Bill Harvey looks at some of the developments in technology and instrumentation on display at this year’s 100% Optical event in London
There is no doubt that the advances made in technology for eye care over the past two decades has greatly improved the standard of care we can offer our patients in practice. With no let up in sight in the further development of technology, it is increasingly important to keep as up to date as is possible with the latest instruments and software. This is what makes events such as 100% Optical, held recently at the London ExCel, an essential part of the eye care practitioner (ECP) calendar.
As always, there was plenty to see at this year’s exhibition and this article offers a snapshot of the highlights that caught my eye. As well as the impressive array of imaging instruments we are becoming accustomed to, there were two other themes to be noted. Firstly, several companies are now focusing on software to enable remote analysis of data, something I suspect will become a major theme of future events. Secondly, dry eye management is becoming increasingly accurate and repeatable with a number of companies now boasting an array of assessment and management options for anterior eye and ocular surface anomalies.
Software
A number of instrument companies are focusing on getting the best out of already established and widely used technology. Birmingham Optical, for example, offered software upgrades for users of their earlier Nidek combined camera and OCT units to include the latest features.
Heidelberg Engineering boasted their latest version of the Spectralis OCT imaging platform, allowing users to upgrade to features, including Multicolor, Bluepeak Autofluorescence and the Glaucoma Module Premium Edition. Of these, I have to say that I find the Multicolor option very helpful in the assessment of an array of retinal and deeper lesions which show up much clearer by selective use of colour channel displays.
Professor David Thomson was on hand throughout the show to offer advice on his latest range of software for eye assessment (figure 2, pictured above). Most popular of his products this year appeared to be the Thomson Near Chart (figure 3), a useful system that allows control of a screen display on a laptop from a tablet either in the same clinic or remotely. I have found this system useful for domiciliary use. For a full review. I also noticed how his Clinical Eye Tracker (figure 4), by use of an ingenious Tobli tracking device mounted below a digital screen, can monitor the movement of each eye during a range of tasks. This data can help to assess reading patterns, but also offers an insight into binocular stability. Could this be future of phoria assessment?
With such widespread take-up of technology by ECPs, the next challenge is for networking these various data gathering points to allow accurate analysis. The pandemic has shown us how vulnerable a healthcare system can be if solely dependent upon regular attendance of patients at a clinic. Technology offers the option of remote data gathering for centralised analysis by an ECP. This improves patient access, reduces the risks of face-to-face clinics and, importantly, frees up ECP time to focus on management and explanation.
Topcon Harmony (figure 5) offers a platform that will seamlessly integrate the various data from a wide range of instruments, both within a single clinic or, impressively, across many, even from different countries around the world. A truly integrated data and analysis platform well worth keeping an eye on.
There were two software companies new to me, both offering options for data collation and analysis. EyeCheckups has developed software that can analyse images captured from fundus cameras to detect, objectively and within seconds, diabetic retinopathy, glaucoma, age-related macular degeneration, retinal vein occlusion and a number of other retinal disorders (figure 6). Initial research has suggested a sensitivity of 96% in disease detection.
Another software company that caught my eye was Altris AI. With roots in Kyiv, Ukraine, this company has, in partnership with all the leading OCT producers, developed an AI-powered, standalone, browser-based software for OCT scan interpretation (figure 7). By offering a secure remote site for the upload of data from multiple sites and systems, Altris AI can use machine learning to help refine analysis and diagnosis. We have all seen ambiguous OCT scans; how useful it will be to have the support of a global network to enhance our decision-making in the years to come.
Dry Eye
Hanson Instruments have been broadening their portfolio for many years and this year had an array of instrumentation on display. Among these was a range of various instruments aimed at the assessment and management of dry eye, so an ECP with an interest in developing a dry eye clinic might be able to buy a complete dry eye suite from Hanson. From the CSO Polaris Advanced Tear Film Analysis system (figure 8), mountable on the pivot of a slit-lamp, or the Me-Check meibography system (figure 9), through to a full range of light pulse treatment options, Hanson has garnered an impressive range of dry eye instruments.
Talking of dry eye suites, Essilor Instruments also can offer a complete range of instrumentation for dry eye clinicians. It is now the supplier of the IDRA system, one which I have had great results using, along with a novel lid massage and heat treatment (the Activa, figure 10), as well as an intense pulsed light treatment system for lid disease, the TearStim.
A new addition to dry eye world was on show at the Grafton Optical stand. The Moptim DEA Dry Eye Analyser (figure 11, right) is a slit-lamp based imaging system capable of a full battery of dry eye and ocular surface tests and analyses.
Also new to the UK market is the SK-MED Digital LED Slit Lamp with incorporated dry eye analyser, available from BIB. I tried this earlier this year and was impressed by the high quality slit-lamp and the number of dry eye analysis options (figure 12, left). The price is a ‘double-take’ moment.
I always think the most dramatic developments in eye care recently are those gadgets focusing on light therapy of the lids and adnexa. Many of the novel assessment and treatment options for dry eye are produced by the Espansione Group from Italy, and this includes much of what was on offer from Hanson and also to be found on the Topcon stand.
Topcon is able to supply the complete Eye-light range of products as part of their comprehensive dry eye suite offer (figure 13). This includes the increasingly established intense pulsed light option and newer additions offering low-level light therapy (LLLT) for a wide range of lid disease management presentations. The use of masks with different light exposures (figure 14) are quite novel and something we are likely to hear more of in the next year or two.
I have always had a soft spot for Mainline Instruments, not just because it is based right next to where I went to school in Brum, but more due to its supply of original and innovative kit, such as the iCare range of instruments. As part of its Huvitz range of instruments, from the South Korean tech company, Mainline now offers the Huvitz HDA-100 Dry Eye Analysis system (figure 15). The device, easily mounted onto a slit-lamp, is capable of a full range of tear and ocular surface: interferometry, meibography, break-up analysis and so on. Well worth a look.
OCT and Imaging
Continuing the Huvitz theme, Mainline was showing its Huvitz HOCT-1 (figure 16, pictured right). I have yet to try this instrument, but with 68,000 A-scans per second and capable of fundus autofluorescence, OCT-angiography and retinal imaging, it certainly looks the part. Anterior OCT is available as an add-on. I also noticed that Mainline was showing the latest hand-held fundus camera from Optomed. I confess that I struggled with earlier hand-held cameras; not so the latest instrument.
The Aurora IQ Handheld Fundus Camera (figure 17, pictured left), uses disposable eye cups to help broaden the possible field of view to 50 degrees, all captured in high resolution. Also of interest is the Tomey CASIA2 Anterior Segment OCT, which offers an excellent cross-sectional view of the anterior chamber (figure 18).
BIB was again showing the Optopol REVO FC130 OCT. I like this, not only because of its ‘one touch’ ease of use, but the way it can offer axial length measurements alongside the high-quality OCT imagery.
Meanwhile, Birmingham Optical was demonstrating the latest Nidek Retina Scan Duo 2 OCT at the show (figure 19, pictured right). The combined camera and OCT incorporates denoising software capable of improving B-scan quality, even when captured in normal resolution or for previously taken scans. Other features include macular and disc OCT-angiography, including vessel density and perfusion overlay measurement.
Refraction and Correction
It is always good to hear of any new developments in refraction equipment. There is increasing interest in the Topcon Chronos system, capable of programmed and remote binocular refraction, all possible by a trained technician under the supervision and triage of an ECP (figure 20).
The Vision-R800 phoropter system from Essilor Instruments (figure 21) is also worth keeping an eye on. The incorporation of advanced algorithms for calculating sphero-cylinder combinations, along with adaptable pre-programming, allows this system to easily refract to very small steps of accuracy. And, again, may be operated by a technician under appropriate supervision if this was ever to be required.
Unsurprisingly, the greatest interest with refractive error is in relation to myopia and there was much to see on display here. The Topcon Myah instrument is proving very popular, combining both accurate myopia assessment and progression mapping with ocular surface analysis options too (figure 22).
I noticed too that Birmingham Optical, supplier of the excellent Oculus Myopia Master, also now supplies the Nidek AL Scan Optical Biometer (figure 23). As well as offering full anterior and ocular surface measurement, I like the way the unit supports optical axial length measurement with ultrasound biometry for when light cannot get through cloudy media.
Medical technology company Occuity was using 100% Optical as its launch base for a brand new instrument. The AX1 is a non-contact, handheld instrument for the accurate measurement of axial length (figure 24) and delegates to the exhibition were able to see a prototype of the AX1 for the first time.
And finally, let us not forget that many patients have benefited from lens correction based on wavelength filtering rather than refracting. Cerium was proudly displaying the latest incarnation of its now well-known Intuitive Colorimeter, the Wave. Building upon the 2018 Curve model , the Wave boasts a smaller footprint, improved software capability and fully integrated secure cloud storage of data (figure 25). A must for those undertaking colorimetry.
