arc at the edge of her vision. An initial assessment with a volk lens and slit-lamp confirmed a retinal detachment, but with the Optos scan it was possible to see the entire scope of detachment, including where the tears occurred.
“It was great to be able to send those images to the eye specialist; the images eliminate any doubt and any back-and-forth discussion over the phone,” she says.
“And I think it helps the ophthalmologist to plan their treatment because they can see whether it’s a little horseshoe tear requiring laser, or as in this case, a quarter of the retina was hanging off and they can prepare for surgery.”
Holmes still remembers the moment she first encountered Optos ultra-widefield imaging. It was about 10 years ago at an optometry conference. During a presentation, the speaker showed an optomap image and she was blown away by the 200-degree scope it could capture. It was streaks ahead of anything she had used before, so she quickly purchased a device. This was upgraded to a newer model six years ago that was easier to position the patient on.
“I think our community underestimates the technology at our disposal and the amazing images we can capture today,” she says.
While she’s able to practise with more confidence, the technology also has a convenience factor, being simple for ancillary staff to conduct the image acquisition.
“It’s very operator friendly. But probably the greatest asset is the ability to capture such great images undilated. In the retinal detachment case mentioned before, I could see it in its entirety without having to dilate the patient. It saves so much time and the patient can immediately go to the ophthalmologist for treatment, and I can continue with my day of appointments,” she adds.
“Overall, it gives me much more confidence, saves time and is hugely beneficial with co-management.”
More reading
How these Australian ophthalmologists maximise Optos ultra-widefield retinal imaging
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