Article Date: 6/1/2001

Instrumental Stategies
A Wider Field of View
See what this nonmydriatic ophthalmoscope has to offer.
By Philip Buscemi, O.D.

Like rough-hewn cloth, the texture of life is imparted by the interwoven fibers of experience and fate. When I was in high school, I met a vision at a party. After talking to her for a while and obtaining the all-important phone number, I started walking toward the front door.

When I woke up, I was blind in my left eye from what I later found out was a hyphema. A large brass belt buckle wielded at high velocity by a previously jilted suitor had bushwhacked me. The loser became a big time basketball coach who's known in these parts for attempting to attack an older coach on the sideline. He doesn't get Christmas cards from me, but the experience influenced my life.

Eye opener

I eventually recovered my vision and attended optometry school, where I became aware of the complete lack of adequate care that I'd received that night and the subsequent days. (I'd been simply sent home by the emergency room doctor -- no dilation, no slit lamp, no indirect, no consult and no follow-up.)

I recently got a demonstration of Optos's Panoramic 200 Non-Mydriatic Ophthalmoscope at the past Association for Research in Vision and Ophthalmology (ARVO) meeting, and I was reminded of that time.

First, the basics

Note the defect at 3 o'clock on Dr. Buscemi's left eye, as shown by the Panoramic 200.

The Panoramic 200 is a new development in scanning laser ophthalmoscope technology. It's capable of capturing an image of the retina that covers approximately 200 degrees. By scanning the retina using a slit of red and green laser light, the instrument compiles a digital image one line at a time. The view is really breathtaking. The Optomap is a color image you get from the Panoramic 200. It gives you an unparalleled feel for what you're seeing. As a clinician, I could instantly find defects. Including the one in my left retina that was deposited by that hunk of brass many years ago.

Studies performed by the Optometry Service at the New England Eye Center scientifically endorsed my subjective observations. One hundred fifty patients were given an Optomap exam prior to dilation and subsequent clinical examination. Two optometrists who were masked to patient history and symptoms reviewed the Optomaps. When the overall sensitivity (true positives divided by true positives and false negatives) to pathologies was calculated, the Panoramic 200 showed a superior 74.09 in comparison to a 64.55 for traditional methods employing dilation. The study also showed that the Panoramic 200 was significantly better than undilated manual exams for detecting retinal abnormalities.

Benefits for your office

What does this mean to you in practice? It means that at least for retinal disease, you don't need to dilate to make accurate diagnoses. That can mean significantly reducing chair time. Typically, dilating a patient is a five-step process that takes 1 hour and 40 minutes from the time the patient enters your office until he walks out. An Optomap is a two-step process that takes 25 minutes, and the patient leaves driving.

The Panoramic 200 should enable you to see more patients, increase revenue, provide better documentation and increase patient satisfaction, generating internal marketing benefits.

You can manipulate the 4-mega-pixel image in several ways. The red portion of the image highlights defects from the pigment epithelium to choroid. The green portion makes defects from the sensory retina to pigment epithelium stand out. These images are displayed in gray scale monochrome. Save them in a condensed format and e-mail them to the retinal specialist when you aren't sure of the diagnosis or when you're making a referral.

Points to consider

The unit is wheelchair accessible, but it's not small and will best fit in a corner. From a patient's standpoint, you simply move your head around until you see a green fixation target in a red ring. This might be problematic in older patients, especially those with significant age-related macular degeneration, or in younger patients who have trouble complying. But there is a built-in alignment camera that allows the technician to move the patient into position.

The Panoramic 200 ophthalmoscope.

I couldn't independently verify the claims with regard to timesavings over dilation, but intuitively, they seem reasonable. Without a doubt, patients would be more comfortable with a nonmydriatic exam than with a dilated exam.

To my knowledge, Optos doesn't offer in-office demos, but you can get a great idea of the capabilities of the instrument by having someone at a trade show perform an exam like I did. Take a look at for more information.

Opportunity knocked

The fabric of my life is once again taking on a new feel. Call it being middle-aged crazy, or just trying to meet new challenges and stretch myself personally, but on April 1st, I accepted the position of Vice President and General Manager of Nidek Technologies America (NTA), which is a new high technology company being formed by Nidek.

Heartfelt appreciation

There are so many people to thank at Optometric Management, but first on my list is Karen Rodemich, my column editor. She's put up with all of my traveling and has still done a great job editing my work and getting the column out in a timely manner. Larisa Hubbs played this role earlier in my career, but she's since moved up the ladder at OM. She has been a great guide and mentor in helping me development my skills as a writer.

Thanks to Art Epstein, O.D., for the initial opportunity, the encouragement and the friendship. And most of all, thanks to my readers. I can't tell you how great it's been getting your e-mails and comments and meeting many of you at shows and seminars.

One of my biggest regrets is not having the opportunity to work with the new team at OM -- Neil Gailmard, O.D., M.B.A., F.A.A.O., is an extremely talented O.D. who really knows the business of optometry. He's going to bring a whole new practicality to this journal.

Time to go

You can't imagine what a pleasure it has been to work with all of the people at OM over the years. Readers, this is truly a quality group of individuals with a high amount of integrity who have your best interests at heart.

I have to tell you -- it's very tough ending this. As I sit at the keyboard, I want to keep writing, but I hear Roy Rogers in the back of my mind singing, "Happy trails to you, until we meet again . . . ."

The cloth of life can sometimes feel like burlap -- strong, but coarse. Goodbye everybody! 

Dr. Buscemi has no financial interest in Optos's products He's vice president and general manager of Nidek Technologies America.

Optometric Management, Issue: June 2001