For optometrist Martin Robinson, iCare’s EIDON fundus camera has supercharged his practice and is an example of superior ergonomics, top-tier imaging quality, and the advantages of ultra-widefield imaging.
At Martin’s Eyecare in Tasmania, Mr Martin Robinson’s investment in iCare’s EIDON fundus camera has elevated his practice to new heights. The imaging modality has played a crucial role in life-saving diagnoses and has seamlessly integrated into his suite of instruments.
A curious case that might not have been diagnosed without the EIDON retinal camera is a naevus melanoma. Thanks to its autofluorescence feature, it can differentiate between an amelanotic melanoma by fluorescing, and a non-melanotic nevus that will not fluoresce.
“We’ve been able to accurately diagnose melanomas in something that are not easily observable – and is outside the range of our OCT – and have then referred those away to an ophthalmologist and then to an oncologist,” Robinson says. “It’s a lifesaving investigation.”
Robinson first experienced the imaging modality at an O=MEGA conference on the Designs For Vision (DFV) booth. There, he was given a textbook featuring traditional images from retinal cameras, OCT scans, and EIDON images for various diseases.
“I thought it was amazing and I was really impressed because at that stage I had an older non-mydriatic fundus camera which I’d had for several years and bought secondhand,” he says.
“I wanted something better, more current and integrated, and with the same footprint as my existing camera.”
For Robinson, the EIDON was ergonomic and integrated seamlessly into his existing workflow. In a practice limited by space constraints, the device slotted right in.
He also sought a refined imaging modality that could cater to the high volume of diabetic patients he sees. Identifying retinal detachments and tears are also important but constitute a fraction of his patient base.
“I was seeking something that was superior for diagnosing early diabetic changes – and that’s where the EIDON kicks butt because its clarity and resolution are off-the-charts-amazing for diabetes,” Robinson says.
Redefining imaging standards
EIDON, distributed by DFV in Australia, is described as the first TrueColor Confocal system that combines the best features of scanning laser ophthalmoscopy (SLO) systems with those of standard fundus imaging to redefine retinal imaging standards.
Robinson uses the imaging modality on most of his patients, while the other optometrist in his practice opts to use it for patients with small pupils and ones with cataract or vitreous opacities that make internal viewing difficult.
The confocal imaging, which can work with pupils as small as 2.5mm without the need for dilation, is reported to be superior to conventional fundus photography, with Robinson describing it as having the ability to “cut through scatter like a hot knife through butter”.
The imaging modality can pick up on micro aneurysms that Robinson has not been able to see using traditional methods such as a normal fundus camera or through slit lamp fundoscopy.
In Martin’s Eyecare, he has opted for the ultra-widefield module – which can be attached to all EIDON models, including retrofitting of many older units – and has been invaluable for detecting early diabetic changes and signs of pathologies that start to appear in the periphery.
With diabetic patients, Robinson completes a three shot horizontal mosaic where he takes three photos in one sequence for one eye – one with the eye looking straight ahead, one looking temporal, and one looking nasal. The EIDON then stitches the images together to produce an image of about 200 degrees across, with that resolution extending all the way to the periphery.
“This means I’ve got an excellent view of any diabetic change happening centrally within the arcades and in the periphery as well,” Robinson says.
Following the scan, he exports high-resolution PDF files direct from the viewing program where he can then discuss and interpret the results with patients. He also attaches the images for triage or for a full referral – with the higher quality images meaning a better outcome for his patients.
“I get communications back from my virtual retinal specialists saying, ‘That’s some amazing imaging camera that you’ve got – there’s no doubt about the diagnosis’,” he says.
“I’m not referring people away for an opinion if I don’t need to, and I can look after them and review them in-house, which is more cost effective for the patient and more time effective for the ophthalmologists.”
EIDON also features Flicker technology that compares a current image of an eye to an historic one. The technology can then overlay them, with the ability to flicker repeatedly between one another to monitor structural changes.
“I can check the nerve and see if there’s any changes to the cup. I can see if there’s any vascular changes around the nerve. I can look at the macula and see if there are changes,” Robinson says.
“So, it’s an incredibly effective communication tool to show the patients how much the eye has changed.”
For example, EIDON’s ability to cut through media opacities such as those associated with asteroid hyalosis and cataracts has enabled Robinson to make life-altering diagnoses.
“In asteroid hyalosis, when the optometrist looks inside, they see these asteroids that are drifting inside the vitreous. Trying to look at it manually with a slit lamp or a traditional camera, all you see is white because it reflects the light you’re shining into the eye and you can’t see through them,” Robinson says.
“I’ve been referring patients along for cataracts, for example, with asteroid hyalosis. I’ve been sending images of the retina, and the surgeons are grateful as it provides a superior fundus view.”
He says that sending images that have cut through the asteroid hyalosis, gives the surgeon more confidence they can give the right advice to the patient.
Beyond its imaging capabilities, machine upkeep is simple and streamlined, according to Robinson, with service updates occurring virtually and remote and without disruption to the workflow.
“I just make sure I have the right settings on the camera, and I’ll leave it on overnight. Diagnostics are run and then the system is updated remotely – which is great,” he says. “I come in the morning and it’s running the new software – it’s seamless.”
In terms of equipment fault, Robinson says DFV were quick to loan him a camera until his could be fixed. Acknowledging these issues are inevitable with the computerisation of most equipment nowadays, he was impressed with the response.
“I didn’t have any worries for that – I had a camera, and I didn’t have any downtime,” he says.
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