An allied health staff member shares his experience with the Optos Silverstone.

Silverstone is a multimodal imaging system from Optos, containing capabilities for an ultra-widefield (UWF) scanning laser ophthalmoscope with integrated, image-guided swept source OCT (SS-OCT) to produce a 200° single capture image. Additionally, Optos technology allows for imaging across the retina, from posterior pole to far periphery, and it offers red-green color, green light autofluorescence, fluorescein angiography, and indocyanine green angiography. The Silverstone device also is capable of registering the OCT scan to the optomap image and tracking as the scan is acquired. This capability makes the device appropriate for monitoring of peripheral retinopathies and uveal neoplasms.

Usage

Anyone familiar with the use of an Optos device will be able to master the software tools on-board the Silverstone. The device offers eight scan patterns: four (including line, raster, and high-resolution rasters) for scanning in the posterior pole and four UWF-guided options, including a 23-mm wide line scan and 6-mm wide line as well as volume scans.

When viewing images, the OCT can be projected onto the optomap image to correlate scan location and allow the reviewer to see where a particular line is located on the corresponding UWF image. Also, since Silverstone is capable of capturing steered images, like a California device, users should note that UWF-guided OCT scanning must be done with optomap images taken with central fixation.

After acquiring the optomap image, a touchscreen allows the user to place the desired scan in the location of interest. The software calibrates the proper Z axis location and focus/polarize the OCT scan for best scan quality.

It is now possible to use OCT even into the far periphery to track changes in uveal neoplasms that are too shallow to track with ultrasound (for example, lesions that are less than 0.4 mm tall). In addition, users can track subretinal fluid resolution in a repaired retinal detachment that has persistent fluid after surgical repair.

Benefits

This single device can take the place of separate OCT and fundus imaging devices, allowing multiple different image types to be acquired without moving the patient from room to room. This has become especially beneficial during the pandemic as we seek ways to minimize exposure, contacts, and overall patient time in clinic.

Additionally, the review software, OptosAdvance, is web browser-based, which allows for secure image viewing at the office and remotely. The software allows for images to be exported for importation into an EMR, or it can be integrated with a compatible EMR. It also is easy to bring up multiple exams for comparison on the same screen.

The future

Though this device is still early in its commercial life cycle, the capture software has already been upgraded with additional scan patterns and better tracking. With future development, scans should be able to be repeated at the same location to track the change in peripheral pathology. OP