Recent Posts
Connect with:
Monday / July 15.
HomemicontactBroaden Your Horizons

Broaden Your Horizons

Rapidly evolving technology presents new opportunities to detect, diagnose, and manage eye disease. It’s well worth the investment.

I’m often asked by optometrists wanting to upgrade an existing practice or those opening a new one, what the ‘dream list’ of equipment should be and whether or not it’s financially sensible.

From experience, a well-planned and executed investment in technology will expand your clinic’s scope of practice, bringing immediate returns and increasing the business’ overall value. This may also add value if you consider selling the practice in the future

We are light years ahead of where we were 100 years ago, or even just last century

The lease cost of any equipment purchased should be covered by additional fees earned for performing the specialised testing it facilitates. Of course, in Australia, Medicare throws a spanner into such calculations but in New Zealand and many other countries, practitioners are not so constrained. This calculation can also be made more complex given the major chains’ propensity to offer testing with sophisticated diagnostic equipment at ‘no additional charge’.

As well as money earning technology, there will of course always be pieces of equipment we ideally want/need which do not generate additional, billable fees. In terms of financing, we just have to suck that up and decide whether or not it’s viable and justifiable.


A few years back I wrote that Optical Coherence Tomography (OCT) and ultrawidefield (UWF) retinal imaging were fast becoming the standard of care. To stay ahead of the game, one would have to add this type of unfortunately rather expensive equipment to the wish list. I also mentioned I’d heard that we were not too many years away from seeing the integration of such equipment into one stand alone machine with a much smaller footprint. For those who’d not yet taken the plunge, I suggested it may be worth waiting for such developments.

I’m pleased to say we are there, with the recent announcement by Optos (now part of Nikon Corporation) that they’ve launched their all in one integrated UWF imaging and OCT machine called Monaco. Optos’ Monaco delivers a non-mydriatic, 200° single capture UWF retinal image in under half a second, with four imaging pathways (composite colour, green laser, red laser, and autofluorescence). The spectral domain OCT provides cross-sectional 40° views of retinal structures at 70,000 scans per second and reasonable resolution.

Significantly, we can replace a standard retinal camera, an UWF device, an OCT, three computers, chairs and tables with this one device that sits comfortably on an instrument stand, saving considerable space and dollars.

If I were still in practice I’d be badgering my partners to order a Monaco today!


Alas the Monaco device doesn’t have the capacity for anterior segment OCT imaging. That makes an anterior segment OCT/imaging device seem like another ‘must have’ item. Whether for scleral lens fitting, anterior segment management, or imaging of the angle/chamber depth, there are various devices available, but could this mean duplication?

Other instruments that can also aid scleral lens fitting by imaging beyond the limbus include the likes of the Eye Surface Profiler, sMap3D and Pentacam with cornea scleral profile. Pentacam, with its slit-scanning technology and Scheimpflug camera, means you have anterior segment imaging as well as more traditional corneal topography while imaging the sclera to 18mm. It’s a good all-round consideration and another instrument that can replace three others. It would be nice if it also offered all the tricks of the Keratograph 5 (for assessing the tear film and meibomian glands) but again, we can’t have everything, (yet).

We are light years ahead of where we were 100 years ago, or even just last century.

Levels of detection, diagnosis and management, so recently unheard of, are now possible.

Who knows what other exciting developments lie ahead.