May 24, 2004.
By Judy Richter,
Chronicle Staff Writer,
San Francisco Chronicle.
Five-year-old Leif Anderson of Scotland had been undergoing regular eye exams for some time because he was severely nearsighted. Nevertheless, he went blind in one eye in 1990 after suffering a spontaneous retinal detachment that doctors couldn't detect in time.
Detection was hindered because the boy couldn't sit still long enough for his eyes to be thoroughly examined.
That experience inspired Leif's father to devise a quicker and easier way for eye doctors to examine patients, especially children.
What he came up with is a dual-laser scanning system called the Optomap Panoramic200, which peers into the back of the eye and instantly records a digital image, without having to dilate the patient's eyes.
Above and beyond the convenience, the Optomap offers vital diagnostic capabilities. Because the back of the eye, or retina, is the only place in the body where blood vessels can be viewed noninvasively, it can reveal valuable information about the patient's overall health.
Some of the conditions that can be detected include age-related macular degeneration, the leading cause of blindness among Americans age 55 and older; diabetes, which can cause damage throughout the body and lead to blindness if untreated; benign and malignant tumors; hypertension (high blood pressure); arteriosclerosis (hardening of the arteries); and high cholesterol. The Optomap also can detect holes or tears in the retina, which also might lead to blindness.
Today, the Optomap, made by Optos PLC of Dunfermline, Scotland, is gaining widespread acceptance by eye-care professionals. It is in about 1,100 U.S. eye-care offices, including more than 40 in the Bay Area, according to Barry Schafer, Western sales representative.
Optos was founded in 1992 by Leif's father, Douglas Anderson, an engineer who owned Crombie Anderson Design Consultants. When Anderson decided to use his engineering skills to devise a more effective way to examine the back of the eye, he had two main criteria: It had to be easy to use and it had to be patient-friendly, especially for children, he said in a recent phone interview during a business trip to Anaheim.
Anderson and his staff tried several approaches using bright light, but they all required dilation, too much time and too much skill. Then they turned to scanning laser technology with an ultrawide field.
They spent an additional two years developing a prototype that they took through three generations and tested clinically. "It took quite a bit of refinement," he said.
The Optomap first received marketing approval in the United Kingdom and then received U.S. Food and Drug Administration approval in 1999. That's also when Optos opened its North American headquarters in Marlborough, Mass.
Because the Optomap is so expensive, Optos leases it to optometrists and ophthalmologists for three years. The doctors pay on a per-use basis and charge patients a fee to cover their costs.
Dr. William Diamond, an optometrist in Dublin, charges his patients $35. Dr. Thomas Aller, an optometrist in San Bruno, has had his Optomap since autumn. Most of his patients don't mind the additional cost because "they appreciate being able to see inside their eye," he said.
From the patient's standpoint, all that's required is to put one eye up against the machine, press a button that flashes a bright light lasting a fraction of a second, then repeat the process with the other eye.
The resulting images are digitally displayed on a computer screen that the patient and doctor can view together. The doctor can magnify areas of concern, measure them, and compare the left and right eyes. If necessary, the images can be e-mailed to a specialist for consultation or further diagnosis.
The images can also be stored as a permanent record so that the doctor can refer to them at the next exam to see if anything has changed.
"It's a superior way of looking into the eye," Aller said.
Using a conventional ophthalmoscope to examine the dilated eye, the doctor sees only about 20 percent of the retina at a time, Diamond said. The doctor takes notes and makes drawings but has to rely on them and memory when trying to visualize the entire retina and compare it from year to year.
"We were just piecing it together," Diamond said.
Dr. Kristina Stasko, an optometrist in San Carlos, said the conventional view is "like looking through a peephole into a room."
The Optomap, a laser scanning ophthalmoscope, sees much more -- about 200 degrees of the retina.
"You can never re-create the complexity of the retina in a drawing," said Dr. Richard Davis of Huntington, N.Y., in the November issue of the Review of Ophthalmology. "You could write down a description, but that will never do it justice either. A picture is simply much better."
Moreover, the lasers penetrate deeper layers of the retina that can't be seen by conventional methods. When viewing the image, the doctor can isolate those layers to see what's happening with them. The process is like an MRI of the eye, Diamond said.
Even though Diamond just started using the Optomap in April, he told the story of a 40-year-old nearsighted patient who was examined with it. The image revealed two inactive holes in the retina that had filled with pigment. The patient is in no danger for now, but a hole can lead to a detached retina. Diamond counseled him about the warning signs of a detachment and told him to seek immediate treatment if he experiences them.
Aller said one of the benefits he has found is that his diabetic patients take their illness more seriously because they can see what it is doing to their blood vessels. Patients with early signs of macular degeneration are given nutritional counseling, for certain nutrients have been found to prevent or slow it, Diamond said.
The rental fee that doctors pay to Optos includes all the maintenance, training and marketing materials. The hardware includes the Panoramic200 scanner and computer plus monitors for each exam room.
The doctors also receive software upgrades as they become available. If they have any doubts about a diagnosis, they can consult with Dr. Bill Jones, an Albuquerque optometrist who specializes in the peripheral retina, said Schafer, the sales representative.
Or if the doctor has a specialist with whom he usually consults, Optos will give that specialist the software needed to view the e-mailed images.
Optos is a privately held company with about 200 investors, most of them in the United Kingdom. Anderson, the founder, said he expects the firm to go public eventually. In the meantime, the Optomap will soon become available in Germany.
Schafer said the company expects to see more eye-care professionals using the equipment, and he expects the Optomap to become a routine part of an eye examination. "We're just scratching the surface" of the potential market, he said.
"Due to its clinical benefits, ease of use and patient acceptance, I believe the Optomap retinal exam has the potential to revolutionize how eye exams are performed and become part of the standard eye examination," said Dr. Thomas Friberg of the Eye and Ear Institute at the University of Pittsburgh, during a conference presentation.
The institute conducted a study of the Optomap and reported its results at the 2002 conference of the Association of Research in Vision and Ophthalmology.
As for Bay Area eye doctors and their patients, "I'm delighted," said Stasko, who has used the Optomap on about 100 patients a month since December 2000. Because she and her colleague, Dr. Carole Hong, see many children, some as young as 2 or 3, the story of Anderson's son cinched their decision to get the Optomap.
A list of eye-care professionals with the Optomap in their offices is available at www.optos.com.
E-mail Judy Richter at firstname.lastname@example.org.
©2004 San Francisco Chronicle.
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