Dec 2017

Is multicolour imaging
better for AMD?
A
new study¹ by the Centre for Public Health at
the Queen’s University in Belfast, Northern
Ireland, has shown that multicolour imaging
has a higher sensitivity for detecting early agerelated
macular degeneration (AMD) compared to
colour fundus photography (CFP).
The study which used a sample of 105 eyes
and the Spectralis Diagnostic Imaging Platform
muliticolour option, was led by Professor Usha
Chakravarthy.
“This systematic analysis of colour fundus
photography versus multicolour demonstrated the
robustness of multicolour imaging in the detection
of early AMD features,” she said. “The ability to
delineate atrophy and fibrosis in late stage AMD
gives added value in the clinical setting, as these
components of the wet AMD lesion have an
important impact on visual function.”
In cases with discrepancies, an analysis of OCT
also showed better agreement with multicolour for
all AMD lesions, with the exception of haemorrhage
and non-geographic atrophy hypopigmentation. For
The Spectralis MultiColor Module is an imaging modality which uses
confocal scanning laser technology instead of white light to visualize
the retina
pigment clumping,
CFP and multicolour
were in equal
agreement to OCT,
the study found.
Multicolour imaging
was able to identify
soft drusen in 85%
of the eyes studied,
Dr Jim Borthwick
reticular drusen in 83% and atrophy and fibrosis
in 100% of cases where these abnormalities were
seen on CFP. When using multicolour as the basis
for analysis, however, CFP was less sensitive. In
this study, soft drusen were identified in only 58%,
reticular drusen in 28%, atrophy in 83%, and fibrosis
in 68% of the cases where such changes were seen
on multicolour images.
Dr Jim Borthwick of Southern Eye said he’s been
using the Spectralis multicolour module for nearly
three years and is impressed with its capabilities
for macular degeneration. “It is great. I’ve found
it very useful for macular degeneration because it
shows up the deeper layers.”
Compared with CFP, the multicolour platform
is proving to be particularly useful for spotting
reticular pseudodrusen, which have been
recognised as important for both identifying
MD and assessing its severity, he said, and for
better visualisation of epiretinal membranes for
preoperative evaluation.
But you do have to get used to using it, said
Dr Borthwick, and it too has its limitations. “For
example, it’s not as good at showing up naevi as a
colour photograph. So, they both have a role. But
it’s certainly a very useful extra tool for macular
degeneration.”
The Spectralis MultiColor Module, is a newer
imaging modality which uses confocal scanning
laser technology with light of discrete wavelengths
instead of standard optics and white light to
visualize the retina. It uses three laser wavelengths
– blue, green and infrared – simultaneously to
provide diagnostic images that show distinct
structures at different depths within the retina.
Each offers unique details, said the company,
New J&J surgical rep
J&J Vision (formerly AMO) has appointed
Camille Furnandiz as a specialist sales
representative for New Zealand, effectively
doubling New Zealand’s on the ground surgical
sales team.
The New Zealand market for J&J Vision has
grown significantly in the last 12 months, says
Helen Cameron, J&J Vision’s surgical sales manager
ANZ, so the country needed additional support,
especially in Wellington and the South Island.
Appointing Furnandiz is an exciting step for the
company as it demonstrates J&J’s commitment
to New Zealand and especially, given Furnandiz’s
background in general surgical, to New Zealand’s
ophthalmologists and registrars, she says.
Furnandiz says she’s thrilled to be on the team
and is loving learning about ophthalmology
and especially cataract surgery. “I’m very
excited about this role. Eyes is the most civilised
speciality and cataracts just have such finesse.”
She’s particular excited to be working with
the ophthalmology registrars, she says, which
is something she also enjoyed in her past roles
in general surgery. “I’m very passionate about
educating the registrars, because they are the
future, so anything we can do to help upskill and
partner with them benefits all of us in the future.”
As well as sponsoring the annual NZORC
(ophthalmic registrars conference), Furnandiz
has put together a registrar training programme,
which she’s run in Wellington and is planning
due to the penetration depth and reflectance
properties of each individual wavelength used:
the infrared reflectance image shows deeper
structures in the choroid and the retinal pigment
epithelium; the green reflectance image is
useful for examining blood, blood vessels, and
exudates; while the blue reflectance image is
best for identifying changes in superficial retinal
structures, like epiretinal membranes or retinal
nerve fibre layer defects.
“It is encouraging to see the clinical significance
of the multicolour module proven in a large study
related to a prevalent pathology such as AMD.
Beyond the clinical value, clinicians also appreciate
the fact that multicolour images can be acquired
Camille Furnandiz, joins the J&J surgical sales team in NZ
on running in Christchurch and Dunedin next
year. The programme covers wet labs, phaco and
IOL education. J&J also runs a free toric training
programme for registrars, towards the end of
their training, which is popular in Australia, but
is not well-known in New Zealand; something
Furnandiz plans to change.
Prior to joining J&J, Furnandiz was surgical
business development manager for Medtronic’s
minimally invasive therapies group, a senior
technical consultant with Coviden and a key
account manager with EBOS Healthcare.
Furnandiz will be based in the capital, with
responsibility for Wellington, the Hawke’s Bay,
Palmerston North and the South Island, while
Matthew Northage will continue to be based in
Auckland, covering the rest of the North Island.
through undilated pupils and in patients with
media opacity or even nystagmus. While we don’t
see multicolour as a substitute for colour fundus
photography... it is a particularly useful diagnostic
tool that can be combined with other imaging
modalities,” said Dr Kester Nahen, managing director
of Heidelberg Engineering, maker of the Spectralis.
References
1. Identifying features of early and late AMD: A
comparison of multicolour versus traditional colour
fundus photography by Katie W. Graham, Usha
Chakravarthy, Ruth E. Hogg, K. Alyson Muldrew, Ian S.
Young and Frank Kee, was published digitally in August
and will appear in the November issue of Retina
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