As an eyecare professional, providing comprehensive exams is tantamount to patient care. By adding tools, such as ultra-widefield (UWF™) retinal imaging with multiple modalities, the ability to detect pathology, which may be missed with single-image modality and/or conventional narrow-field fundus photography, is a game changer.

UWF retinal imaging is performed by a specially designed scanning laser ophthalmoscope (SLO) that generates a high-resolution digital image covering 200 degrees (or about 82 percent) of the retina, in a single capture. By comparison, conventional 7 standard field (7SF) ETDRS and fundus camera photographs produce a relatively narrow view (75 degrees or less) of the retina. The SLO simultaneously scans the retina using two low-power lasers (red – 633 nm and green – 532 nm) that enable high-resolution, color imaging of retinal substructures. The resulting UWF digital image – optomap or optomap af – UWF retinal imaging utilizing fundus autofluorescence (FAF), is produced.

What is Fundus Autofluorescence?

FAF, is an imaging modality used to provide information on the health and function of the retinal pigment epithelium (RPE). Over time, the retinal photoreceptors naturally age and produce a metabolic waste known as lipofuscin. Lipofuscin is the fatty substance found in the retinal pigment epithelium. Excessive amounts can …

A recent study (Friberg, Ophthalmology Retina) evaluated morphologic and angiographic changes in the peripheral retina associated with age-related macular degeneration (AMD) using ultra-widefield (UWF™) retinal imaging.  The purpose was to illuminate the potential value of using UWF optomap^® imaging as a potential tool for detecting peripheral changes that could flag the early warning signs and/or progression of AMD.

AMD is a common eye condition that causes damage to the macula, and is a leading cause of vision loss among people age 50 and older. In some people, AMD advances so slowly that vision loss does not occur for a long time. In others, the disease progresses faster and may lead to a loss of vision in one or both eyes. AMD by itself does not lead to complete blindness, with no ability to see. However, the loss of central vision in AMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, write, or do close work, such as cooking or fixing things around the house.¹

As the disease progresses through the asymptomatic phase, it moves from Dry AMD to Wet AMD. In geographic atrophy (dry AMD), there is a gradual breakdown of the light-sensitive …

Glaucoma is a degenerative, sight-threatening disease regarded as one of the major causes of blindness, accounting for an estimated 60  million people worldwide. By the year 2020 this number is thought to increase to around 80 million people globally.¹

In a recent study², the potential use of UWF imaging to detect glaucoma, and specifically to evaluate the reproducibility of measures of vertical cup-to-disc ratio (VCDR) using UWF, and the agreement between UWF and standard color digital stereoscopy (CDS), was conducted.

The purpose of this study was to evaluate the reproducibility and validity of UWF imaging in estimating VCDR measurements.

Observational study 100 eyes from 100 consecutive patients using CDS and UWF Northern Ireland Cohort for the Longitudinal Study of Aging (NICOLA)

A factor to consider when estimating VCDRs using different ophthalmic techniques is the dimension of the image it produces. 3D v 2D, as well as image color affecting appearance for interpretation of cup depression and elevation and vessel contours. However, previous studies have reported on the value of non-stereo fundus images to evaluate disc cupping reporting no differences in diagnostic performance between monoscopic and stereoscopic images when detecting glaucoma.^3,4

All color fundus disc photographs and UWF retinal images were …

Ultra-widefield (UWF™) technology supports and enables practice efficiency for eyecare professionals across all settings¹. The integration of optomap^® technology as a routine diagnostic and screening tool has shown to improve workflow and increase service capacity within a very short time, according to many eyecare professionals. Its ease of use makes for a smooth implementation process, and clinically, optomap has been found valuable as documented in over 400 peer-reviewed papers. Further, optomap can facilitate timely referrals for clinical opinions, supporting earlier treatment interventions and promoting collaboration between a variety of healthcare professionals and eyecare professionals alike. These all equate to improved patient workflow, clinical accuracy, and timely diagnosis and treatment for patients².

Practice Efficiency in all Eye Care Settings

In an attempt to improve patient flow in his practice, optometrist David Anderson (Miamisburg Vision Care, Ohio) invested in a Daytona from Optos and, found his expectations exceeded for efficiency and as a diagnostic tool. Dr. Anderson noticed that the addition of the optomap allowed for more proficient patient service, from start to finish. Likewise, ophthalmologist, Scott Segal, MD started using optomap imaging in his practice (Pasadena Eye Associates, Texas) four years ago. Within the first two weeks, it became an integral part of his practice and had positively impacted how he practiced medicine.

For the …

As the number of patients with diabetes worldwide continues to skyrocket, Australia’s current population of 24.6 million people is not immune. In fact, 1.1 million individuals have diabetes. As diabetes increases so does the prevalence of Diabetic Retinopathy (DR) making it the leading cause of visual impairment and preventable blindness in working age people in Australia¹.

In general, most individuals are not aware how risky DR is to sight loss, therefore it is critical for them to be educated on the risks.  Even if a patient is asymptomatic, they may have early non-proliferative stages of DR which typically shows progressive vascular changes within the retina which usually occurs before any change to vision. Once disease reaches the proliferative stage, vision loss can occur rapidly and can be permanent. Key symptoms of proliferative DR include new abnormal blood vessels on the retinal surface, these new blood vessels are weak and may bleed causing retinal damage or lead to vitreous hemorrhage; this may also be associated with the formation of fibrous scar tissue and can cause retinal detachments.

optomap® ultra-widefield (UWF™) retinal imaging assists eyecare professionals detect, manage, and treat the diseases associated with diabetes. In Australia, optomap UWF imaging provides a cornerstone …

The Daytona from Optos captures 200° or 82 percent of the retina in a single ultra-widefield (UWF^™) optomap^® image in less than half a second. The built-in eye-steering technology allows non-mydriatic, visualization and imaging of all quadrants beyond the standard 200° view,¹ which can make it a valuable technology in early peripheral pathology detection, timely decision-making and, ultimately, sight preservation.

Dr. Nicole Kish has been using the Daytona in her Visionworks practice (Norman, OK) for more than a year now and has seen the value of its integration into the practice workflow protocols. With the full support of an Optos account manager, Dr. Kish has been able to incorporate her entire staff into the pre-testing process, which, in turn, reduces clinical “chair time” and increases the time spent talking with patients.² According to Dr. Kish UWF imaging has supported her ability to identify early peripheral changes in patients suspected of having undiagnosed diabetes.

The educational value of the optomap system was a big selling point for Dr. Kish. She has been able to educate large numbers of patients about their eye conditions, providing them with “…a level of education and images of their own eyes they’ve never seen.”

According to Dr. …

Diabetic eye disease is a leading cause of blindness and vision loss,¹ and, according to the World Health Organization, the incidence of diabetes worldwide is escalating.² It is estimated that by the year 2035, the number of people worldwide with diabetes will have soared to almost 600 million.³ The National Eye Institute (NEI) reports that there are another 86 million American adults who have pre-diabetes.

Diabetic eye disease describes a group of eye conditions that include diabetic retinopathy (DR), glaucoma, diabetic macular edema and cataracts. DR is often reported as the most common form of diabetic eye disease. It is a serious complication of diabetes mellitus (DM), afflicting one third of all people with the disease, and it is the leading cause of blindness among the working population in the world.⁴

In its report, “Diabetic Eye Disease Projected to Increase Among U.S. Population,” the NEI states that there are currently 7.7 million people ages 40 and older who have DR, and this number is expected to increase to around 11 million by the year 2030. With advances in technology and medicine, adequate management and regular eye examinations, sight loss associated with diabetes may be prevented in 98 percent of …

Uveitis describes a group of intra-ocular inflammatory conditions, where etiology is diverse and may be characterized by inflammation of the uveal tract or indirect inflammation of adjacent tissues¹. In his paper, A Long-Term Game Plan for Non-Infectious Uveitis, Sam S. Dahr, MD, reports that the majority of uveitis cases seen in daily practice are non-infectious and idiopathic in origin. This report estimates that the disease affects approximately 300,000 American adults and 22,000 American children. Of great concern for the young, is the lack of proper treatment in the early stages of the disease, which can be attributed to a poor visual outcome ².

Proactive and effective management of non-infectious uveitis relies heavily upon developing a therapeutic strategy and a long-term plan, which may involve systemic therapy, patient counseling, close follow-up, dosing adjustments, combination therapy, and consultation with rheumatologists. In his report, however, Sam S. Dahr, MD, suggests that imaging metrics are “…more powerful than any blood test the rheumatologist can order to monitor response”; positioning ophthalmologists to “… bear the decision-making responsibility for these patients.” Many patients with non-infectious uveitis suffer “…inflammatory breakthroughs during systemic therapy, most of which tend to be fairly mild and treatable with topical, injected or …

A survey conducted by the American Academy of Ophthalmology (AAO) highlighted a significant discrepancy between the perceived versus the actual danger of the home environment being a threat for eye injuries¹. The survey determined that fewer than half of the respondents saw the home environment as a potential site for eye injuries, and those that did cited the garden and garage as the most dangerous places. In reality, however, each year it is estimated that 50 percent of all eye injuries occur in the home and most could have been prevented if proper eye protection had been worn². Sadly, only 35 percent of people surveyed claimed to follow a practice of home eye safety by always wearing eye protection when it was needed.

Statistics show that there are several ways that people are at risk of eye injury in their homes. The AAO reported that 125,000 eye injuries occur each year due to accidents involving common household products, such as bleach and oven cleaner. Unprotected eyes are also at risk where there are things that move at high speed, such as debris from yard work, power tools or nails being hammered into hard surfaces and even champagne corks.

In the …

Athletes of all levels need to protect themselves from injury. Injuries are unfortunately a part of playing sports – anyone from weekend warriors to professionals, has probably nursed some sort of injury. In some cases, these injuries happen directly to the eye, from orbital blowout fracture, ruptured globe, or a detached retina and some can be detected, along with other types of ocular and systemic pathology, by looking at the health of the eye.

There have been, and continue to be, many studies in the area of sports-related eye trauma. And with more and more interest in the effects of concussions on athletes, seeing “inside” the eye is becoming increasingly important. An x-ray, MRI, CT scan will tell you if something is broken and may confirm a diagnosis of concussion. But what about the effects of repetitive concussive injury? Can that be detected by imaging the eye itself? According to the Centers for Disease Control, up to 3.8 million sports-related concussions occur each year. And detecting these injuries is not always straightforward or based exclusively on objective signs and symptoms. Or what about treating the whole athlete and monitoring systemic as well as ocular health?

Because the retina is the …