Article

DIAGNOSTIC FOCUS

A WIDE VIEW

Imaging platform provides ultra-widefield and OCT images

In this Focus column, the author answers questions about a new diagnostic device, based on his firsthand experience.

Can you describe what makes the Monaco UWF OCT unique?

Monaco (Optos) marries two standard-of-care technologies — ultra-widefield retinal imaging (UWF) and OCT — into one instrument. It combines widefield (40°) central pole SD-OCT with optomap UWF (200°) color and autofluorescence (AF) fundus imaging.

UWF color image of a patient with geographic atrophy demonstrating drusen.
Image courtesy of Optos

How does it work?

The Monaco uses confocal scanning laser ophthalmoscope (cSLO) technology for imaging and an ellipsoidal mirror to expand the field of view.

What procedure does your practice follow to use the technology?

We use the pre-programmed option to take sequential color, AF and OCT images of both eyes in 90 seconds. We incorporate the “image everyone” philosophy at our practice. Comprehensive eye exams have screening imaging as a part of the protocol. Occasionally, patients may opt out, due to the additional cost, but this is rare. In our practice, more than 90% opt for the screening. Patients say they like it because they understand that, by catching pathology early, we can often prevent bigger issues.

What disease states has the device shown to be beneficial in helping to identify and/or monitor?

It is essential for diabetic retinopathy and AMD and is helpful for virtually any retinal disease, including choroidal melanoma, glaucoma, retinal vein occlusion and retinal detachment.

What are the practice benefits?

Preliminary testing increases operational efficiency by decreasing time spent gathering data and allowing me to spend more time analyzing data and discussing recommendations. Having pertinent data available at the beginning of the exam enables our doctors to focus on the patient and provide better care.

Also, the Monaco saves me four to seven minutes per patient. This is because the technician doesn’t have to move patients from device to device, reenter demographics, realign them or ask them to focus on different targets. The UWF image helps me identify and document pathology in the periphery that may not have been visible using limited field imaging.

Has the technology changed patient education?

Yes, the single, comprehensive view makes it easier to explain how images relate to each other, and I can better explain findings. It is my experience that patients trust information gleaned from technology.

How is the practice reimbursed for usage?

Some insurance plans cover the UWF retinal imaging and OCT screening images we incorporate as part of our comprehensive eye exam, but usually patients pay out-of-pocket for the testing. If there’s a medical diagnosis, for which there is a separate procedure, I use CPT codes to bill the insurance company.

Can you provide a case illustration of how the device has impacted patient care?

I detected an epiretinal membrane at the onset of an exam and knew right away that it was unlikely the patient could achieve 20/20 vision no matter how well I refracted him. Because I was able to explain this limitation up-front, he was satisfied when I could only refract him to 20/30. OM