Optos V2 Vantage Pro Download

[Evangeline Mellon]

Over the last few months Optician has published a number of case studies from UK practitioners using the Optomap retinal exam. Here, US optometrist William Jones describes the system and offers some hints on image interpretation.

The main advantage of the Optomap retinal exam is that it is able to capture a 200 fundus image with or without dilation. The instrument is operator-friendly and only requires a practice assistant to operate it. The 200 imaging (80 per cent of the fundus) allows for detection of most lesions. The ora serrata is 240 and eye steering increases the field of view to around 230 in most cases.

optos V Vantage Pro Review is developed by Optos and is used by 1 user of Software Informer. The most popular version of this product among our users is 2.1. The name of the program executable file is Review.exe. The product will soon be reviewed by our informers.

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In 2008, the 12-year follow-up was conducted on 573 participants of the Reykjavik Eye Study. This study included the use of the Optos P200C AF ultra wide-angle laser scanning ophthalmoscope alongside Zeiss FF 450 conventional digital fundus camera on 121 eyes with or without age-related macular degeneration using the International Classification System. Of these eyes, detailed grading was carried out on five cases each with hard drusen, geographic atrophy and chorioretinal neovascularisation, and six cases of soft drusen. Exact agreement and κ-statistics were calculated.

Comparison of the conventional and ultra wide-angle images in the macula showed an overall 96.43% agreement (κ=0.93) with no disagreement at end-stage disease; although in one eye chorioretinal neovascularisation was graded as drusenoid pigment epithelial detachment. Of patients with drusen only, the exact agreement was 96.1%. The detailed grading showed no clinically significant disagreement between the conventional 45 and 200 images.

The main purpose of this article was to determine the feasibility to use ultra wide-angle (200) digital imaging to record phenotypic variation of AMD in the macula of eyes from the 12-year follow-up of Reykjavik Eye Study.

The Reykjavik Eye Study includes a random sample from the Reykjavik population census 50 years and older in 1996, in which 1045 persons participated, all having an eye examination and stereo fundus photography using films.10 In 2008, the 12-year follow-up was conducted in which 573 persons participated, that is, 73% of the survivors. Participants were photographed using the P200C AF, an ultra wide-angle (200) scanning laser ophthalmoscope that was operated by an Imaging Team provided by OPTOS and supervised by the Reading Centre of Moorfields Eye Hospital (MEHRC). The 45 fovea centred macular photographs were taken by a ZEISS FF 450 digital camera, operated by trained senior nurses of the Reykjavik Hospital Medical Retina Clinic and supervised in part by the MEHRC. Both conventional digital and ultra wide-angle images were taken through pharmacologically dilated pupils.

Tenets of the Declaration of Helsinki were followed. Ethical approvals were obtained from the Data Protection Authority and the National Bio-Ethics Committee in Iceland. Signed informed consent was obtained from each participant. The digital images were sent to the MEHRC with a unique ID number displayed on all photographs. These ID numbers were used to identify patients and grading records in the Reykjavik Eye Study.

For our current protocol, 121 eyes were selected from the 12-year follow-up, and care was taken to cover the whole spectrum of ARM and AMD. Images were graded in random order without access to clinical information. Both conventional and ultra wide-angle images were graded using the Optos V2 vantage DX review software that allows the automatic fitting of a standard grid after manually defining the centres of the fovea and the optic disc. This definition of grading grid ensured that the very same macular areas were graded in both image modalities (see examples of corresponding images in Figure 1). Standard circles were used to measure the drusen and lesions sizes. Only abnormalities related to ARM and AMD were graded. Both conventional and ultra wide-angle images were phenotyped by the same person using the categories of the International Classification (IC):7 hard and soft drusen, geographic atrophy (GA), and chorioretinal neovascularisations (CNV) were identified. Intra-observer agreement was calculated once the images were regarded after a minimum of 14 days interval.

Of the phenotyped images, detailed grading was conducted on five cases each with hard drusen, GA and CNV, and six cases of soft drusen (21 eyes in total), on both imaging modalities using the Optos V2 vantage DX review software by individually recording all drusen types and sizes for all three zones of the IC grading, together with recording RPE changes, characteristics, and size of CNV and GA. This represented the same grading protocol that was used as for the baseline and the 5-year follow-up of the Reykjavik Eye Studies to allow incidence estimates at the later date.10, 11 Incidental finding were commented on the grading form. Intra- and inter-observer agreement was calculated once the images were regarded after 14 days by the same or by another certified grader.

To assess the feasibility to use the P200C AF images for grading for ARM and AMD in the macula we used a two-step analysis. First, macular pathologies were graded both on ultra wide-angle and conventional digital images from 121 (10.56% of total) eyes by one grader. Of these, nine conventional digital images were not gradable. All ultra wide-angle images were sufficiently good quality for grading. After comparison of the 112 remaining eyes, there was a 96.43% agreement (κ=0.93) in the overall diagnosis of end-stage diseases (19 eyes). The only disagreement came from one eye that was graded as CNV on the ultra wide-angle image and drusenoid pigment epithelial detachment (PED) on the conventional digital image. Seventy-seven eyes were graded as drusen only on conventional digital images and 74 on the P200C AF images. Disagreement came from three eyes that were graded as normal on the P200C AF images (exact agreement 96.1%, κ=0.00). There were no disagreements in grading normal fundus images (16 eyes).

In the second step detailed grading was carried out by two independent graders on five cases each with hard drusen, GA and CNV, and six cases of soft drusen using the International Classification used for both the baseline and the 5-year follow-up of the Reykjavik Eye Study. Grading categories, exact agreement and κ-statistics are listed in Tables 1,2,3. As there was no clinically relevant difference between the two graders, their detailed grading was collapsed and the grading of the two imaging modalities were compared. The agreement between the two imaging modalities was overall high in all categories, except grading hard (

Ultra wide-angle images had not previously been used to grade changes associated with ARM or AMD, although the presence of pathological abnormalities in the macula had been described.17 In this study, we compared grading of ultra wide-angle images and conventional digital images using the IC system developed earlier.7 Our first observation was that although all ultra wide-angle images were gradable, there were nine conventional images that fell short of grading standards, predominantly due to media opacities and technical difficulties with positioning the patient for long enough to take gradable images. As lasers are much less susceptible to any media opacities18, 19 and they outperform even very high resolution digital images in terms of sharpness and contrast,20 the better image quality is perhaps not surprising. However, it must be acknowledged that new graders must learn to appreciate artifacts related to the broad depth of focus of this device, such as the presence of eyelids, eyelashes, floaters (eg, see Supplementary Figure 1), the optics and the haptics of the intraocular lens or lens opacities. Also the image, as it is generated by green and red laser lights rather than the more widely used white light illumination, is unfamiliar to graders in the first instance. In our experience, most of these aspects can be overcome or minimised with practice and good imaging techniques. The camera can accommodate wheelchairs and there is no need to move the patient, a real advantage in imaging an elderly population similar to those in the Reykjavik Eye Study. In general, imaging did not require dilation, though when seeking to obtain the best quality of images in the most elderly and fragile dilation was necessary.

The phenotype of 112 eyes in this study showed a very high level of agreement between the image modalities, suggesting that the ultra wide-angle images of the P200C AF is a reliable way to identify fundus abnormalities. This was reinforced by the detailed grading of the select 21 eyes, which again showed good agreement between the grading of the two image modalities. Intra- and inter-grader variability was low (agreement was high) in both image modalities. Only one image was interpreted differently, and graded CNV by one grader and drusenoid PED by the other. This, however, is not unacceptable as to establish the correct diagnosis for PED fluorescent angiography would have been required. Despite the fact that the graders had a short learning period to understand the P200C AF images and get enough knowledge for grading small lesions and differentiate artifacts from real abnormalities the agreement was high with high κ-values, except in those instances where there were too few categories to compare. The identification of small hard drusen gave difficulties especially at the beginning of the grading. This is reflected in the somewhat lower agreement and κ-values. This might be attributed to the similarities between drusen and pixel sizes in the ultra wide-angle images. Small hyper- and hypo-pigmentation of the RPE can be an early sign of AMD; however, grading pigment abnormalities from digital images had been shown to be difficult4 and our study confirmed this. Neither the conventional nor the ultra wide-angle images had good enough quality or resolution to reliably grade for small pigmentary changes.

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