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NEW HORIZONS IN FUNDUS IMAGING

Enhancing reliability, quality, and workflow efficiency
with the NW500 non-mydriatic retinal camera
Jacob Cheng Yen Chuan, MD
Director, Retina Services
Eagle Eye CentreSingaporeFundus camera systems have continued to evolve over the decadeswith the introduction of advances
allowing for non-mydriatic and widefield capture, and providing higher
quality images that enable accurate diagnosis and optimal follow-up. Topcon
Healthcare, a leading manufacturer ofdiagnostic solutions for eye care, has always been at the forefront of innovationin this field, and the company’s commitment to developing new technology thatcan enhance patient care and practiceefficiency is once again apparent with
its newest fundus camera, the NW500.
When deciding to acquire a newfundus camera, the system’s ability toproduce sharp, detailed images withtrue colors, close to what is observed on
BIO examination, is among my primaryconsiderations. I also look at wide-field
capability, which enables identificationof pathology lurking in the periphery,and speed of capture, which is important for making the imaging sessioneasy for the technician and more comfortable for the patient. After having
the opportunity to use the NW500 fora short time in our clinic, I can say that
the NW500 easily met these criteria andexceeded expectations.
The NW500 is a non-mydriatic,
fully automated retinal camera witha 12-megapixel sensor that captures
sharp, high quality images with a single
touch, with the option of stereo imaging. It is a robust system with enhanced

capability compared to other fundus
cameras because it provides evaluable
true color images even when the capture
is done in ambient light, through small
pupils, or in the presence of appreciable
media opacity.
With an angle of view of 50°, theNW500 can capture a wider area of theretina compared to other models. In addition, the NW500’s peripheral photography mode has nine internal fixation
positions available, making it possible
to create a wide panorama image (approximately 90° angle of view) without
loss of detail. Because of its reliable
performance, ease of use, and otherfeatures, the NW500 also enables workflow efficiency.

needed for acquiring high-quality retinal images with enhanced color fidelity.
With Topcon’s slit-scanning technology,illumination enters the eye as a narrowslit that is scanned over the desired area
in a top to bottom motion while the illuminated area is captured by the camera’s rolling shutter mechanism. The
slit illumination plays a major role inallowing image capture through small
pupils of 2.0 mm. The thin slit illumination reduces backscattering of lightthat occurs with conventional cameras
and is the cause of flare, shadows, andblurred, hazy images.

Impressive initial experience
The following cases demonstrate how
imaging with the NW500 enhances diagnostic ability and overcomes the limitations of other camera systems.
The excellent clarity, sharpness, andcolor fidelity of images acquired using
the NW500 are appreciated in images
from a patient who presented with bilateral retinal atrophy and with vitreomacular traction (VMT) and an epireti-

A state-of-the art system
The NW500 is engineered with uniqueslit-scanning technology that provides
capture of high-quality images in welllit rooms and through small pupils. It
uses LEP (laser excited phosphor) andLED (light emitting diode) light sourcesthat give consistent, bright illumination
AB

Figure 1. NW500 fundus images show bilateral retinal atrophy (A,B) and retinal thickening
from an ERM and VMT OS (B).

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A

B

Figure 2. The OCT report (A) and NW500
image (B) from an eye with an ERM and VMT.

nal membrane (ERM) in the lefteye (Figure 1). Because of the true
colors in the NW500 images, thearea of thin retina in the left eye
is easily distinguished by its color
difference when compared to adjacent thickened tissue.
Figure 2 shows the OCT report
and NW500 images from anothereye with an ERM and VMT. I havebeen frustrated in the past when
pathology identified on OCT was
not able to be captured, documented, and recorded with other fundus
camera systems. A pseudohole andmild wrinkling of the macula inthis eye are clearly evident zooming in on the NW500 image. Thesefindings may also not be picked up
easily on clinical exam.
Figure 3 shows images from apatient with age-related maculardegeneration (AMD), intraretinal
swelling, and areas of atrophythat were detected on OCT. Areasof hemorrhage were also visible
in the close-up view of the NW500
fundus image from the left eye.
A case involving a teenager
seen on referral further highlights
the quality of the NW500 images and their impact on patientcare. The teen was complainingof headaches, and suspicion forpapilledema was raised based onFigure 3. NW500 images from a patient with AMD show bilateral areas of atrophy and retinal
hemorrhage OS.

the appearance of the optic discin a slit-lamp image taken with a90 D lens. The patient was determined to have pseudopapilledema based on review of the NW500
images (Figure 4). Thus, he wasspared further diagnostic workup
with magnetic resonance imaging
to rule out papilledema.
Images from a patient withdiabetic retinopathy also demonstrate the exceptional clarity andcolor accuracy of NW500 photographs (Figure 5). The different
pathologic features associatedwith diabetic eye disease (eg, dot/
blot hemorrhages, cotton wool
spots and hard exudates) areclearly showcased. Serial images
obtained before and one week
after the patient underwent laser
photocoagulation for diabetic retinopathy, highlight the reproducibility and consistency of colors
generated with NW500 photography. This performance combinedwith the sharp quality of the images (note the greyish white laser
scars and evidence of resolving
hemorrhage in the post-laser image), empowers clinicians as we
make management decisions
based on monitoring for changes.
With wide-field capability
from the software’s auto-montage
feature, imaging with the NW500
can also pick up findings of diabetic eye disease that might bemissed using conventional color
fundus cameras for 7-standard
field photography. Of course, theNW500 does not take the placeof a dedicated wide-field system
for imaging the peripheral retina
because it does not capture theextreme periphery. Nevertheless,the NW500 gives a good pictureof the retina up to the mid-periphery (Figure 6), which may obviate
the need for additional imaging insome patients.

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Imaging through media
opacity and small pupils

Figure 4. A diagnosis of papilledema suspected based on slit-lamp imaging was ruled out on review ofNW500 images.
AB

Figure 5. NW500 images from a patient with diabetic retinopathy showing dot/blot hemorrhages, cotton wool
spots, and hard exudates. Photographs taken before (A) and 1 week after laser photocoagulation (B), document
the reproducibility and consistency of colors achieved with NW500 imaging and show light photocoagulation
burns post-treatment.

Due to limitations of the penetrance of light in the visible
spectrum, no fundus camera
system is able to obtain clear
images of the posterior polein eyes with very dense media
opacities. Yet even moderatemedia opacities can be an
obstacle to obtaining good images with some fundus cameras. Because of its slit-scanning technology that reduces
backscattering, the NW500
is able to document pathology in the posterior pole, inthe presence of moderately
dense media opacity, as illustrated in an image from aneye with a NS 2+ cataract andAMD (Figure 7). Identifying
existing macular pathology isessential in the preoperativeevaluation of patients needing cataract surgery. Again, it
can be frustrating when OCT
imaging identifies pathology
and it cannot be documentedin images obtained using other fundus cameras.
Images from a pseudophakic patient with bilateral small pupils (2.0 mm) show
the ability of the NW500 toimage through miotic pupils(down to 2.0 mm in diameter) (Figure 8A-C). The righteye appeared normal, but athin ERM with a pseudohole
is seen in the NW500 imageof the left eye (Figure 8B),
and these findings were confirmed on OCT (Figure 8C).

Increasing clinic efficiency

Figure 6. NW500 auto-montage image , created using IMAGEnet 6 software, from a patient with retinitis
pigmentosaIn addition to its imaging
capabilities that enable optimal patient care, the NW500
provides value through its
effect on workflow efficiency.

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AB

Figure 7. NW500 image from an eye with NS+2 cataract shows retinal
pigment epithelial changes and drusen in this patient with AMD.

Its abilities to image throughsmall pupils and in lighted
conditions, translate into timesaving benefits. Reliably consistent generation of high-quality images by the NW500 alsomeans there is reduced needfor recapture. Furthermore,
imaging is completed quickly.
The NW500 is equipped withauto-alignment,auto-focus,and auto-shoot features, movement of the optical head fromfirst to second eyes occurs automatically without operator
intervention, and imaging atdifferent fixation positions isdone without the need for obtaining intermediate previews.
These functions combinedwith the system’s fast processing speed means that imaging
with the NW500 enables clinical workflow efficiency.

greatest assets of the NW500
using just three words I
would highlight its speed,
consistency, and dependability. Unquestionably, however,
the three-word limit fails toencompass the multiple attributes of the NW500 that I
believe make it an excellent
choice for all busy clinics.
With its ease of use, reduced
need for dilating all patients,and fast processing speed, theNW500 has certainly contributed to the smoothness of ourdaily operations while also
making for happier technicians
and patients. Most importantly,
the ability of the NW500 to reliably capture high-quality, true
color images, including in eyeswith small pupils and media
opacities, makes it a valuable
tool for optimizing patient care.

Conclusion

Dr Cheng has no relevant financial

If I was asked to describe theinterests to disclose.

Not all products, services, or offers are approved in every market, and products vary fromone country to another. Contact your local distributor for country-specific information.

CFigure 8. Imaging with the NW500 in an eye with a 2.0mm pupil (A) revealed a thin ERM with a pseudohole (B);these findings were confirmed on OCT (C).