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An optomap of Optos

Beyond its superior optomap retinal imaging technology, Optos has a rich history that all started with a father motivated to right an avoidable wrong that happened to his son.

In 1990 in the small Scottish city of Dunfermline, a 30-minute drive north of Edinburgh, five-year-old high myope Leif Anderson suffered a blinding retinal detachment. It was an event that would not only alter the course of his young life, but that of the ophthalmic imaging technology.

Leif’s father, Douglas, was perplexed. His son had regular eye examinations, but no one had picked it up with existing instrumentation. While he didn’t have any ophthalmic or academic experience, Douglas funnelled his experience as a healthcare product development expert into inventing a device that would ensure others with missed pathology in the retinal periphery did not face the same fate as his son.

Primarily he was concerned with scanning the peripheral retina of a young child without dilation, but discovered along the way that even adult retinal examinations needed improvement.

Two years later in 1992, Optos (called Zenoplan Ltd at the time, then Besca Ltd) was born, with the goal of producing a patient-friendly device to capture a much broader image of the retina than anything else in the market. Through this, Optos developed a device capable of ultra-widefield (UWF) high resolution digital images called optomap that capture approximately 82% and 200° of the retina, something the company says no other device can do in a single capture.

As Optos – whose Australian subsidiary is based in Adelaide – marks 30 years in business, it counts itself as a market leader in its field. It has progressively improved its technology over the decades to now offer four core imaging platforms – the Daytona, California, Monaco and Silverstone – with tens of thousands of devices installed globally helping millions of patients.

Silverstone, launched in 2019, spearheads the Optos portfolio today. It’s unique because it is the only UWF retinal imaging device with integrated, UWF-guided swept-source OCT. It also takes a 200° single-capture optomap image in less than half a second and enables guided OCT scanning across the retina and into the far periphery.

Optos Silverstone is the only UWF retinal imaging device with integrated, UWF-guided swept-source OCT.

The quality of Optos’ technology is such that the company has reported significant growth with record revenue of US$254 million (AU$385 m) in the year to March 2022, up 14%.

“We are proud of what Optos has achieved over the past three decades. We have remained true to Douglas’s core purpose of improving patient outcomes by providing the best imaging technology and so reduce the risk of sight loss,” Mr Rob Kennedy, CEO of Optos, says.

“In pursuit of this purpose, we pioneered the only single capture ultra-widefield retinal imaging, and now more than 22,000 optomap devices are in use worldwide. We have delivered significant growth, continued to develop our technology, and ultimately enabled our customers to help save the sight of their patients.”

The optomap systems can be found in many optometry and ophthalmology practices across Australia and the world, as well as in hospitals including the world’s leading teaching hospitals such as Great Ormond Street Hospital in London and Harvard Medical Center in Massachusetts.

Because the business has continued to invest significantly into research and development, it has continuously released new and improved versions of its UWF devices. For the year ended March 2022, it’s R&D budget amounted to US$18.6m, up more than 40% on the previous year.

This commitment to continual improvement has seen its early models such as the Plus 180 (first displayed at the American Academy of Ophthalmology in 1995) and the Panoramic 200 (launched at the American Academy of Optometry and the American Academy of Ophthalmology in 1999) morph into its current crop of devices, with the first of these, Daytona, launched in 2011.

UWF guided OCT enables OCT capture even in the far periphery.

Today, Optos says more than 2,000 published clinical studies show the long-term value of optomap imaging and OCT in diagnosis, treatment planning, and patient engagement. Some highlights include:

• optomap improves management of retinal detachments: one study showed the technology was equivalent to dilated fundus examination (DFE) when assessing rhegmatogenous retinal detachment (RRD) and was also consistent with intraoperative findings

• optomap improves clinic efficiency: a study conducted at a prominent research university found a 28-minute (33%) reduction in patient visit duration after implementing centralised optomap imaging

• optomap-guided OCT with Silverstone improves patient management: studies have shown this imaging impacts clinical decision making in 84% of cases, and 69% of cases had pathology only in the periphery while 31% had pathology in the central pole. In 38% of cases, optomap navigated SS-OCT directly contributed to patient management plans (laser, injection or surgical treatment).

• optomap equivalent to Early Treatment Diabetic Retinopathy Study (ETDRS): The results of several studies comparing optomap images have indicated that there is substantial agreement with ETDRS 7-standard film photographs and dilated fundus examination in determining diabetic retinopathy severity.

The Optos business, here and abroad

Optos has an intriguing history beyond the technology itself. Anderson, the company’s founder, met the late Queen Elizabeth in 2006 to receive the Order of the British Empire for his distinguished service to the sciences. Acquisitions have also formed part of the company’s journey, such as the 2011 takeover of Opko Instrumentation for its OCT technology.

More significantly, Optos itself was acquired in 2015 by Nikon, a Japanese company famous for cameras and binoculars. Bringing Optos into Nikon – in a £260 million (AU$470 m) deal – is part of the latter’s strategy to develop a global medical business.

Although Optos is now a division of Nikon, the Optos business employs more than 500 people in a variety of roles including R&D, manufacturing, clinical research and sales.

In Australasia, the business is headed up by managing director Mr Jason Martone. Optos Australia bases itself in Adelaide with employees serving all states and New Zealand. The technical support team takes care of installations and everything associated with product, with staff also selling and providing product training for eyecare professional customers.

The Optos AU NZ office provides support to Asia Pacific distributors of Optos devices. This includes customer service for APAC and the Middle East and parts of Africa, with additional functions such as orders coordination, technical support and shipments.

A major and recent addition to the Optos Australia business has been optometrist and Optometry Board of Australia board member Ms Renee Slunjski, who has taken on a newly created role as a regional product specialist.

Martone says Slunjski will play an important role in ongoing training, meaning customers can see first-hand how to integrate Optos systems into their practice.

“As an additional resource for customers, Renee will interact with internal and external customers, including optometrists, ophthalmologists, practice personnel, product managers and the sales team,” he says.

“Renee will partner with the sales team to ensure that optometrists and ophthalmologists develop a thorough understanding of our optomap devices. She will take the lead in education: confirming the practice needs, running product demonstrations – both in person and virtual.”

An optomap indocyanine green angiography image – Courtesy of Srinivas Sadda, MD.

Because Optos aims to be “the standard of care” for all optometrists and ophthalmologists, Martone says the company services a broad range of customers from small independent practices through to large groups, hospitals – and anyone else providing eyecare services.

Several factors make the technology a tantalising prospect for various practices types and sizes, particularly when it comes to workflow efficiency, ease-of-use and disease detection.

“optomap is the only UWF technology proven to improve practice flow. The technology has been proven to reduce patient visit time and improve practice flow and practice economics,” Martone explains.

“Optos UWF imaging is the best investment for increasing patient throughput and improving practice economics.”

In addition, optomap ultra-widefield (UWF) systems – said to be the only device offering single-capture UWF non-mydriatic images – have been shown to help doctors find more pathology. Martone cites a 2021 report that found 97% of optomap users reported finding unexpected pathology in the eyes of patients with no visual complaints.

“This means that Optos UWF imaging might be the eyecare professional’s most powerful tool in the fight to protect vision,” he says, adding that optomap imaging have been shown to improve treatment decisions.

“optomap UWF imaging is a proven tool for effective clinical decision making. Optos UWF technology is helping tens of thousands of eye doctors make better clinical decisions every day.

“optomap imaging is also enabling eyecare providers to see and document the retina with no face-to-face interaction; therefore it may help protect patients and staff by reducing the spread of airborne disease.”

With such a rich and varied history, Optos can count itself as an ophthalmic imaging powerhouse. But despite its global footprint, it’s remarkable to consider how the corporate firm has stuck to the guiding principles laid out by founder Douglas Anderson three decades ago. And with an aging population and more children suffering high myopia like Anderson’s son, Leif, the technology has potentially never been more relevant.

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Optos poised to welcome Silverstone to Australia

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