For Sydney paediatric ophthalmologist Dr Loren Rose, one of the greatest challenges has been thoroughly examining the retina of a young patient who is tired, restless, or just reluctant to sit still.
In this article, Dr Rose discusses how ultra-widefield retinal imaging has changed her workflow and made a difference to patient outcomes.
Dr Rose didn’t have access to a 45° retinal camera prior to acquiring an Optos ultra-widefield retinal imaging device for her practice – primarily because she was unsure she had the time to use one.
“In children to actually get a picture, it takes a bit of time, and I do a lot of paediatrics,” she explained.
“But the idea here now [that she is using Optos ultra-widefield imaging] is that I’m able to take not only a picture, but a wide angle to see the periphery of the eye.
“It’s become part of my workup for almost every paediatric patient now, because I’m able to have a better look at the back of the eye; I’m looking for signs of life-threatening disease – signs that are easily missed because of the examination difficulty.”
The images have also transformed conversations with families. “I’m able to show pathology at the very edges of the eye, which I haven’t been able to show before.”
She said the Optos’ wider view is particularly relevant in children with myopia where changes can occur in the retinal periphery long before symptoms develop.
“I’m really keen to document that, and then to follow it, and be able to explain to parents what I’m seeing and why.”
Optos ultra-widefield imaging captures more than 80% of the retina in a single image, providing a wider field of view than traditional fundus photography. The technology has been adopted across a range of ophthalmic and optometric settings because it allows clinicians to visualise pathology in areas of the retina that may otherwise be difficult to assess.
Additionally, Optos imaging can often be performed without dilation, and it captures retinal images in less than half a second, reducing waiting times and making examinations more efficient.
“When you do paediatrics and you’re dilating a lot, there’s a lot of waiting around… which means the child and the parents are here for a long time; by the time they’ve finished with me, it’s often too late for them to return to school.
“If I don’t need to dilate them… then I can actually take a picture and avoid the drops, which parents and children are very, very grateful for.
“So the Optos allows me to get all the retinal imaging pretty much at the very beginning of the consult. I’m able to get better pictures or at least pictures… because I didn’t have pictures before… it means the workflow overall is better, which is good for my clinic team, and I think families are very appreciative of saving that time as well.”
Improving Patient Communication
The images have also transformed conversations with families.
“I’m able to show pathology at the very edges of the eye, which I haven’t been able to show before. Being able to do this makes it much easier for families to understand the diagnosis and proposed treatment plan.
“I might see a patient with a little papillary atrophy or a little bit of peripheral white without pressure. That is concrete information that even though they can see okay now, the myopia is changing their eyes permanently, for the rest of their life.”
She believes the images also help families better understand why ongoing monitoring and myopia management matter.
“Discussing the images with patients has become an important part of the consult; when a 12-year-old can see the impact myopia is having on their eyes, they’re more inclined to engage. They’ll think, ‘This is actually my eyes, this is what’s happening’.”
Long-Term Implications
The implications extend beyond convenience and communication. In paediatric ophthalmology, where many conditions require monitoring over years, having objective photographic documentation provides a valuable baseline for future comparison.
“I do feel that I am now able to document healthy eyes as well as pathology,” Dr Rose said. “This is a new approach to disease management, and it makes a significant difference, especially in children, because we are monitoring them over such a long period of time.”
One case, in particular, reinforced the value of routine imaging.
“I have had a patient who has moderately high myopia. I had been monitoring them since they were quite young, but hadn’t seen them for six months. They weren’t complaining of anything, but when I saw the Optos picture, there was clearly a very peripheral hole and retinal detachment.
“It had not reached the point of symptoms. So, we had very early intervention. That patient had surgery within, I think, two days and their outcome could have been very different had we not been able to pick that up really early.”
