Whether ophthalmologists are scanning a three-month-old or elderly patient, the ability of Optos ultra-widefield imaging devices to capture 200° of the retina in a single snapshot means pathology isn’t only detected – but is done so earlier to give patients the best chance of a positive outcome.
When Dr Deepa Taranath opened her private clinic, iSight Specialists, in Frewville, Adelaide, in August 2023, there was one device she coveted most: the Optos California FA, featuring the first ultra-widefield red/green/blue colour image.
Having used Optos UWF retinal-imaging devices in previous roles, she knew it was the right device for patients at the clinic.
An ophthalmologist with subspecialty interest in paediatrics, strabismus and ocular genetics, Taranath is also senior staff specialist at Flinders Medical Centre, a public hospital in Adelaide. She hopes that one day all public hospitals will have UWF retinal imaging devices such as Optos cameras to enable invaluable imaging especially in paediatric patients.
As Optos – whose Australian subsidiary is based in Adelaide – marks 30 years in business, it counts itself as a market leader in its field. It has progressively improved its technology over the decades to now offer four core imaging platforms – the Daytona, California, Monaco and Silverstone – with tens of thousands of devices installed globally helping millions of patients. These devices produce optomap images that capture approximately 82% and 200° of the retina, something the company says no other device can do in a single capture.
For Taranath, it was just a matter of which of the four Optos imaging platforms to choose.
“There are several retinal cameras on the market but Optos ultra-widefield can image the entire retina ora-to-ora, the entire circumference of the eyeball. It’s also user friendly, and quick. Children have short attention spans, so I need a camera which is quick in capturing images but also easy to position a child’s head,” she explains.
“With other cameras, you may need to take several shots but when it has a bright flash, you’ve missed the boat because the child doesn’t want to cooperate anymore after one or two bright flashes. Whereas, with Optos UWF, within a couple of quick shots, you can capture a lot more information.”
Its speed and true ultra-widefield imaging sets Optos apart for another reason, Taranath explains.
“In paediatrics, ultra-widefield retinal photography is usually done when the patient is asleep or under sedation or under general anaesthetic. But with Optos UWF, we are finding we don’t have to put the child or infant through this invasive procedure. We can perform imaging by having the parent hold the baby, with dilated pupils, in certain positions close to the camera, without needing to make direct contact of the equipment with the eye,” she says.
Taranath is not alone in this approach. At a recent paediatric health practitioner meeting in Noosa, a colleague presented a case of a two-month-old baby, who upon presenting with unusual eye movements, had been held in the ‘flying baby’ position while photographed using an Optos UWF camera. The technique has also proven successful for imaging babies with retinopathy of prematurity (ROP).
“It’s been a game changer for paediatrics,” Taranath says. “It’s why I chose Optos for iSight Specialists – because I see a lot of children.”
Optos UWF also allows her to perform fluorescein angiograms on children without needing to use a needle to flush the dye. Instead, fluorescein can be administered orally, mixed with apple or orange juice for example, allowing the patient to drink the dye, before then performing ultra-widefield imaging.
“By using Optos ultra-widefield photography, I have more confidence in early diagnosis and management of peripheral retinal diseases. In conditions like Incontinentia pigmenti (a dermatological condition) and FEVR (familial exudative vitreoretinopathy), which is a genetic condition associated with retinal vasculopathy, it may cause intraocular bleeding leading on to retinal detachments and blindness. I can look at the child’s fundus clinically and see the posterior pole, which is 50-60 degrees or maybe even 100 degrees, but not beyond it, missing out on where the actual pathology is. Instead of having to put these children under general anaesthetic, or use a contact camera, we can use the Optos UWF FA.
“That way, it is possible to do fluorescein angiography in clinic in an awake child with the confidence of the child and their parents. It is quite a useful investigation when dealing with complex paediatric retinal vascular diseases, which is why I invested in Optos California FA,” Taranath says.
In addition to her paediatric patients, she says Optos UWF is also breaking new ground in early diagnosis of genetic eye disease. She runs a monthly genetic eye clinic at Flinders Medical Centre and fundus autofluorescence imaging is an essential tool in screening for inherited retinal diseases.
“Fundus autofluorescence imaging picks up the earliest signs that an area of cells in the retina is dysfunctional, sometimes even before I can see clinical changes in the eye, or on OCT scans. Fundus autofluorescence definitely assists in early diagnosis of genetic eye disease,” Taranath says.
This bodes well as the profession moves towards gene therapy to treat inherited retinal diseases, she says, with TGA-approved Luxturna to treat RPE65 mutations already rolled out in Australia. Fundus autofluorescence is also expected to have a greater role in monitoring geographic atrophy with new therapies expected in Australia soon.
“Within the next couple of years we might have more gene therapies in the market. Once gene therapy becomes easily accessible, I think we will find that we’re doing a lot more genetic screening for early diagnosis, which means patients may ask paediatric specialists, ‘Dad has this condition, do you think my children have it?’,” Taranath explains.
“It would be advantageous to utilise UWF imaging on those children and know if there are signs of genetic eye disease, rather than saying, ‘I’m not sure. We’ll have to wait and see’.”
Yet another benefit Taranath has found with Optos UWF is its ability to render a 2D retinal photograph in 3D – a powerful visual communication tool.
“Optos California FA has a 3D module where you can see a three-dimensional eye and how the retina looks inside, so you can show parents where a haemorrhage or lesion is, and I think people have a better understanding and coping mechanism once they know what it is. I think it’s a very good educational tool because people believe what they see, more than what they hear,” she says.
“I like to show the 3D image and explain, ‘This is what I’ve seen. This is why I’m worried, or this is why I’m not concerned because the lesion is not in the sight threatening area, it’s not in the macula, it’s not near the optic nerve, but it’s at the periphery’. That is another advantage of Optos UWF.”
Although only a matter of weeks into using Optos California FA in her clinical practice, Taranath says it’s improving her treatment decision making, including early and more definitive diagnosis.
She says interstate colleagues who bought an Optos UWF camera two years ago have spoken about the many cases where the camera has proved indispensable.
“I was inspired, realising it’s worth spending on this equipment because if it’s going to help my patients and improve their diagnosis and management, it’s worth it.”
Reassurance to stay the course, or change tact
Sydney retinal specialist Dr Rajeev Chalasani finds Optos UWF assists with managing patients with retinal diseases and improves workflow in his workplaces, including Coastwide Eye Surgery and Strathfield Retina Clinic in Sydney.
The standard protocol for Chalasani’s new patients is for clinic staff to perform retinal imaging on an Optos Silverstone before he sees the patient.
“It really does help before you see a patient to identify any areas of pathology that you might need to focus on when you examine the patient. It helps with honing in on what you might need to look at, rather than searching for something during the clinical examination,” he says.
It’s here that the Optos system shines.
“The biggest advantage of Optos is it allows you to go right out to the edge of the retina to monitor diseases that are affecting those areas. I find that it’s particularly useful for diseases like diabetic retinopathy, where often there may not be changes in the macula, but there may be significant disease further peripherally that you wouldn’t see on a normal photo of the fundus,” he says.
He says it’s particularly good for screening for diabetic changes before he sees the patient.
“A lot of these diabetic patients then need to have fluorescein angiograms to better assess the level of disease in their retinas. The Optos is the gold standard for assessing the circulation right out to the edge of the retina. Often, with these patients who might be developing proliferative retinopathy, new blood vessels may only start at the edge of the retina, so you wouldn’t see them with other types of imaging systems,” Chalasani says.
Seeing it is one thing. What he does with that information is another. Is it helping to improve treatment decision making?
“One of the areas Optos really helps with management is – for someone with diabetic retinopathy for example – if you’re not sure whether they’ve got proliferative retinopathy or not, doing a fluorescein angiogram and getting a good view of the overall circulation, and whether there’s a new vessel will decide whether you need to treat them with laser or you can just observe them,” Chalasani says.
Experience has also proven Optos UWF is particularly useful for monitoring tumours or lesions around the edge of the retina, Chalasani says, and informing treatment decisions.
“It’s very helpful when you’re seeing someone every year to monitor a mole in the eye or something similar. A photo really tells 1,000 words. You can see in an instant whether it has changed in appearance when you’ve got a high quality image,” he says.
“With lesions in the periphery, seeing if they’re changed in size, and if there’s a change on the OCT through that lesion, that may well prompt you to be comfortable to continue to monitor them with conservative treatment or may prompt a referral to an ocular oncologist for further assessment. It helps alter your management, or conversely, it gives you reassurance that you can keep doing what you’re doing.”
Chalasani reserves his highest praise for the Optos Silverstone, the only ultra-widefield (UWF) retinal imaging device with integrated, UWF-guided swept-source OCT.
“That’s their top end device that we have at our Strathfield Retina Clinic. Previously, we were never able to get good OCTs through lesions or areas at the edge of the retina. Whereas the Optos Silverstone takes a photo of the whole retina and allows you to then select an area and perform an OCT through an area right at the edge. It’s good for getting a cross sectional image of lesions or tumours, which allows us to better characterise whether it might be benign or not,” he says.
Chalasani also lists the ability to acquire an image quickly, in a comfortable position for the patient, as additional attributes of the device. It’s also user-friendly, so doesn’t take a lot of effort to train staff to use it.
“It’s very patient and operator friendly, it gets you the furthest to the retinal periphery compared to other imaging options, and having OCT capability for peripheral areas is really helpful,” he says.