Optos’ latest system is so new that Insight took its search global to find an ophthalmologist who has installed the technology in their clinic. What upgrades has the company made to its popular Monaco system?
It’s been a while since a device has come along and created that ‘wow moment’ for Dr William Blase. But after only a day consulting with the latest ultra-widefield system from Optos, it’s got him prophesying about the way it’ll deepen his clinical work and even questioning the need for his standalone OCT.
The medical director of California Eye Professionals is among the first globally to have the MonacoPro installed across his three clinics since its commercial launch. The technology has just become available in Australia with Sydney’s ODMAFair25 to be its first major unveiling in June 2025.
For his Australian counterparts, Dr Blase – a proponent of Optos ultra-widefield imaging for several years – has some real-world insights into how Optos has taken its retinal imaging capability to a whole new level.
“MonacoPro is giving us a much deeper dive into the ocular tissues, it’s like going from a superficial snapshot, with the previous technology we had, to putting on 3D glasses. This instrument is geared up to get so much more granular in its analysis of the back of the eye,” he says.
“And then there’s the software to guide you through what you’re seeing – it’s a day and night difference. I honestly didn’t expect it to be this good when I agreed to get the upgrade, but now I’m so convinced of its value.”
MonacoPro comes with the features Optos is famous for, mainly its 200-degree, or 82%, optomap image of the retina in a single capture. Hardware-wise, the big addition is spectral domain-OCT (SD-OCT), allowing the user to scrutinise the retinal layers in greater detail anywhere they choose to across the scan.
This makes it the only device delivering optomap colour red/green, sensory retina, choroidal, green autofluorescence, and high-resolution SD-OCT. All up, eyecare providers can perform a five-modality bilateral capture in 90 seconds.
Optos says that, by bringing these features together, MonacoPro increases the identification of macular pathology when compared with fundus imaging alone by 29.4%.
That’s reassuring for Dr Blase, who believes the hardware upgrades are just as impressive as those to the software, which he’ll touch on later.
His first encounter with Optos ultra-widefield imaging was in 2020 when Optos Monaco devices were installed across his sites, recognising it could accelerate the patient journey.
But the biggest benefit was knowing his clinics were sending patients home with a confident diagnosis.
“Our doctors became very dependent on it,” he says.
“Some would put a contact lens on the eye and perform limited retinal examinations of only the posterior pole. They could continue to do that if they needed to with our Optos system, but they were gaining greater confidence in the overall health of the retina by having this picture on file that showed the peripheral retina as well.”
With MonacoPro, that sense of certainty is elevated thanks to its ability to capture what he now describes as “much more than just a medical photo of the retina”.
Four of these devices will be installed across his practices, each networked to one another so ophthalmologists can pull up patient data regardless of their location.
“We’re obtaining incredibly good, granular detail now. The images presented of the optic nerve of the posterior pole are just so much better than what we’ve had before,” Dr Blase says.
“The software now allows us to look at the optic nerve and provides a definitive cup-to-disc ratio of the nerve head, which is important in the evaluation of glaucoma, and up to this point, it would essentially be up to the clinician to make a guesstimate based on his or her experience.”
Other features of the MonacoPro software include OptosAdvance Image Management that streamlines image review and consultations.
It’s also equipped with AreaAssist, a tool designed to improve the efficiency of retinal imaging workflows by enabling users to automatically measure continuous areas of matching colour and adjust the sensitivity of the selected area.
Plus, distance (mm) and area (mm²) measurements provide objective assessment of change over time.
For Dr Blase, it’s MonacoPro’s ability to automatically segment, measure, and display key parameters that’s making the biggest difference, with more quantifiable and objective data removing any guesswork.
“When we turn our attention to the area adjacent to the optic nerve, we can now use what’s called red-free light and red light to examine the different layers within the retina. So as we analyse the optomap, we can discover subtleties like early dropout of the retinal nerve fibre layer (RNFL), which would be indicative of some optic glaucoma or optic nerve pathology on the surface of the retina,” he says.
“But we can look more deeply at the choroid, the area underneath the retina, too and determine whether areas of different pigmentation represent an absence of pigment epithelial cells or a choroidal melanoma.”
When reviewing images, he can look at both eyes side-by-side and even keep a longitudinal history by superimposing previous optomap images onto the new one.
This is key for macular disease and managing patients with diabetes.
“I believe, with this red-free light allowing us to see the superficial layer of the retina, we’re going to be able to detect diabetic microaneurysms much earlier than before,” Dr Blase says.
“So in patients we suspect are in the pre-diabetic phase, or those we consider glaucoma suspects, we’ll be able to get hard data much earlier that allows us to refine that diagnosis and take their condition much more seriously.”
Five modalities in one
By integrating SD-OCT, MonacoPro is offering various OCT scan types, so eyecare professionals can diagnose with more precision.
These include optic nerve head topography, retinal topography, a widefield line scan, widefield raster scan, and a RNFL circle scan.
With so much functionality, it has Dr Blase reconsidering his workflow and even the role of his current OCT.
“We have a separate, and not inexpensive, instrument in all three offices that allows us to do OCT measurements of the optic nerve and the macula, and now, because of the enhanced image quality here with MonacoPro, those instruments, in my mind, are effectively redundant,” he says.
“Early on, with that preliminary examination of the patient, you can get so much data without having to move them to another room, get another test, or perhaps in a busy clinic, reschedule them to come back. It’s way more productive.”
He anticipates this newfound efficiency will have an impact across all subspecialties in the practice, even cataract refractive surgeons.
“When implanting multifocal IOLs, they really like to take a detailed look of the macula before suggesting these lens designs to the patient, something that would have involved an additional test on an OCT. Now we do it in one fell swoop,” Dr Blase says.
While he’s excited about these efficiencies, he says the device will require a new way of thinking – from technician through to the optometrist and ophthalmologist.
In busy clinics, he has seen a tendency for ophthalmic technicians, or similar, to take the functionality of equipment for granted, thinking it’s as simple as pushing a button.
While a hallmark of Optos technology is its ease-of-use, he encourages practices adopting MonacoPro to freshen up their training, ensuring the patient is positioned just right and their eye lids are adequately lifted to allow adequate retinal exposure.
“There needs to be a mindset shift, acknowledging this is a key step in the patient journey. It has to be done with a bit more scrupulous detail, so that it sets up the doctor with excellent data,” Dr Blase says.
And once the optomap image reaches the practitioner, it will offer more information to work through and present to their patients on the spot.
“But it should have an incredible effect, because the patient is going to see this is not some superficial image. This is actually a deep dive, microscopic if you will, analysis of the tissue of their retina,” he says.
“It should, in my mind, enhance the doctor-patient experience significantly and promote the return and follow-up of those patients, because they know there’s important data being gathered by a practitioner who’s well-equipped.”
More reading
When an Optos scan tells 1,000 words
Why these two Australian optometrists invested in Optos ultra-widefield imaging
A strong business case for Optos ultra widefield imaging
