Two specialists explain how ultra-widefield imaging with Optos technology has helped them find pathologies that might have been missed before, and allowed them to intervene earlier.
For Queensland retinal specialists Dr Abhishek Sharma and Dr Alexander Newman, the Optos California has become so embedded in daily workflow that the word “scan” has almost disappeared from their vocabulary.
Patients are now “getting an Optos” as routinely as they once had visual acuity checks, and both clinicians say the device, which captures a 200-degree image (up to 82%) of the retina, has fundamentally reshaped how they detect, document, and manage retinal disease – particularly when it emerges on the periphery.
“Ultra-widefield imaging has really changed everything for us,” Dr Sharma says. “For so many surgical conditions, most of the pathology is happening in the periphery.
“Optos has become our baseline for almost every retinal patient.”
The pair work across busy public and private clinics in Brisbane, managing a spectrum of vitreoretinal, medical retina, uveitic and genetic eye diseases.
In both settings, the California system now operates as a first-line investigation.
“It’s pretty much standard for all my new patients,” Dr Newman says. “Optos is indispensable – photo documentation, patient education, remote access, multimodal imaging, all of it. And the image quality is consistently excellent.”
Both specialists emphasise that the California’s single-capture ultra-widefield capability – rather than mosaics assembled from multiple shots – provides clarity and consistency they rely on daily.
“You’ve got one image showing around 80% of the back of the eye,” Dr Sharma explains.
“Without 50 pictures stitched together, you get one clear record. If I need to get right to the ora, I can use directional imaging. Monitoring becomes incredibly straightforward.”
This ability has become transformational for pre-operative assessment as well.
“Previously, the requirement was really just a macular OCT before intraocular surgery,” he says. “Now it’s baseline Optos first. It gives you the confidence you’re not missing other pathology, especially in high myopes or patients with previous tears or detachments.”
Dr Newman adds that the integration with legacy software in their public hospital environment has improved workflow further.
“At the Royal Brisbane and Women’s Hospital, it integrates seamlessly with our Forum system. As an added bonus, the web-based interface is so intuitive that both multi-modal and historical image composition combined with sophisticated analysis tools makes this an indispensable part of our patient care.”
Patient groups and workflow
Dr Sharma works across the Queensland Children’s Hospital as well as adult public and private sites, managing everything from paediatric inherited retinal disease to adult detachments, trauma, vascular tumours and peripheral lesions.
He also performs retinal surgery, where ultra-widefield imaging assists both pre-op planning and post-op education.
“The range of patients is from zero to 100, literally,” he says. “Premature babies, paediatric retinal disorders, traumatic cases, choroidal nevi, melanomas, vascular tumours, tears, detachments. And for all ages, we now use Optos imaging.”
Dr Newman, meanwhile, works extensively with medical retina, uveitis and inherited retinal conditions, and increasingly with patients who must be screened carefully for emerging geographic atrophy (dry age-related macular degeneration, dry AMD) therapies.
Many of his patients are also geographically isolated.
“A lot of our patients are regional or international, and they often need to travel long distances,” he says. “Optos images can be given to them directly or sent to their referring clinicians.
“It changes how efficiently and safely we can manage them.”
Pathologies caught early
One strength of the Optos device is its ability to pick up pathologies at the periphery, eye health issues that might not have been picked up without its ultra-widefield imaging.
A recent case stays firmly in Dr Sharma’s mind. An optometrist performing a routine pre-cataract check on his own father captured an unexpected peripheral lesion.
“He noticed a tear in the top right corner of the right eye, with sub-retinal fluid. Completely asymptomatic,” Sharma says. “It was caught by chance because Optos was done routinely.”
The father was referred immediately, seen the same day, and treated with laser before the tear progressed into a full retinal detachment.
“That would absolutely have become a major surgical case if it wasn’t seen early,” Dr Sharma says.
“This is where ultra-widefield imaging shines. There was no indication that anyone needed to look that far out, and the patient had no symptoms.”
Dr Sharma also cites multiple patients with proliferative diabetic retinopathy who are being managed with intravitreal injections to avoid further peripheral laser, which can compromise night vision.
“Optos is perfect for monitoring these patients.
“You can see the peripheral vessels, ensure nothing is leaking or bleeding, and confirm stability after treatment.
“I have three or four patients like this where it’s been invaluable for long-term care.”
One of Dr Newman’s most compelling cases involved a patient referred for treatment with what was thought to be geographic atrophy.
Something didn’t align clinically, so he proceeded with ultra-widefield autofluorescence to make sure.
“What clinched it was the Optos ultra-widefield autofluorescence,” he says.
“The pattern was classic for central areolar choroidal dystrophy, an inherited condition – not AMD.”
This avoided an inappropriate and costly management pathway.
“Without careful assessment, the patient could have been considered for complement inhibitor therapy or commenced on nutritional supplements, delaying their diagnosis. The widefield view was diagnostic. If you only imaged the central macula, you simply couldn’t make that call confidently.”
Another example is a patient with progressive retinal vascular disease.
“The photo documentation and ability to easily refer back to previous images has been essential for monitoring change and planning treatment,” says Dr Newman.
Why Optos finds what others miss
Both clinicians see key advantages of Optos’ single-capture ultra-widefield image over systems that rely on stitching multiple fields.
“It’s the difference between assembling a puzzle and seeing the whole picture at once,” Dr Newman says. “One 180–200-degree image gives you clarity. And you avoid artefacts that can happen when you splice images together.”
Dr Sharma highlights patient comfort – and feasibility.
“With indentation, you’re pressing on the eyeball with a metal instrument to bring the periphery into view. Many patients can’t tolerate that. Kids certainly can’t,” he says.
“Optos lets you capture peripheral pathology without putting them through that.”
This, he adds, has shifted more responsibility safely into the hands of frontline clinicians.
“You don’t always need a subspecialist exam now. Optos allows optometrists and general ophthalmologists to monitor many peripheral conditions confidently.”
Both doctors work with substantial numbers of patients from across Queensland and beyond.
“Being able to send images electronically or give them directly to patients is a tremendous advantage,” Dr Newman says.
“For someone flying in from a regional or remote community, continuity of care becomes much easier.”
Dr Sharma agrees: “It means high-quality imaging doesn’t just happen in tertiary centres. Patients get access to proper screening and follow-up without the burden of multiple long-distance visits.”
Both are happy to recommend the Optos devices to other professionals.
“Anyone dealing with the back of the eye should have ultra-widefield imaging,” Dr Sharma says. “We’re detecting conditions earlier, monitoring earlier, and intervening earlier.”
Dr Newman calls it “essential”.
“When I first trained, we were measuring lesions manually with a reticule at the slit lamp. Now the documentation is precise, fast, and reliable. In oncology and uveitis it’s been a complete game-changer.”
Both are happy with their California device, but there is more than a little professional jealousy when they talk of the Optos Silverstone and Silverstone RGB.
“I’ve used it before in Sydney, and it’s extraordinary,” Dr Newman says. “At a quaternary centre [highly specialised hospital], it’s the future. When it helps, it really helps.”
Dr Sharma’s colleagues interstate are already using the Silverstone RGB. “You look at their images and you do get jealous,” he laughs.
Both would welcome the upgrade.
“We’ve got enough clinicians who want it,” Dr Sharma says.
