Non-Mydriatic Cameras: User Reviews

Physicians evaluate the performance of cameras in real-life practices.

COMPILED BY RENÉ LUTHE, SENIOR ASSOCIATE EDITOR

Non-mydriatic cameras have proven themselves valuable imaging tools for retinal analysis. In this article, I profile manufacturers’ latest offerings and share feedback I received from the doctors who use them in their daily practices.

■ Canon’s CR DGi

Product Specifications:

Angle of view: 45°

Operational distance: 45 mm from the front of the objective lens

Minimum pupil diameter: 4 mm (3.7 mm with Small Pupil Switch)

Image size: 17 mm on the sensor

Sensor resolution: 8.2 million pixels with Canon EOS 30D (resolution depends on model of attached camera) Some Canon Ophthalmic dealers offer the EOS-5D with 16.7 mp resolution

Fixation target: Dot matrix

Dimensions: 12.8" W x 19.5" L x 23.2" H

Company contact information:

Phone: (800) 970-7227

Web: www.cusa.canon.com/eye-care

Physician Review:

Setting up the Canon CR DGi from taking it out of a carrying case (when performing community performing screenings) will typically take under 10 minutes. In our group, we cross-trained our screeners so that anyone of them could perform this task after having assisted at a screening site three times. The skill level required is that of an ophthalmic assistant.

The camera is very easy to use and to train on. Most of our screeners are trained for 1 hour prior to a screening and then they take over (under supervision for three screenings). The instrument can be considered very intuitive. We do, however, use software that tracks each user so we can evaluate their performance and help with additional training when required.

The CR DGi

I have read that 45% of all patients with diabetes are not aware they have diabetic retinopathy, so the non-mydriatic digital cameras can play a very important role in patient education — there is nothing like seeing your own retinal images. It also helps improve patient compliance with a lifestyle change (diet or medication adherence). The non-mydriatic retinal camera does not require that the patient’s pupil be dilated and makes it easier for patients to be able to drive their cars after having their eyes imaged. This means non-mydriatic cameras help to dramatically increase participation in community retinal screening.

The Canon CR DGi is equipped with a 8.2 megapixel sensor as a standard (it can be up-graded to up to 17 megapixels) that produces images of extreme high definition/resolution, allowing us to magnify very small retinal details that could be otherwise missed.

The Canon CR DGi is bundled with one of Canon’s three proprietary software programs called Eye-Q (Classic, Pro and Prime). The software allows for patient-record navigation, storage, retrieval (by name, identification number, date of birth, referring doctor, diagnostic findings, etc.) as well as enhancement tools that assist doctors in looking at specific areas of the posterior pole such as the nerve fiber layer, the retinal layers and choroidal structures. Software-driven tools help in illustrating glaucoma (using the blue channel), diabetic retinopathy (using the green channel) and age related macular degeneration (in the red channels).

The instrument itself is totally manual, allowing the user full control over the camera’s imaging capabilities and possible challenges offered by the subject’s ocular condition (such as ocular media that is not clear).

Images produced by this camera are initially captured at full-spectrum resolution in a BITMAP format and then converted to a jpeg format for ease of Internet transfer, printing, archiving or transferring to back-up devices.

Reimbursement is possible on the same basis as other similar retinal imaging systems and varies slightly from state to state. As for return on investment, in a clinical setting, a non-mydriatic camera can become profitable in less than 8 months, depending on patient flow.

Bernard C. Szirth, Ph.D.

Newark, N.J.

■ Carl Zeiss Meditec’s Visucam Pro NM

Product Specifications:

Angle of view: 45° and 30°

Operational distance: 40 mm

Minimum pupil diameter: 4.0 mm, 3.3 mm (30°, SP mode)

Pixel size: 3.4 x 3.4

Sensor size: 11 mm

Sensor resolution: Scientific/medical grade ZK-5

Fixation target: external internal Optional Programmed sequences or freely positionable, size selectable

Dimensions: Basic system: 16.1" W x 18.9" L x 26.4" H,

Monitor: 15.7" W x 15.7" L x 3.9" H

Company contact information:

Phone: (800) 342-9821

Web: www.meditec.zeiss.com

Physician Review:

The Zeiss Visucam Pro sets up easily and captures high-quality images of the retina and optic nerve in minutes. After an initial half hour in-depth training session, our staff quickly adopted this technology. We have seen no resistance to using this technology as is often times the case with integrating new technologies among the staff. We have built it seamlessly into the patient-flow process.

The adage "a picture is worth a thousand words" could not be truer. As much as you try to explain glaucoma to patients, there is nothing more compelling to them than seeing their disc photos. This helps them to understand the disease process and increases their compliance with treatment.

The Visucam Pro NM

We have done hundreds of photos since recently acquiring this unit. As part of our glaucoma management protocol, all glaucoma patients are receiving disc photos. Sometimes I will draw the extent of cupping right over the color printout that is in the chart. This is far superior to a hand-drawn disc, and it is much easier to retrieve than 35 mm slides attached to the back of the chart. As any glaucoma specialist will tell you, at the end of the day, when all of the fancy nerve fiber layer analysis has been performed, nothing is more helpful then good quality disc photos to determine progression and make clinical decisions in the treatment of glaucoma.

Kevin T. Lavery, M.D.

Battle Creek, Mich.

■ Kowa’s Nonmyd a-D 5 Mega

Product Specifications:

Angle of view: 45° and 20°

Operational distance: 30 mm

Minimum pupil diameter: 3.7 mm

Image size: 7.5 MB (uncompressed)

Sensor resolution: CCD 5.0 megapixels

Fixation target: Internal fixation target is a multiple-position green point used for alignment

Dimensions: Basic system: 15.7" W x 20.5" L x 29.1" H

Company contact information:

Phone: (800) 966-5692

Web: www.kowa-usa.com

The Nonmyd a-D 5 Mega

Physician Review:

The Kowa rep installs the camera for you, and then the unit is ready to use simply by turning on the workstation and the camera. The camera is very easy to use and provides good documentation to help the novice. Because the photos are instantly available for review, there is a very short learning curve. The ability to review photographs directly, enlarged on a LCD monitor or 8"x10" color photos is very impressive to patients. The adage "a picture is worth a thousand words" holds true when it comes to patient education.

The camera produces very high quality images that do not degrade when expanded to fill a 20" LCD monitor. The photo database is accessible via the Kowa work station software. Photos can be queried by patient name, patient number, date of photo, etc. This makes it easy to organize photos by date and view them as necessary. The work station software also allows the user to easily send photos via e-mail or to export to jpg files directly to the computer. Photos obtained by the camera may be reimbursed by the CPT codes for fundus photography and external photography; the exact reimbursement varies by region. I found that return on investment is very quick by virtue of the efficiencies gained using a digital system. There is less time used in sorting, processing and filing pictures, now that it is all done electronically.

Gary Keoleian, M.D.

Bloomfield, Mich.

■ Nidek’s NM 200D Portable

Product Specifications:

Angle of view: 30°

Operational distance: 8 mm

Minimum pupil diameter: 4 mm

Image size: Not available at press time

Sensor resolution: CCD 1.5 megapixels

Focusing method: Focus chart (Ring mark)

Dimensions: 16.7" w x 8.6" l x 15.2" h

Company contact information:

Phone: (800) 223-9044

Web: www.usa.nidek.com

The NM 200D

■ Topcon’s TRC-NW6S

Product specifications:

Angle of view: 45° and 30°

Operation distance: 42 mm

Minimum pupil diameter: 4 mm at 45°; 3.7 mm at 30°

Image size: 3872 pixels x 2592 pixels

Sensor resolution: CCD 10.1 megapixels

Fixation target: Internal fixation target, 9 fixed points, or external target

Dimensions: 12" W x 22.3" L x 23.9" H

Company contct information:

Phone: (800) 223-1130

Web: www.topconmedical.com

The TRC-NW6S

Physician Review:

A company rep comes for the initial set up. Then, you just turn on the camera and the computer, and you are ready to go. Tech training only took approximately 15 minutes. The TRCNW6S produces excellent images that are very helpful with patients because now they can actually see the problem they have. The camera can group photos by diagnosis and allows you to compare old vs. new photos side by side. It also allows you to highlight and enlarge photos and also offers transferability of images. Medicare provides reimbursement; I got a return on my investment in this camera within 6 months. OM

David Liebergall, M.D.

Suffern, N.Y.