Ultra-widefield optomap retinal imaging has transformed care at Rachel Cauchi Optometrists, where every patient is now screened on the device. For this regional practice, it’s delivering one of the most valuable outcomes in eyecare: trust between the clinician, patient and ophthalmologist.
For patients living in and around Ingham, a regional town in North Queensland, accessing specialist eyecare often means travelling more than 100 kilometres to Townsville – a trip that can be time-consuming, costly, and difficult to arrange at short notice.
It means that every referral carries significant weight – not only in terms of the patient’s time and resources, but also for the region’s hard-working ophthalmologists juggling full appointment books.
It’s one of the reasons why ultra-widefield retinal imaging has become such a vital part of the patient workflow at Rachel Cauchi Optometrists.
With the ability to capture a high-resolution 200-degree view of the retina in a single image, the Optos Daytona system provides an elevated level of clinical confidence for the practice’s three optometrists.
Offering several imaging modalities, including autofluorescence, it helps them to detect conditions they might not have otherwise, especially out in the peripheral retina, while minimising unnecessary referrals. Ultimately, it galvanises relationships with patients and local ophthalmologists.
“We wouldn’t have a practice without our Optos system,” says Mr Travis Cauchi, who co-owns the practice with wife Ms Rachel Cauchi, the principal optometrist. “Every patient receives an optomap image in the pre-test phase – it’s that essential to how we work.”
As the only optometry provider in the Hinchinbrook Shire, the practice serves a large catchment, including parts of neighbouring Cardwell Shire. That kind of reach brings its own set of challenges: the nearest ophthalmology services are an hour and 10 minutes away, which is more than an inconvenience, especially with elderly patients.
“We work closely with the public eye clinic at Townsville Hospital and the local ophthalmologists down there. They’re booked out most of the time, and it’s not simple to just pop someone down the road for a quick check,” Travis says.
The Optos system allows the practice’s optometrists to triage patients more effectively, monitor progression and determine the right moment for referral.
It feeds into their collaborative care with ophthalmologists in Townsville who also use Optos systems. Interestingly, it was during a monthly satellite clinic at Rachel Cauchi Optometrists that prompted well-known Townsville ophthalmologist Dr Todd Goodwin to look into the technology himself.
“He started comparing our optomap images to what he was getting on a competitor device, and he saw a clear difference,” Travis says.
“Six months later, he got an Optos system for himself.”
Using the same imaging platform provides a level of familiarity and continuity between primary and tertiary eyecare. It also means ophthalmologists can assess optomap images remotely and provide feedback quickly.
“We’ve had specialists ask us to email the scan so they can check it on their phone. Thanks to the resolution of the image, they’ll have a look and call back straight away with advice,” he says. “That speed of assessment has been a real advantage.”
A modern regional practice
Rachel Cauchi Optometrists’ journey with retinal imaging began back in 2007, when the practice purchased its first fundus camera, one of its first eye health instruments.
“It was a 45-degree camera, and that in itself felt like a big step at the time,” Travis recalls.
The motivation came from a Canadian optometrist working at the practice, who had experience using pre-test lanes and more advanced technology in his own clinic overseas. It was a turning point for Rachel and Travis, who decided to modernise their workflow despite some early pushback.
“Pre-testing was a foreign concept back then, especially in regional practices. Some of the staff really struggled with the idea. But we knew we had to start moving beyond how optometry had been done for the past 20 years,” Travis says.
strong bonds with ophthalmologists and GPs it refers to in the Hinchinbrook Shire, North Queensland. Image: Rachel Cauchi Optometrists.
Going from refraction-based optometry to a more eye health-focused model was gradual, but not without hurdles. Introducing a $40 imaging fee was a major shift for patients who had never paid for such services before. But looking back, Travis says it was an important move.
“I’m glad we went through that journey early. It set the foundation for everything we do now.”
Today, that retinal imaging is performed with the Optos Daytona. It’s the second Optos device the practice has owned, after switching to the manufacturer in 2016.
The practice became aware of Optos’ imaging capability after a locum ventured up from Brisbane, where she’d seen the technology in action.
Later, she went to a trade show and returned with Optos brochures. Understanding the power of an outside voice, especially for an isolated regional practice, Travis and Rachel “made the leap” not knowing how transformative it would be.
“The first time our optometrists saw a widefield image like that, they were blown away. They were used to trying to view the periphery manually with an ophthalmoscope, but seeing it captured so clearly in one image was a completely different experience,” Travis says.
The system quickly began picking up pathology that might otherwise have been missed, particularly in the far periphery. Retinal tears, for example, became far easier to detect and manage early.
“It really did change how we assess eye health,” Travis says. “We went from a narrow field to seeing so much more – and doing more for our patients as a result.”
Finding its footing
Initially the practice was going to acquire optomap scans judiciously, but the locum optometrist intervened again.
“She’d done her MBA, and said, ‘look here’s a working model for you. It’s amazing technology, you should do it on everyone, and make it that little bit more affordable’,” Travis says.
“At the end of the day, you can’t make that kind of investment and only use it occasionally. We did the numbers and realised using it consistently made the most sense – financially and for better patient care.”
It was integrated into the pre-test lane. The 200-degree widefield view can be captured without dilation. While Rachel Cauchi Optometrists doesn’t dilate during routine eye examination, it does for diabetic patients, and on indication.
With three full-time optometrists seeing patients in 30-minute slots, the device runs continuously throughout the day.
“Every optometrist is worried about having a piece of equipment that turns out to be a white elephant, but this just goes and goes. It’s a very reliable machine, which is important when your closest service support is a flight away in Brisbane.”
And support from the Optos team has also been a strong point. “They’ve been great to deal with. That matters in a regional setting.”
‘Picture book of our patients’ eyes’
After using Optos ultra-widefield for nine years, it has become more than just a diagnostic tool. It’s offering a long-term record of each patient’s retinal health.
“After using it for that long, we now have what I call a ‘picture book’ of our patients’ eyes,” Travis says. “Especially for our older patients, we can scroll through and see how their retina has changed over time, and now we’re starting to gather images of their kids and grandchildren too.”
That capability is invaluable for monitoring progressive conditions.
“It gives us the ability to keep an eye on things accurately. If someone’s waiting to see a specialist, we can do a review and know if anything’s changed since their last image,” he says.
The images also form part of the practice’s communication with local GPs, particularly for diabetic patients.
“We automatically send optomap scans with our GP reports. It helps them understand how well a patient’s diabetes is being managed and whether it’s affecting their vision. GPs appreciate having that certainty, and it really builds the professional relationship.”
As regional practices continue to hold significant weight in the broader healthcare landscape, tools like Optos Daytona provide a level of confidence and trust between the optometrist, ophthalmologist and patient.
“For us, it’s not just about keeping up with technology,” Travis says. “It’s about being able to deliver the kind of care that patients deserve, without them having to travel unnecessarily or wait longer than they should.”
And when asked what things would look like without Optos, Travis doesn’t hesitate.
“We just wouldn’t. That’s the truth. From the clinical point of view, it’s a must-have.”
More reading
Early insights into the new Optos MonacoPro
When an Optos scan tells 1,000 words
Why these two Australian optometrists invested in Optos ultra-widefield imaging
