From screening for retinal pathology to acquiring images for use in telemedicine applications, non-mydriatic fundus cameras are a mainstay in the exam suite. In an effort to keep users on the cutting edge of retinal photography, companies constantly upgrade their camera systems and produce add-on hardware that increases their functionality. Here’s a look at the latest upgrades and updates to non-mydriatic cameras that have arrived so far in 2015.

Kowa WX3D and Nonmyd 7
Both the WX3D and Nonmyd 7 cameras from Kowa received upgrades to their imaging systems in June, bringing them up to 24-megapixel resolution.

“The 24-MP resolution is particularly helpful when the imaging is in the macular area,” says Kowa’s Rick Torney, “since doctors are focused on catching abnormalities such as AMD in the macula area earlier. They need to be able to blow up that area a good deal, and doing that takes a lot of megapixels.

“The main feature of the WX is one-shot stereo imaging,” Mr. Torney adds. “It has two light pathways that allow two images taken non-mydriatically to come together in stereo. In the stereo view you get a 3-D view of the optic nerve and, after you’ve taken several of them, you can align them, stack them and then play them back in a video to see if a patient’s glaucoma condition has progressed or swelling in the optic nerve head has decreased.” Mr. Torney says capturing the stereo images in non-dilated pupils is possible in about 95 percent of patients, though in some patients, “they just have too small a pupil size.”

Mr. Torney says users of Kowa’s older Nonmyd systems, such as those that used 2 or 5 MP, might be more inclined to upgrade to the higher resolution. “The real advantages would be for the people taking images in the 1-, 2- or 5-MP range,” he says. “Going to 24 will make a difference for them. So, really, for the upgrade, the Nonmyd 2 MP and Nonmyd 7 MP are essentially the same; you put a different camera back on them to get the higher resolution. If the user had a WX, he could put the higher-resolution camera back on it now. However, there would be few who’d choose to go that route since the earlier WX cameras had 12-megapixel resolution, so going to 24 MP wouldn’t be a huge advantage.”
To upgrade the Nonmyd 7 camera system would involve purchasing a new computer that’s able to run the Windows 7 operating system, the software and a new camera, and would cost between $4,500 and $5,500. If a user wanted to upgrade the WX to 24 MP, it would cost about $1,500 since he already has most of the necessary equipment. For information, visit kowa-usa.com.

Canon CR-2 AF
This is a new retinal camera that was just launched in late May, and is equipped with several features that may help users acquire better patient images.

Since many patients have issues that may make images appear less than ideal, such as early cataract, the CR-2 AF has a contrast-enhancement function. “Contrast enhancement examines the structures of the eye and then increases the contrast as needed,” says Canon’s Jim Laux. “This can allow the user to see such things as the edges of the veins and arteries more cleanly. As a corollary to this, the camera also provides auto exposure. It does this by reflecting an infrared signal off the back of the eye and using that exposure information to drive the camera settings to generate an optimal image. This means you don’t need a highly skilled technician who, in the past, would have to bracket the exposure by changing the ISO and flash intensity to take different photos at different exposure levels in order to get the level of contrast the doctor wants. Because of this, the user can do more with less flash intensity, which avoids pupil shrinkage due to a bright flash or photophobia, and generally makes it more comfortable for the patient.”

The camera also has a function called auto fundus, which is basically the camera’s way of confirming it’s got the fundus in sharp focus and is ready to begin shooting. “It works kind of like the way you used a microscope in biology class in high school,” explains Mr. Laux. “When using a microscope to look at a slide, you’d start with the lowest magnification to get it semi-focused, and then increase it until the subject was in focus. Similarly, in the CR-2 AF, you begin with a split image of the eye in the camera. When the eye is focused, the upper and lower halves of the image come together and form a single picture. When that happens, the camera knows it’s in focus and it automatically jumps to high magnification and moves the imaging to the back of the eye. This means the technician doesn’t need to know when to push that button—it automatically takes him there. This is helpful because this can be where some of the stumbling occurs in image acquisition—if the patient suddenly moves and the user needs to go backward, you can press a button manually and do the rough alignment again, rather than having to go back to the very beginning of the whole process. Also, if a technician is a little uncomfortable determining if it’s a good time to take the picture, he just looks at two small dots on the screen. When the dots are in a box on the screen and in focus, the camera automatically takes the picture because it knows it’s in focus.” The camera can get an image through pupils 2.7 mm in diameter or a bit smaller; it also comes with image management software that allows users to save high-resolution images for use in an electronic medical records system.

The base price of the CR-2 AF is $15,450. For information, visit usa.canon.com.

Zeiss Visucam Pro NM
The Visucam Pro NM will now feature fundus autofluorescence, a function that, until now, was only available on the higher-end model of the Visucam.

“Fundus autofluorescence lets physicians see the condition of the RPE layer,” says Zeiss’ Sunny Virmani. “Certain parts of the retina will fluoresce in different ways based on their condition. In a normal retina, the fundus autofluorescence image would look like a black and white retinal image. However, if there’s any activity going on in parts of the retinal pigment epithelium, they’ll display as bright. The bright areas are an indication that those areas are in danger of dying. If there are any areas of geographic atrophy or RPE atrophy, they will look dark.” Fundus autofluorescence also aids in the visualization of retinal detachment and central serous chorioretinopathy; the detection of hereditary dystrophies, such as Stargardt’s and Best’s disease; and the detection of changes due to hydroxychloroquine toxicity.

In addition to traditional non-mydriatic fundus photos and fundus autofluorescence, the Pro NM has auto-focus, auto-flash and allows users to image the anterior segment.

For information on the Visucam Pro NM, visit zeiss.com.

Ezer EFC-5200/5200 FFA
Ezer, which distributes its cameras through U.S. Ophthalmic (Doral, Fla.), introduced two new cameras in June, the EFC-5200 and the 5200 FFA, with the main difference between the two being that the latter can perform fluorescein angiography, indocyanine green angiography and fundus autofluorescence.

Both cameras can shoot the retina through a 3.3-mm pupil, and have a nine-dot internal fixation target to use for creating mosaic images of the retina. “The 5200 FFA uses optical electromechanical integration to combine digital fluorescein fundus photography, digital video capture and image processing,” says U.S. Ophthalmic’s Henry Morales. “It’s capable of displaying both the continuous, real-time, high-quality color fundus photography image as well as the fluorescein monochrome fundus video image. The color images and retinal fluorescence photos can then be stored and are available for image processing, report generation, lesion measurement, graphical editing and for use with electronic medical record systems.”

For information on either camera system, visit usophthalmic.com.

Canon’s Mr. Laux says the new features on fundus cameras remind him of the advances in prenatal ultrasound. “When my wife had our first child, the ultrasound was very basic,” he says. “Now, however, these ultrasounds are more like pictures of the child. Fundus photography is similar. With signal processing, higher-resolution cameras and the way the image is handled after it’s taken, retinal photography has become a more valuable tool.”