In case studies, peer-reviewed papers, and a growing body of real-world practice, the ocular health community is improving patient management with the wider use of ultra-widefield (UWF™) imaging. Like all diagnostic breakthroughs, adoption of UWF imaging has been a long term process, paced by the accumulation of validated clinical experience. But now, more than a decade after UWF imaging was first introduced, the evidence is overwhelming that UWF imaging may have the potential to improve the diagnosis and management of a significant group of ocular diseases and conditions.

UWF imaging technology captures a 200-degree image of the retina – which enables ocular health practitioners to capture peripheral retinal images that can not be captured with conventional imaging methods. Starting with color (red and green) optomap imaging, Optos has systematically extended its UWF-based technology into a multi-modal platform that supports fundus autofluorescence (optomap af), fluorescein angiography (optomap fa) and indocyanine green angiography (optomap icg).

Where does UWF imaging have potential to improve diagnosis and treatment?

Proliferative Sickle Cell Retinopathy (PSR)

In a first of its kind case study¹, researchers used multi-mode UWF imaging to examine the vascular changes associated with PSR, a complication of sickle cell disease that impacts the retinal …

Recent research suggests that patients suffering from various systemic disorders may have their disease state impacted by the addition of ultra-widefield (UWF™) retinal imaging to their examination.  New research has found that patients with sickle cell disease may benefit from UWF retinal imaging for the diagnosis and management of sickle cell retinopathy (SCR).

Background

Sickle cell disease is an inherited disorder in which the body produces blood cells with abnormally formed hemoglobin. Symptoms include anemia, severe and chronic pain, infection, hypertension, hand and foot swelling, leg ulcers, and retinal vascular changes¹. Sickle cell disease can also have an impact on vision. Sickle cell retinopathy mainly affects the peripheral retinal vasculature² as the result of abnormal, sickle-shaped blood cells becoming trapped in the small blood vessels of the eye³. Non-proliferative SCR, characterized by retinal hemorrhage from superficial blood vessels, can cause loss of visual acuity. Proliferative SCR is marked by vascular occlusions that lead to localized ischemia, neovascularization, and in later stages blindness from vitreous hemorrhage or tractional retinal detachment. Patients with sickle cell disease are at varying degrees of risk of developing SCR, but those with the type SC or S-Thal hemoglobin genotypes are at significant risk for developing …

Over the past decade Optos has expanded the capability of its core ultra-widefield fundus imaging technology, and with that has come a widening number of clinical applications.

Ultra-widefield (UWF™) imaging technology – enabling the capture of a 200-degree view of the retina without dilation – gives ocular health practitioners imagery and diagnostic information that can’t be provided by conventional imaging methods. Starting with color (red and green) optomap imaging, Optos has systematically extended its UWF-based technology into a multi-modal platform that supports fundus autofluorescence (optomap af), fluorescein angiography (optomap fa) and indocyanine green angiography (optomap icg).

Optos has also been incorporating the latest developments in image processing, providing users with important diagnostic and treatment management tools. In its latest software release, Optos has incorporated an advanced, proven stereographic projection algorithm that corrects for peripheral image variations that occur when a spherical image is flattened.

Clinical Applications

While the most common use of UWF technology may be in the diagnosis and treatment of diabetic retinopathy (DR), optomap imaging is also being used for characterizing pediatric retinal disease; age-related macular degeneration (AMD); retinal breaks and tears; uveitis, ocular oncology; central serous chorioretinopathy (CSCR); retinal vein occlusion (RVO); and a growing list of other …

Why did Prevent Blindness, a national organization dedicated to advocacy for healthy vision, choose August as Children’s Eye Health and Safety Month? The three-word answer — back to school. Common eye conditions such as astigmatism, hyperopia (farsightedness), and myopia (nearsightedness), can compromise a child’s ability to read, comprehend classroom materials, and participate in games and sports. Over time, this can result in poor performance in school and social difficulties. What are the numbers? Studies report that nine percent of children ages 5 to 17 are affected by myopia; 13 percent are affected with hyperopia; and more than 15 percent with astigmatism. With statistics like these, August is an ideal time to schedule annual eye exams as part of every back-to-school checklist.

But annual eye exams aren’t just for the back-to-school crowd. Children under the age of six can also have vision difficulties. This is of particular concern, as undiagnosed vision difficulties in younger children can lead to developmental delays, affecting visual-motor and even cognitive functions. Along with the astigmatism, myopia and hyperopia, children 6 and under are also at risk for amblyopia, or “lazy eye.” Affecting 2 percent of children aged 6 to 72 months, if untreated, amblyopia can lead to permanent …

As medical communities around the globe work to make the transition from treating sickness to preventing it, it’s still not the norm for healthy, asymptotic individuals to receive routine screening exams.

Ocular health is no exception. How often do adults with 20/20 vision and no eye-related symptoms schedule themselves for an optometric exam? That’s especially of concern considering that a number of ocular diseases such as, diabetic retinopathy (DR)¹, open angle glaucoma², age-related macular degeneration (AMD)³, and degenerative retinoschisis⁴, may not present any symptoms during their initial phases. Early detection of these diseases can have a significant impact on courses of treatment and the probability of positive outcomes.

One illustration of how UWF™ (ultra-widefield) imaging can improve the early detection of eye disease are the results of what amounts to an inadvertent experiment in the screening of healthy individuals. Training for Optos users and new Optos technical employees involves hands-on familiarization and instruction on UWF imaging systems. Part of that involves trainees taking color optomap images of themselves.  These training exercises sometimes yield unexpected results:

— Chad, who joined Optos in 2013, is a single parent and at the time of his hire had no history of eye problems. Prior to coming to Optos his full schedule and absence …

The widening use of ultra-widefield (UWF^™) retinal imaging by ocular health practitioners is prompting researchers to address what appears to be a straightforward question: What’s normal? That is, now that UWF imaging is providing a more complete visualization of the peripheral retina, what is the physical extent of healthy retinal vasculature?

It’s not an academic question. On one level, baseline information about the extent and appearance of healthy retinal vasculature is an essential part of clinical practice. But more important, as practitioners use UWF to measure the extent of retinal pathology – for example, in estimating areas of ischemia in patients with diabetic retinopathy (DR) or retinal vein occlusion (RVO) – it’s critical to measure the portion of the retina that is affected. These estimates need to start with accepted measurements for normal, healthy retinal vasculature, one derived from statistically significant population studies and adjusted for any variations in age, sex, or other characteristics.

New research is giving first indications of the extent of healthy retinal vasculature as well as important population variations. This work is being enabled by recent advances in UWF image processing which allow optomap^® fa (fluorescein angiography) images to be corrected for peripheral distortion. These new processing algorithms – a part of Optos ProView^™ imaging software – create …

A recent report describes a unique, high-value application of ultra-widefield (UWF^™) retinal imaging in the treatment of Diabetic Macular Edema, or DME.

There are over 400 million people¹ worldwide afflicted with diabetes and the long-term incidence of DME in this population is estimated at twenty to forty percent². UWF imaging is already impacting the diagnosis and treatment of DME as well as Diabetic Retinopathy (DR), which frequently precedes or is associated with DME. Ultra-widefield imaging is unique in that it visualizes a much larger area of the retina (200°, or over 80%) as compared to conventional techniques that may image 45° or less of the retina. By imaging the peripheral retina practitioners and researchers have shown they can more accurately measure the extent of diabetic retinopathy³ as well as better predict the risk of future progression⁴. UWF is also helping public health initiatives by enabling accurate and cost-effective screening for DR⁵.

This novel application of UWF imaging supports a relatively new therapy for DME.  While the standards for DME treatment are undergoing intense study⁶, corticosteroids are often prescribed if anti-VEGF medications fail to control the chronic inflammation associated with DME. These corticosteroids are administered by direct injection into the eye, a …

At Optos, delivering breakthroughs in pediatric ocular health is a driving vision. Douglas Anderson founded Optos in 1992 with the express goal of developing an imaging technology that could provide early diagnosis of the kind of retinal detachment that ultimately caused his five-year old son, Leif to lose vision in one of his eyes.

Now, almost a quarter-century later, UWF™ (ultra-widefield imaging) technology developed by Optos is transforming the way optometrists and ophthalmologists care for their patients. UWF imaging enables faster, more comprehensive routine exams, increases the cost/effectiveness of telehealth programs, improves the scope and accuracy of screening for diabetes and other eye disease, and makes possible new approaches to managing and tracking treatment.  And, if you’re a pediatric ophthalmologist, UWF imaging is making possible new, better approaches to diagnosis and treatment.

Practitioners treating infants with ROP (retinopathy of prematurity) report¹ that UWF imaging delivers clinically useful, high-quality post-treatment images while overcoming some of the problematic aspects of traditional imaging technology.  The authors observed that a major advantage of ultra-widefield technology is that images can be obtained without placing the diagnostic instrument in direct contact with the infant’s eyes. This eliminates a potential source of post-operative infections. Non-contact UWF imaging — which is generally faster than traditional digital imaging — also …

One of the questions ocular health practitioners ask about Ultra-widefield retinal imaging (UWF™) is about optomap acceptance rates. Will patients really be interested in a new and possibly unfamiliar diagnostic procedure that’s not covered by insurance? It’s the right question, because even a proven technique such as UWF is of limited clinical value if patients are reluctant to authorize the procedure.

Many doctors using UWF imaging report high optomap acceptance rates, leading to improved patient experience, better patient flow, and faster recovery of initial system costs. They’ve accomplished this by engaging their patients on a number of levels.

Explaining the Benefits

One common practice among doctors reporting high acceptance rates is that they take the time to explain to their patients the real medical benefits from incorporating an optomap into their annual examination. While comfort and convenience are also patient considerations, having an engaged and properly trained staff that can explain the medical benefits before, during, and after the exam is more impactful. As one doctor said:

“Explaining the tests you are performing, including high-level testing like optomap, that come with an out-of-pocket expense, need not add significant time to pre-testing. For that small amount of time and effort, …

As the longer, sunny days of summer approach, many people pull a pair of beat-up, dusty sunglasses out of the side pocket of their car door and start wearing them while driving or spending time outdoors. The problem? If you think you’re doing everything you can to protect your eyes from harmful UV rays, you may be making a big mistake.

UV Rays – A Year-round Fact of Life

Most people have heard or read that long-term exposure to ultraviolet (UV) rays increases the risk of developing a variety of eye-related health problems. Cancer and benign growths on the eye (pterygium, also known as surfer’s eye or farmer’s eye) is associated with increased UV exposure, but of bigger concern are cataracts, which are found in 30 percent of those aged 70 to 74 years of age, and in more than 50 percent of those over 80. UV radiation is known to contribute to the protein breakdown that helps cause cataracts and impaired vision.

But less well understood is the fact that we’re exposed to UV radiation all year-long.

— The two types of UV radiation that present health risks are UV-A and UV-B. They are part of …