Spotlight ON TECHNOLOGY & TECHNIQUE

Optos' Technology Delivers Ultra-Widefield Views

By Leslie Goldberg, Associate Editor

The P200 Series (Optos, Marlborough, Mass.) series of scanning laser ophthalmoscopes delivers both ultra-widefield and ultra-high-resolution images, known as Optomap retinal images, to facilitate disease detection, management and clinical analysis. These images can cover up to 200° or approximately 82% of the retina in a single capture.

Features

Optos' P200 technology platforms incorporate multiple low-powered, coherent laser wavelengths that scan simultaneously. The devices use a red 633nm laser and a green 532nm laser to image the choroid and retina. In the P200MA, a blue 488 laser allows for the addition of fluorescein angiography.

Once the Optomap images are captured, practitioners use the proprietary Vantage software platform for evaluating and manipulating images. Adjustments to magnification, contrast and brightness enable clinicians to enhance areas of interest and highlight fine details of the individual laser separations. In addition, measurements, annotations, clinical notes and diagnostic codes may be added to, and saved with, the scans. The software also facilitates communication with colleagues and third parties by allowing Optomap images to be imported, exported and emailed.

The P200

"The P200 is a widefield retinal imaging system that is designed to work without dilation," says Uday Devgan, M.D., F.A.C.S., partner at the Maloney Vision Institute in Los Angeles. "In a fraction of a second (about 0.25 seconds), it takes a wide-field, high-resolution photo of the retina, even through small pupils. The extent of the retinal view, without dilation, is more than I could achieve using slit-lamp biomicroscopy or direct ophthalmoloscopy."

Additionally, Dr. Devgan says that he gets an instant digital image that can be saved in a patient chart for future reference and comparison. He says that patients appreciate the efficiency, the ability to examine the retina without dilation and the high-tech nature of the P200.

"The P200 is particularly useful for cataract and refractive surgeons to ensure that the posterior segment of the eye is normal prior to proceeding with anterior-segment surgery," says Dr. Devgan. "Retinal pathology can be detected and documented prior to cataract surgery. For example, presence of macular abnormalities may preclude a patient from achieving good quality vision with a premium multifocal IOL. Knowing this ahead of time steers IOL selection towards monofocal or accommodating IOLs instead."

The P200C

Donald Digby, M.D., of Digby Eye Associates in Greensboro, N.C., is a P200C user. "The P200C has a higher resolution than earlier versions of the device and corrects the elliptical appearance of the previous version. The optic nerve now looks as the optic nerve should. You have the ability to measure the optic nerve and determine whether it is a large or small nerve and you can look at both optic nerves simultaneously on the screen side-by-side."

Dr. Digby says the P200C has a feature that allows users to measure the ISNT Rule and look at the rest of the fundus to see if there is something going on right out to the retinal periphery that might be affecting the optic nerve. Without this wider view, users might receive false information, leading them to think that they are looking at glaucoma, when they're not.

Additionally, says Dr. Digby, you can flip between a color image and a red-free image with a push of the button. "Because it has two different layers, if you want to look and see if something is in the choroid or if it's in the retina, it's another push of a button and it will give you a better look at the choroid for choroidal nevi versus a look at the retina," he says.

"It's a useful device for diagnosis and unbeatable for patient education. When I walk in the room, the staff has the images pulled up and I review them with the patients," says Dr. Digby. "The ResMax feature provides excellent resolution in the macula. You can see if the patient has early drusen, early RPE dropout or anything that looks like an epiretinal membrane pretty readily."

Dr. Digby explains that when you are looking for raking or nerve fiber layer dropout, it is much easier to see with the P200C because of the wider view. "If you find an area of concern, you can toggle between color and red-free again. For example, if you are looking at glaucoma, it gives you a good view of nerve fiber defects and retinal or disc hemorrhages. Again, you can toggle from red-free to color, and in red-free, the hemorrages stand out as black and stick out like a sore thumb. Lastly, it is wonderful for detecting diabetic retinopathy (DR). With this device, what we found is that DR doesn't start in the posterior pole, but in the periphery. This helps in earlier diagnosis of DR."

The P200MA

Mathew W. MacCumber, M.D., Ph.D., associate professor, Department of Ophthalmology, Rush University Medical Center, Chicago, says that the ability to view the peripheral retina with the Optomap for color photography or angiography is likely the most beneficial feature for doctors and patients because additional peripheral sweep images are not required. "Patients seem to prefer the Optomap compared with conventional fundus photography for comfort and ease of use," says Dr. MacCumber.

Dr. MacCumber finds the P200MA most useful for patients with diabetic retinopathy or retinal vein occlusion because he can get a better sense of the degree of peripheral pathology. "Laser treatment can be delivered more precisely and we can better assess laser and pharmacologic treatment response. Macular views are adequate for focal treatments as well," Dr. MacCumber concludes. OM

For more information on Optos' scanning laser ophthalmoscopes, visit the company's Web site at www.optos.com.