Opinion piece: Wide-angle view
Dr Steven Squillace is one of the first doctors in the US to use the system, having come across it at the American Academy
of Optometry meeting in Boston, October 2011. "I had an old fundus camera that needed to be replaced" said Dr Squillace who
is on staff at Johnson Memorial Medical Center and trained at Joslin Diabetes Center whilst attending the New England College
of Optometry in Boston, Massachusetts, USA.
"I've worked with SLO technology for retinal evaluation over 10 years ago as part of a group practice. We saw the benefit
of undilated fundus images, but also the drawback: ergonomics and economics. Patients needed to tilt their head to acquire
an image, and costs for both the doctor and patient would be an issue in my current solo practice," he said. "When I heard
there was a smaller version being launched, I thought it could be what I needed. Unfortunately it wasn't, because the price
meant it wouldn't have worked out for my practice. Walking around the AAOPT meeting, I spotted i-Optics. I'd never heard of
them but they had an SLO device that looked about the size of the HRT machine in my office. They were expecting to get FDA
approval soon and I told them to get back to me when they had it. A few weeks later they called and said they had it!"
Dr Squillace has so far used the new technology on over 100 patients. "EasyScan is wonderful. It's better than a fundus camera
— I can't think of an application for which a fundus is better except, maybe, for making hard copy print. It gives us a great
view of the internal retina via a 532 nm green laser and choroid via a 780 nm infrared laser. This allows for early detection
of maculopathies not typically seen by dilated fundus exam, and thus proper nutritional counseling and referral to an ophthalmologist
if indicated. The ability to scan into a 2 mm pupil even if a patient has mild cataracts is an advantage over white light
cameras. The instrument also images central vitreous floaters so that patients can see their anomaly by the vitreous movie
feature. I've had three patients in which I saw changes in the macula that I would not have seen with a fundus camera, even
if I had dilated the pupils. I take two pictures, one of each side, and that gives me a 60 to 65-degree view, allowing me
to analyse the major eye structures."
Dr Squillace says his experience confirms that EasyScan eliminates the need to dilate but that his protocol remains to dilate
on a first visit: "I want to be sure I'm getting the outer reaches of the retina." He also dilates trauma patients, but "I
use EasyScan to document the central retina." For routine check-ups, however, he now uses it exclusively unless a patient
asks to be dilated, which rarely happens. "Patients love EasyScan because it makes scheduling much easier," Dr Squillace explained.
"They can schedule much closer to the examination time because we don't need to apply drops and so there is no waiting. Patients
can insert contacts, if worn, and go back to work or school and see!"
1. DRIVE is a head-to-head clinical trial comparing the performance of the confocal EasyScan to a traditional fundus camera
for the early diagnosis of Diabetic Retinopathy. Randomized and rater-blinded, this comparator study looked at 100 people
with diabetes at the Eye Hospital Rotterdam, the Netherlands. Trial participants were 18 or older, with 58 being female and
42 male. Mean age (± standard deviation) was 60 ±11 years. All participating patients received retinal imaging with both the
EasyScan confocal SLO system and a conventional fundus camera; they were first subject to retinal imaging using EasyScan.
Endpoints included normalized sensitivity and specificity, referral rates for follow-up exams, false positives and negatives,
and the percentage of gradable images for both instruments. I-Optics is to present detailed findings at this year's ARVO Annual
Meeting, in Fort Lauderdale, Florida, USA, in May.
Mr Alastair Bruce is a freelance writer based in Amsterdam, the Netherlands.
More information about the EasyScan can be found on the company's website at