MEDICAL RETINA
Dr Paul Baddeley (left) and Dr Oliver Comyn assess retinal images at their St George's Eye Care clinic.
ENHANCING RETINAL PATHOLOGY DETECTION UK-trained ophthalmologist DR OLIVER COMYN made it a priority to install a state-of-the-art imaging device when he joined a well-known private hospital in New Zealand as its sole retinal specialist. Now that piece of equipment has become an essential part of the clinic.
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hen St George’s Eye Care appointed Dr Oliver Comyn as its first dedicated medical retina specialist, it did so with the intention of expanding its suite of services beyond cataract and glaucoma care. Comyn arrived at his new post in Christchurch, New Zealand, in 2018 having completed vitreoretinal fellowships at the Sussex Eye Hospital and the world-renowned Moorfields Eye Hospital in London, in addition to internationally published works on diabetic eye disease and retinal imaging. For St George’s – the first private hospital in New Zealand to invest in fulltime ophthalmologists – it was an important appointment because it meant medical and surgical retinal treatment would become a significant component of the clinic, with Comyn complementing the practice’s other consultant ophthalmologist Dr Paul Baddeley, whom he trained under in West Sussex in 2013-14. Imaging equipment is a key tool in the repertoire of any medical retinal specialist, so upon his arrival Comyn was determined to advocate for investment in a state-of-the-art instrument that would offer superior results and usability than the existing fundus camera. That device was the Optos California FA ultra-widefield (UWF) retinal imaging device with optomap. After stating his case, the instrument was swiftly installed and has now cemented its place as a key piece of equipment. “The hospital recognised in order to have a comprehensive and credible retinal practice we needed something to capture images and conduct fluorescein angiography, without the need to employ a retinal photographer who could use a fundus camera effectively. We also didn’t
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INSIGHT October 2020
want to risk acquiring poorer images with the existing camera,” he says. “Ultra-widefield images are essential to managing retinal disease today, and widefield angiograms and the ability to do targeted laser treatment based on identifying vascular changes in the peripheral retina is part of modern retina care, so my argument was if they were serious about having a retinal specialist who could treat all patients coming through the door then this was the piece of equipment to do that.” EASY ACQUISITION Optos California has been available to the Australasian market for five years and remains the company’s premium offering to optometry and ophthalmology practices. It comes in three versions, with up to six imaging modalities including three-in-one colour depth imaging (colour, red-free and choroidal in a single image), as well as autofluorescence (AF), fluorescein angiography (FA) and indocyanine green angiography (ICG). According to Optos, the California RG version has been popular among general ophthalmologists because it allows for high resolution 200° ultrawide field (UWF) colour and AF images of the retina, without the need for dilation, in as little as 0.1 seconds. The mid-range California FA has the added benefit of UWF angiography to provide diagnostic information of the mid and far periphery for general ophthalmologists and retinal specialists. California ICG incorporates the technology of the other two models plus interweaved ICG. This added feature is for retinal specialists to optimise management of AMD, uveitic conditions and other choroidal pathology. According to Optos, up to 82% of the retina is captured in one
