New ultra-widefield imaging technology is supporting ophthalmologists and optometrists with enhanced visualisation, streamlined workflows, and improved patient understanding across a range of retinal conditions.
The evolution of retinal imaging continues to reshape how eyecare professionals diagnose, monitor, and communicate disease.
The ZEISS CLARUS platform, spanning both the CLARUS 700 and CLARUS 500, is being adopted across ophthalmology and optometry settings, with both professions leveraging distinct capabilities of the system.
At Marsden Eye Specialists in Western Sydney, retinal specialist Dr Jennifer Arnold and orthoptic team leader Mitchell Bagley have been working with the CLARUS 700 equipped with indocyanine green angiography (ICGA), a feature that extends imaging deeper into the choroidal circulation.
Further south near Wollongong, optometrist Dr Annie Tran uses the CLARUS 500 to support diagnosis, documentation, and patient education through ultra-widefield colour imaging.
Together, their experiences highlight how imaging technology is being integrated across the care pathway, from primary assessment through to specialist investigation.
Advancing angiography
For Dr Arnold, the addition of ICGA to the CLARUS 700 has expanded diagnostic capabilities, particularly in complex retinal and choroidal conditions.
She describes the ability to capture both fluorescein angiography and ICGA simultaneously as a key advantage, enabling clinicians to assess retinal and choroidal circulations side by side.
“The ability to capture ICG images not just in the central retina but also in the periphery has been a really welcome addition,” she says. “It allows really easy and accurate correlation of features.”
The system’s wide field of view is central to this capability. Using a six-image montage, clinicians can generate a single image extending to nearly 270 degrees, supporting more comprehensive assessment of peripheral pathology.
Dr Arnold notes this is valuable not only for clinical interpretation but also when explaining findings to patients.
Image quality across different phases of the angiographic process is another focus.
Early-phase imaging, often characterised by rapid dye influx and high contrast, and late-phase imaging, where contrast diminishes, can both present challenges.
Dr Arnold reports that the system maintains interpretable images across these phases, supporting continuity in assessment.
“There are particular patient pathologies where this is useful, including ocular inflammation, where we really want to see the choroid,” she says. “But there are many other conditions where a full evaluation of both the choroid and retinal circulation is important.”
The integration of ICGA into existing workflows has also been significant. Fundus photography remains a starting point, but angiography is increasingly performed as a combined procedure, broadening the scope of investigation within a single session.
Workflow, comfort and image capture
For orthoptist Bagley, the practical aspects of imaging are equally important. He highlights patient comfort and operator usability as factors that influence both image quality and efficiency.
“Patients have been very happy to go through the process,” he says. “They don’t find it too uncomfortable, and it’s very easy for them to position themselves so we can get the best images possible.”
The system’s tolerance for eyelids and lashes has reduced common artefacts that can obscure peripheral views. This has been particularly relevant in ultra-widefield imaging, where capturing the superior and inferior retina can be challenging.
“I do find it’s much more forgiving in terms of eyelids and lashes, and that helps with the overall image quality,” Bagley says.
Ergonomics and workflow design also play a role in angiography procedures, which often involve multiple clinicians. The CLARUS 700 allows space for cannulation and dye injection, while keeping imaging controls streamlined.
Bagley notes that this enables operators to focus on patient positioning and image acquisition rather than manual adjustments.
One feature that has drawn attention is the system’s movie mode, which captures the dynamic flow of dye through the ocular vasculature. This provides clinicians with a visual sequence of early-phase circulation, complementing static images.
“Right from the beginning, when the dye is first injected, you can see the incoming dye and the transition of phases,” he says. “It’s very useful when reviewing the exam.”
The ability to identify and correct image issues in real time further supports consistency. If a frame within a montage is suboptimal, it can be retaken immediately, improving overall image quality without requiring a repeat procedure.
For Dr Arnold, this contributes to more reliable imaging outcomes across a broader patient cohort.
“The ease of use allows photographers to control the situation better and get high-quality images,” she says. “That includes both fluorescein and ICG, even with their different focal planes.”
Imaging in optometric practice
While ICGA remains within the scope of ophthalmology due to the need for dye injection, optometrists are using other aspects of the CLARUS platform to enhance everyday clinical practice.
At Malinda Halley Optometrist, an independent practice in Dapto, Dr Tran has been using the CLARUS 500 since 2025. The decision to adopt this model reflected the needs of the practice, which does not perform angiography but sought to expand its imaging capabilities.
“The CLARUS 500 allows us to have a really wide field of view,” Dr Tran says. “Compared to a traditional fundus camera, it captures much more of the retina, including the periphery.”
This extended view supports both detection and monitoring of pathology. In cases such as choroidal naevi or other peripheral lesions, ultra-widefield imaging provides a clearer picture of size, location, and progression over time.
Dr Tran recalls a patient with a choroidal melanoma, where follow-up imaging with the CLARUS 500 provided a more comprehensive view of the lesion than earlier conventional photography.
“You could see the complete extent of it,” she says. “It really helped both clinically and in terms of showing the patient what was happening.”
By visualising the retina in a single, wide image, patients can better understand their condition, which can influence engagement with treatment and follow-up care.
“A lot of patients are fascinated when they see the images,” Dr Tran says. “It helps them connect what we’re explaining to what’s actually in their eye.”
The integration of imaging into a broader digital workflow also supports efficiency. Through the ZEISS Forum platform, images from multiple devices, including OCT and visual field testing, can be accessed from a single interface. This allows clinicians to review results alongside patients in real time.
“We can show everything from the computer without needing to go back to each machine,” Dr Tran says. “It brings all the information together.”
Although optometrists do not perform ICGA, Dr Tran notes that its outputs can still inform care through shared management with ophthalmologists. Reports and images from specialist investigations can assist in diagnosis and ongoing monitoring within the optometric setting.
“There are cases where it would help differentiate between conditions,” she says. “We can use those results to guide our understanding and management.”
Across both ophthalmology and optometry settings, the CLARUS platform reflects a broader shift towards integrated imaging pathways. In ophthalmology, advanced angiography techniques such as ICGA are extending diagnostic depth, while in optometry, ultra-widefield colour imaging is supporting earlier detection and improved communication.
As imaging technology continues to evolve, its role across the continuum of care is likely to expand further, linking primary and specialist practice through shared visual data and collaborative management.
“The CLARUS system with ICGA has really filled a gap that we had in our current diagnostic capabilities and workflow,”
Dr Arnold says.
