THE IMPORTANCE OF RETINAL IMAGING

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Marco’s AFC-330 is designed to increase practice efficiency and patient comfort.
The ClearPath DS-120 from Freedom Meditech is a non-invasive, fluorescence biomicroscope.

Treating patients affected by early diabetic retinopathy is critical.

Listing the statistics on diabetic retinopathy is enough to scare a person. According to the Centers for Disease Control (CDC), there are 18.8 million people diagnosed with diabetes and approximately seven million undiagnosed. Eighty percent of blindness in those aged 20 to 74 is related to this disease. But what’s even more frightening: The American Optometric Association’s (AOA) estimate that 26% of type 1 diabetics and 36% of type 2 diabetics have never had an eye exam.

Here’s another eye-opening statistic: Early referral and treatment of diabetic retinopathy reduces the risk of severe vision loss by 50%-60%. Certainly, a comprehensive eye exam which includes evaluation of the fundus through a dilated pupil is key. But so, too, is, retinal imaging. The follow instruments can help you help your patients get to the root of the problem sooner rather than later.

RETINAL CAMERAS
Marco’s non-mydriatic 12 megapixel (MP) AFC-330 retinal camera captures single 45° fields, stereo pairs, and multi-field panoramics fully automatically. The AFC-330 also self-adjusts settings for acquiring anterior segment images. The speed and automation remove variability between operators, while the low flash intensity, quiet shutter sound, automatic small pupil mode, and AutoBlink detection increase practice efficiency and patient comfort.

The DRS (Digital Retinography System) by CenterVue is an affordable, compact, 5MP non-mydriatic camera that requires minimal operator training due to its fully automated system including patient autosensing, autoalignment, autofocus, autoflash adjustment, and autocapture. The DRS can obtain single and seven-field images, in full color and red-free, and is capable of stereo and external imaging. It is a user-friendly camera that can connect to any computer network.

With Canon’s CR-2 PLUS AF Digital Non-Mydriatic Retinal Camera, users can switch between auto and manual focusing for ultimate control and ease-of-use with the press of a button. The new Autocapture function determines the appropriate moment to capture an image by analyzing when exposure and alignment are ideal. The CR-2 Plus AF also features Fundus Autofluorescence (FAF) that can help doctors assess and predict both the direction and the rate of future vision loss.

OCT
The Carl Zeiss Cirrus HD-OCT 5000 is likely the most familiar name in OCT (Optical Coherence Tomography) . The latest 5000 model includes advancements such as FastTrac (which reduces eye motion artifact), Advanced RPE Analysis, and Ganglion Cell Analysis. The Cirrus photo 800 incorporates OCT, color, and fundus autofluorescence imaging, and fluorescein and ICG angiography. The Cirrus photo 600 may be better suited for comprehensive eyecare practices, combining the OCT with a non-mydriatic fundus camera and optional fundus autofluorescence imaging.

Optovue’s iVue and RTVue are both OCT options. The iVue is a spectral domain OCT with 3D and en-face imaging as well as retinal change and OU analysis all offered in a portable and small footprint package. The iVue also has cornea, pachymetry, and angle visualization capabilities. The iFusion combines the iVue with the iCam, a 5.2MP non-mydriatic LED camera, for a complete retinal imaging system.

The RTVue is also a spectral domain OCT/non-mydriatic fundus camera combination. In addition to macular and glaucoma analysis, RTVue is capable of mapping both the anterior and posterior cornea along with angle measurements. There are two retinal OCT image modes: vitreoretinal and chorioretinal; both are equipped with vTRAC eye tracking.

Optovue recently debuted the Avanti, what the company calls “the next generation diagnostic device.” According to press material, Avanti provides an all-in-one solution for posterior and anterior high-speed, high-resolution OCT imaging offering 70,000 A-scans per second, Widefield 3D motion correction and 3 micron digital resolution (sampling).

Topcon’s 3D OCT-2000 combines a spectral domain OCT with a 12.3MP non-mydriatic fundus camera in a compact design. Features include the FastMap software that provides simultaneous viewing of the fundus image and 2D and 3D OCT data while reducing artifacts caused by eye movements and Legacy Data Compatibility, which allows historic data from the 3D OCT-1000 and the Stratus OCT to be imported and analyzed. Topcon’s Synergyâ„¢ Image Management System offers accessibility of images across multiple devices.

“¢The Spectralis from Heidelberg Engineering offers a wide variety of spectral domain/confocal scanning laser ophthalmoscopy integrated systems in an upgradeable platform: standard OCT, OCT Plus, with BluePeak, with HRA (Heidelberg Retinal Angiograph), and with FA (fluorescein angiography). The Spectralis features many proprietary imaging capabilities such as TruTrack (active eye tracking), BluePeak blue laser autofluorescence (images lipofuscin without dye), Heidelberg Noise Reduction (enhances image detail), AutoRescan (automatically places follow-up scans in precisely the same location, bypassing operator variability), and FoDi (fovea-to-disc alignment).

OTHER TECHNOLOGY
The Optomap 200Dx and Optomap Daytona from Optos deliver non-mydriatic ultra-widefield scanning laser digital retinal imaging. The 200° images are captured in under a second through as small as 2mm. Green and red channels offer anterior to and posterior to RPE separation views, respectively. The 200Dx has features such as comparison image overlay and auto review, 3D Wrap functionality, and export tool. The Daytona is a desktop model with an 18-in. x 20-in. footprint, and in addition to the capabilities of its predecessors, it is capable of autofluorescence capture as well as a resolution of 14 microns.

•Recently FDA approved in January 2013, Freedom Meditech’s ClearPath DS-120 is a non-invasive bio-photonic lens fluorescence biomicroscope designed to quickly detect autofluorescence of the crystalline lens. Industry studies have shown “elevated autofluorescence measurements have been linked to high levels of advanced glycosylated end products which accumulate as a result of the aging process and the presence of systemic disease,” such as diabetes. Testing is quick (within six seconds), with reliable results.

The OcuMet Beacon (OcuSciences) is currently being evaluated in clinical trials for the early diagnosis of diabetic eye disease and rapid assessment of therapeutic efficacy. This instrument utilizes a patented, non-invasive ocular imaging technique called Retinal Metabolic Analysis (RMA) to detect a functional biomarker called flavoprotein fluorescence. This particular autofluorescence occurs when there is metabolic stress and does not require the use of injected dye in order to visualize the target biomarker.

The bottom line: Retinal imaging makes a difference, and is an effective tool to screen for patients affected by early diabetic retinopathy before functional vision loss occurs.

San-San Cooley practices at Eye Care Professionals in Powell, OH.

WHERE TO FIND IT:
Canon Medical Systems •A Division of Canon U.S.A., Inc. •800-970-7227 •usa.canon.com/eye-care Carl Zeiss Meditec, Inc. •800-342-9821 •meditec.zeiss.com/usa CenterVue •408-988-8404 •centervue.com Freedom Meditech •858-638-14337 •freedom-meditech.com Heidelberg Engineering, Inc. •800-931-2230 •
heidelbergengineering.com
Marco •800-874-5274 •marco.com OcuSciences •734-205-5854 •ocusciences.com Optos •866-OPTOMAP •optos.com Optovue Inc. •866-344-8948 •optovue.com Topcon Medical Systems, Inc. •800-223-1130 “¢
topconmedical.com

 

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