After a hiatus, during which hands-on exhibitions were much missed, it was a joy to be able to see and play with the very latest in ophthalmic instrumentation and technology at the recent 100% Optical show recently held in London. As expected, key themes were myopia management and imaging, but there was much more of interest, including some new developments supporting the advances in therapeutics being made by our profession.
Myopia
There are a number of new instruments on the market capable of supporting practices involved with myopia management, an area in which many of the big players in ophthalmic technology are investing.
Topcon Healthcare continue to attract much interest in their Myah (figure 1). This multifunction instrument is capable of axial length measurements, increasingly essential for monitoring myopic progression, and has lately incorporated growth curves to allow comparison with expected growth with various interventions (figure 2).
The Myah, however, offers much more and is capable of topography (including keratoconus screening and pupillometry) and a battery of dry eye assessment tools, such as non-invasive break-up time and location measurements.
Essilor Instruments continue to expand their exciting range of ophthalmic instruments, and I am keen to hear how their new Myopia Expert 700 performs (figure 3). The instrument is linked with the Essibox Myopia Care software platform and offers the ability to accurately monitor myopia parameters during treatment and for monitoring purposes. Among its functions are precise axial length measurement, capable of accuracy up to 27µm, and corneal topography.
Figure 2: (left) Axial length curves; figure 3: The Myopia Expert 700
Birmingham Optical Group were showing the Oculus Myopia Master (figure 4), an impressive piece of kit that encompasses all of the important myopia management measurements in one instrument, including Scheimpflug imaging, autorefractometry and keratometry functionalities to simultaneously measure refractive error, axial length and corneal curvature. It also provides additional information on pupil diameter and corneal diameter. All of these are easily undertaken via a touchscreen interface.
BIB Ophthalmic Instruments had much interest in their now well-established REVO OCT instrument. The latest incarnation, the REVO FC130, now comes with a real-time hardware eye tracking function, which compensates blinks, loss of fixation and involuntary eye movements during OCT scanning. It also, most usefully for those interested in myopia management, allows accurate axial length monitoring, measurements which it displays most elegantly (figure 5).
Figure 4: (left) Oculus Myopia Master; Figure 5: Tim Baker and Ron Wright of BIB Ophthalmic Instruments showing axial length results taken with the REVO FC130
OCT
And talking of OCTs, no ophthalmic exhibition would be complete without an array of the latest in OCT technology. Heidelberg Engineering, as always, impressed with their latest developments. The much-loved Spectralis is now able to operate using their new SHIFT technology. This allows clinicians to switch between 20, 85 and 125kHz A-scan rates to find the ideal balance of image quality and clinical workflow. The ability to choose the most suitable OCT and OCTA scan speed for each individual patient increase efficiency and optimise workflows in daily routines in clinic. Need convincing? Have a look at the video at heidelbergengineering.com/int/spectralis-shift-technology.
Many readers will be users of the Nidek Duo OCT, so I was interested to see the newly released Duo2 at the Birmingham Optical Group stand. Capable of 70,000 A scans per second for faster acquisition, the instrument also includes a new Retina Map Scan, combining Macula and Disc OCT with colour fundus in one rapid scan. Also, new de-noise software helps to improve B Scan quality, even when captured in normal resolution and on previously taken scans (figure 6, pictured below). This will be great for those trickier patient scans.
Zeiss Instruments were boasting their extensive range, including the impressive Cirrus 6000 OCT, which can also incorporate their AngioPlex software to allow accurate OCT angiography. A key theme for Zeiss over the years has been integration of data, and I remember they have been crucial in combining functional and anatomical measurements over the years, perhaps not surprisingly from the brains behind the good old Humphrey VFA. So, I was perhaps not too surprised to hear of their Zeiss Visuconsult 500 connectivity, a whole ‘ecosystem’ allowing combination of the pretest data, screening and objective refraction devices. Images can also be shared from other imaging and diagnostic systems, such as slit-lamps, OCT and VFA. This also now has potential for those looking at developing accurate remote testing strategies.
The swept source Topcon Triton continues to impress and, less familiar to me, I also had a quick look at the Huwitz OCT on display at Mainline Instruments.
Imaging
Mainline Instruments also boast a number of imaging instruments worth a look at. The Eidon AF is a true colour, confocal imaging device capable of high resolution image capture (figure 7), an exceptional mosaic function, and a one-touch operation that can allow high quality imaging by even the least skilled of operators. Also on display was the newly introduced DRSplus, the latest kit from iCare, which again utilises a confocal fundus imaging system. It uses a white LED illumination system and creates greater image sharpness, optical resolution and contrast when comparing to a traditional fundus camera (figure 8).
Figure 7: (left) The iCare EIDON AF Confocal Scanner; figure 8: The iCare DRSplus Fundus Imaging System
Optos have made great strides in recent years. Perhaps most impressive has been their introduction of systems that allow combination of OCT technology with ultrawide field (UWF) scanning laser technology. Their latest UWF technology offers a near-miraculous 200 degree retinal field view of high resolution and, perhaps less importantly for some, all possible using the sexiest looking kit on the market in my humble view. Patients love this scanning technology as there is rarely any need to dilate and the ‘flash’ during image capture is barely noticed.
Test Charts and Screens
I have been using the Thomson Software Solutions test charts for some time and have recently been trying out their new Near Chart software, so far with great success. I took advantage of a quick lesson from their product director, Chris Hunt, who showed me how I can personalise the charts on display (figure 9). Most helpful.
I also managed to catch up with Graham O’Regan, of Sight Risk, who was demonstrating his latest chart system, as reviewed recently in this publication (see Optician 22.04.22) on the German Ebiga Vision stand (figure 10).
Figure 9: (far left) A quick lesson from Chris Hunt of Thomson Software Solutions; figure 10: Graham O’Regan (right) with keynote speaker Professor John Nolan (left)
Paediatrics
Simon Berry, a specialist optometrist from the North-East, has invented an excellent device to help test children’s eyes, firstlaunched in the UK in 2019. I was keen to see this and my clinic is hoping to trial it shortly. The kit is aimed at helping the testing of people with learning disabilities, people who are 10 times more likely to have sight problems and yet often do not get the full testing they require.
Called the Visual Fixation System (or VFS), the device is used to maintain the attention of a tricky patient (figure 11). As Berry explained: ‘It was primarily invented to help measure accommodative lag, but I have found it to be very useful in a number of different examinations, such as cycloplegic retraction, gross binocularity assessments, frame fit assessment, indirect ophthalmoscopy and so on. It is useful to grab the attention of patients when you cannot get their attention in any other way. I have used it for young children, patients with learning disabilities and patients with dementia. It comes with different attachments depending on which test you are doing. It is also very useful for myopia control.’
Figure 11: (left) The Visual Fixation System in use by Simon Berry; Figure 12: The Adaptica Kaleidos Mobile Vision Analyser
Mainline Instruments were displaying the new Adaptica Kaleidos Mobile Vision Analyser (figure 12) is a mobile binocular refractometer and vision analyser, able to fully detect refractive errors, eye abnormalities and vision defects by measuring objective refraction in the range of -15DS to +15DS, and phorias/tropias in prismatic dioptres. It does this using a camera-based unit, employing sound and lights, and captures data in just a few seconds. Can’t wait to try it out.
Topcon also displayed their impressive Chronos suite, something I reviewed in Optician 15.01.21 and well worth a look (figure 14, pictured right).
Visual Fields
Grafton Optical has introduced an impressive new visual fields analyser, the AP-300 (figure 14). This single platform combines kinetic and static perimetry, including white perimetry, SWAP and flicker perimetry for early glaucoma detection, plus real Goldman kinetic perimetry. This spectrum of functionality offers tailored personalised testing for the patient and the clinician. Advanced application software provides unique function analysis of patient results, making diagnosis easier and faster. The standard presentation of patient results allows the user to print a single test and present clinical changes in the visual field over time.
Tests can be performed within standard testing area covering various ranges of angular field of view (up to 80 degrees for one eye). There are fields with concentric arrangement stimuli (ie macula, 22°, 30°, 50°, driving wide, glaucoma, peripheral) or the rectangular system (ie 10-2, 24-2, 30-2). The built-in editor allows the user to define specific tests of the test field. It is also possible to test the central vision like a micro-perimeter. Fields is still very much with us.
Slit-lamp and Ophthalmoscopy
One small stand was being run by a new company to me. The Ophthalmic Instrument Company (OICO) was displaying its range of acrylic fundus viewing lenses but also, at the back of the stand, a prototype slit-lamp designed for remote operation (figure 15). As I found out, the aim is to develop this to be made available in a build-yourself kit form at a competitive price and making remote assessment realisable for even those on tighter equipment budgets. One to watch out for.
Figure 13: (left) Topcon Chronos; figure 15: Prototype self-build remote operation slit-lamp from OICO
Talking of slit-lamp adaptations, I noticed that Essilor Instruments is introducing two new digital slit lamp adapters, each designed to perform dry eye assessment and anterior photography. The DEM100 takes a complete tear film automated digital analysis with multiple tests, while the DSLC200 slit lamp imaging system provides high quality images and videos of the eye. Paul Cumber, Essilor Instruments director, said, ‘Both devices take less than five minutes to set up and can be easily installed in a spare examination room to inexpensively create a dry eye clinic and an additional revenue stream. Furthermore, it can be fitted to a slit lamp in the primary examination room to allow the ECP the flexibility to provide dry eye services from the one location.’
Lest we forget the posterior segment, it was good to see Heine displaying its new headset indirect ophthalmoscopy unit, the Omega 600 (pictured, right). This lightweight, but powerful, unit is easy to use, as I can confirm from trying it out on Heine sales manager Sean Lyons at the stand. The ophthalmoscope includes visionBOOST, which allows better retinal viewing through cataracts. I am also interested to try the unit out on paediatric patients as the new system claims to offer better viewing through undilated patients.
Pachymetry and Tonometry
Pachymetry has become a significant part of the optometric repertoire ever since its important in adapting tonometry readings was realised, as anyone involved in glaucoma and ocular hypertension monitoring will well know. Another name new to me is Occuity, a company based in Reading that specialises in the research, design and production of handheld non-contact optical instruments for use in healthcare screening and monitoring. Their hand-held non-contact pachymeter, the PM1, is so easy to use as I found when measuring Optician editor Simon Jones’ cornea as he walked past (figure 17, below). Other products from the group include a non-contact axial length biometer and a blood glucose monitor, both of which I am hoping to play with soon.
I have become a big fan of the iCare rebound tonometer over the years, especially for learning disabled patients and for domiciliary visits. So, I was interested to see the new iCare IC200 on the Mainline stand (figure 18, below), which seems to have addressed any concerns about positional error when using it.
In recent years, non-contact biometry has stolen most of the limelight, but many readers will remember using contact ultrasound pachymeters and A-scan units. I was pleased to see optometry guru Nick Dash enthusing about a new incarnation of such, the DGI Scanmate, which is able to measure axial length with a contact technique (figure 19).
Software
Life got much easier once paper records were replaced by electronic ones; not least for those people trying to read my writing. Among the software on display this year, the latest incarnation of the i-Clarity platform (figure 20) seemed to be the most comprehensive yet, offering a clear user interface able to coordinate all aspects of practice life.
Figure 19: Nick Dash with the DGI Scanmate; a contact biometry alternative for axial length measurements
Dry Eye
As well as the aforementioned slit-lamp adaptations, I note that Essilor Instruments are now distributing the excellent IDRA system for tear analysis (see Optician 21.12.18). This will help identify those patients who might benefit from their new Activa heat mask treatment; look out for a forthcoming review of this.
A somewhat more leftfield approach to dry eye management is the BlinkNow video attachment for computer screens (figure 21). Having a blinking eye in your peripheral field is claimed to encourage better blink rate in screen users. Might be worth a go?
Figure 20: The latest i-Clarity practice management software; figure 21: The BlinkNow attachment encourages screen users to blink more
Therapeutic
One sign of the way the profession is moving in the future was evident at the Carleton Optical stand (figure 22) where delegates could have a look at the latest SLT treatment technology, something I believe will be a key part of many an optometrist’s services in the coming years.
Figure 22: Nick Fitrzyk and Andrew McWhirtershow off the latest SLT instrument
A range of Intense Pulsed Light therapy instruments were also attracting much interest, and I was keen to look at those on display at the Hanson stand (figure 23) under the watchful eyes of Kristen Coleman.
I was also lucky enough to have a demonstration of the latest kit from Lumenis, the OptiLight IPL unit (figure 24). I guarantee that this type of treatment for chronic ocular surface disease will become a familiar part of future eye care practice.
Figure 23 & 24: (left to right) Kristen Coleman, of Hanson Instruments, with IPL units; Demonstrating the Lumenis OptiLight
