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K. Rarey, T. Friberg, A. Eller; The Optos Imaging System as an Ophthalmoscope: Fundus Assessment of Problem Eyes Where Conventional Examination Techniques Fail. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4367.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the utility of Optos P200 (Dunfermline, Scotland) imaging to evaluate the fundi of patient eyes where tiny pupils or media opacities made conventional ophthalmoscopy and biomicroscopy impossible to perform.
In a 12-month retrospective case analysis, we reviewed 8 patients [12 eyes] with extremely limited or no views to the posterior segment due to very small pupil diameters, dense nuclear cataracts, extensive posterior synechiae, or other media opacities, alone or in combination. These eyes were unable to be satisfactorily examined by standard slit lamp biomicroscopy using any standard contact or hand-held lenses lenses, or by indirect ophthalmoscopy. The examinations were attempted by two retina specialists, each with more than 25 years experience as subspecialists. The patients were then sent for imaging using the Optos P200 device and B-scan ultrasonography if no fundus images could be obtained
Of the 12 eyes that were imaged in our study, the cause of the poor view to the posterior pole included extensive posterior synechiae (3 eyes), anterior or posterior lenticular capsule fibrosis (3 eyes), pupils less than 3mm in diameter (5 eyes), and dense nuclear sclerotic cataract (3 eyes). Imaging quality was deemed adequate to make a clinically relevant assessment in all cases except 3 eyes, two of which had pupils less than 2 mm in diameter, and one that had dense vitritis. In all, Optos P200 images were clinically useful and allowed appropriate diagnoses to be made in 9/12 cases studied. Diagnoses included uveitis/parsplanitis, proliferative diabetic retinopathy, vasculoproliferative tumor, necrotizing retinitis, Vogt-Koyanagi-Harada Syndrome, and fungal endophthalmitis.
In many eyes with tiny pupils or media opacities, retinal examinations using the Optos P200 ultrawidefield imaging system can often be conducted where conventional examination techniques yield virtually no view of the retina. Such eyes would typically be deemed impossible to examine with light, and would be assessed with B scan ultrasonography only. In this setting, the Optos P200 system can be considered a specialized ophthalmoscope capable of documenting the retina findings very quickly.
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