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    UWF: ultra-widefield imaging or ultra-widefield fighting?




    • Lids and shadows partially block the superior and inferior views. With all the dermatochalasis and blepharoptosis in my patient demographic, I often see less than the lofty 200 degrees (but still more than with a 90 D undilated or with BIO and poor dilators and uncooperative and/or photohobic patients).

    • Doesn’t replace dilated ophthalmoscopy as the standard of care. Doctors who are hyping Optos (and in some cases, charging extra) as a replacement for dilation should know (and in most cases, probably do) that they’re taking their chances medico-legally.

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    That said, if I were in a situation in which a patient either wouldn’t or couldn’t be dilated, I would strongly prefer UWF over 90 D through an undilated pupil alone. Standards of care evolve with time and technology, and we may be witnessing such an instance here, especially as optical coherence tomography is added and the color, resolution, and field of view improve over time.

    • Less resolution and color, and no stereo. At this point in time, Optos is no replacement of precorneal lens evaluation of glaucomatous optic nerve changes and macula edema and less useful for documentation of optic nerve and posterior pole disorders than traditional fundus photography.

    • High cost and spotty customer service. The pricing structure didn’t bother me because I wasn’t footing the bill, admittedly, but it can be a hurdle for many private practices. I can speak to the second one—my calls and emails to customer service have, at times, had the feeling of bureaucratic purgatory. More competition in the future should improve both problems.

    • Optos Daytona isn’t the most patient or user-friendly device. Patients often have a hard time centering themselves and “finding the green” in the fixation target to optimize the image. Also, the user doesn’t have a direct view of the retina, and it does take lots of practice to learn how to maximize image quality, especially getting those patient lids out of the way.

    Michael Brown, OD, MHS-CL, FAAO
    Dr. Brown has practiced medical optometry in a comanagement center and with the U.S. Department of Veterans Affairs Outpatient Clinic in ...


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    Optometry Times A/V