# Optical Forums > General Optics and Eyecare Discussion Forum >  Optos Optomap

## ExpressOptical

We have been using this technology in our office since november.  I was just wondering what you guy's think about it?

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## orangezero

Decent technology.  Incredibly ridiculous pricing structure by the parent company, imo.  It seems you are only making money for the company, and it just plain sucks you can't buy one for a reasonable amount.

I think the biggest draw is the impression that your office is high tech and up to date.  I cringe every time I see one though.

They need another company to come up with something similar or better and put them in their place financially.  :)

I think a good fundus camera would do a lot more things and be just as effective as a "wow" device to have in an office.

I think another bad thing that I hate seeing is when offices sell it as a "replacement" for dilation.  Its not a replacement, from a standard of care/medico-legal perspective.

What are your feelings?  feel free to pm me...

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## HarryChiling

Lots of hype, the equipment is just a souped up tricked out fundus camera.  The pricing makes it so you are indebted to the company and the machines cost is somewhere in the ballpark of $180,000 which has to be insured in case anything happens to the machine.  You have a quota of pictures you have to meet per month as well as you pay almost half of the collected copays to the company for allowing you to take the photo.  It does allow a wider field of view, but if it was such a worth while piece of equipment to have why has it not poped up inside retinal specialists offices around the country?  You'd think that the company would target these doctors as the first market to exploit.  We did a break even analysis some time ago and it would take us about 50-60 images a month for the equipment to make sense, the quota was somewhere in the ball park of 45 so not much margin for error there.

Also as orangezero mentioned whent he company first began offering this equipment they were offering it as a replacement to dilation, they have only recently revised their stance to a screening.

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## ExpressOptical

To be honest we do mention that in some cases it replaces dialation, BUT if the doctor see's something concerning then he will go ahead and dilate anyway.  The cost is pretty ridiculous, @ 22 bucks cost per patient to us we're charging 35 to the patient, so there isn't much room for profit.  Plus their customer service sucks.  We were having a problem with the latch underneath that you can unlock with a key.  It was popping open and when we called they didn't seem to think it was a big enough issue to send out a repair tech.

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## HarryChiling

> 22 bucks cost per patient to us we're charging 35 to the patient


Do you guys have to meet a quota?  And have you?

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## ExpressOptical

we have to meet a quota to break even, but not so we can keep the optomap in the office.

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## orangezero

i was told somewhere it WOULD be pulled out if they weren't making enough money on it (notice how I phrase that).

there have been some studies attempting to prove this machine could detect peripheral pathology better than certain highly trained and well educated doctors.  i'm sure we would have all heard of them if this was the case.

i've heard of doctors dilating one year, and then doing this the next, but that wouldn't fit into their rental agreement very nicely.



harry, isn't it great we agree on something :bbg:??  someone sticky this thread.

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## ExpressOptical

Well from what I have been told/read the optomap is also a good indicator for other diseases besides eye diseases.  Mainly high blood pressure, diabities and high cholestorol just to name a few.  Have you seen any literature on this??  I am a fairly new optician, i've been working as an optician for 4 months, so I'm no expert on any of this by any means.  I'm just trying to learn as much as possible to better serve my patients and the practice.

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## nickrock

My personal opinion is that it can be a good option for documenting and tracking retinal pathologies, but that is exactly what a good fundus camera is for. The problem with the technology is that the "patented" ellipsoidal mirror provides a distorted i.e. elongated view of the fundus. It also lacks a true stereo view. The price and "lease" is outrageous and outright price gouging. The local optom school uses it after dilation as well as a fundus camera. Certainly NOT a replacement to a dilated BIO exam or if you are billing a 92004,92014 since dilation is required.
My 2 cents

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## HarryChiling

> harry, isn't it great we agree on something :bbg:?? someone sticky this thread.


This company is an equal oportunity exploiter. I guess it isn't too hard to agree on that.

I know at one point you couldn't even bill it as fundus photos because the dpi was terrible, I have heard that this has changed but still its just a fancy new gimmick.




> we have to meet a quota to break even, but not so we can keep the optomap in the office.


That's exactly what I was talking about, you have to pay for lets say 45 pictures per month weather you use them or not.  I guess what I am trying to get at is, is it orth it?

I know when they gave the speal in our neck of the woods they were quoing data from a practice in FL, heaven waiting room.  The demographic is totaly different from ours here in MD and we just couldn't justify it.

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## Ory

> Well from what I have been told/read the optomap is also a good indicator for other diseases besides eye diseases. Mainly high blood pressure, diabities and high cholestorol just to name a few. Have you seen any literature on this??


Diabetes is diagnosed with blood sugar monitoring, hypertension with BP monitoring, and high cholesterol with cholesterol testing.  End of story.

Sure, I have seen patients with retinal pathology who I can pretty much guarantee have diabetes, hypertension, etc., but fundus evaluations are not the best screening tool.  When we had an optomap in the office I tried several times to capture retinal anomalies like microaneurysms with no success.  The machine just doesn't have the resolution.

On a side note:  Once we cancelled our contract with them, the machine still sat in our office for months before they sent someone to remove it.  I guess there just isn't the demand for these things like they would have us believe.

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## ExpressOptical

Our office is guilty of saying it can replace dialation, which I now don't think is a good idea. I'm going to bring it up in our next meeting.

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## scograd

We've had the Optomap for about 4 years now.  In a commercial setting sometimes this is the only way I'm going to get to see any of the peripheral retina.  I tell each of my patients everytime that I recommned that they be dilated or at least have the Optomap.  Most of my patients think that because we're in a mall that we don't dilate.  I do, but I also can't force patients to be dilated.  Also, a lot of people come in during their lunch break, so it's difficult to send them back to work as a presbyope.  Even with the Optomap, it's sometimes difficult to get patients to agree to it, let alone agree to dilation.  I just make sure with everyone that I document that I educated them on the importance of Optos/ DFE, and that they refused.  Ideally I'd like to dilate one visit, Optomap at the next and keep rotating.  My BIO skills are adequate, but it's also nice to have a photodocument, I'll admit that I might not always get a full 360 degrees out to ora everytime!  And with kids, Optos can actually be better!  We charge $35 for it, and we're averging around 200 patients a month.  It's $22.50 for  the first 125, then drops significantly to $7.50 for each one after that, or something give or take that.  It's still rough though when that bill comes in!

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## HarryChiling

> We charge $35 for it, and we're averging around 200 patients a month. It's $22.50 for the first 125, then drops significantly to $7.50 for each one after that, or something give or take that. It's still rough though when that bill comes in!


I really can't talk about it's effectiveness, not my place, but given your figures you are paying out 48% of what you earn with this equipment and the company shares very little risk for essentially becomeing a 50/50 partner.  You pay to insure the equipment (cost), you work the equipment (time and labor), and you sell and collect the fees (time and labor).  They share in the spoils and if you don't meet their monthly minimum they still share in the spoils.  Just sounds like a bad business deal to me.

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## ExpressOptical

as far as the high resolution goes, I thought that the Optomap Plus took higher resolution pics than just doing the regular opto map pictures.  You can focus it on the periphery, or central etc..  I'm not a big fan of it. Mainly because of the technical problems.  It has to be practically broken down to get a tech to come and look at it.

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## kdog2020

We are watching optomap with a cautious eye. It certainly has a wow factor for patients, but our doc has doubts about it as a replacement for a DFE, and of course the pricing schedule is outrageous. Maybe if they would change their business model we would be more interested.

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## Oedema

I had an optomap done on me once - I was not impressed.  First of all, it took about five trys to get an image that wasn't completely obscured by lashes.  Second, I did not appreciate having my face shoved into the instrument, nose squished and bent up against the soft ring pad thing (and my nose really isn not that big). And third, the image quality sucks, equivalent to about 1.2 megapixels I last heard - NOT impressive at all, I mean my cell phone has better resolution.

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## 1968

Our two-year lease of the Optomap recently ended. I would definitely NOT recommend this product to anyone. As far as I am concerned, its a bad product with bad customer service. My complaints mirror those that others have touched on:




> Also as orangezero mentioned whent he company first began offering this equipment they were offering it as a replacement to dilation, they have only recently revised their stance to a screening.


 I remember getting the letter and e-mail which stated something like: Its come to our attention that many of you (i.e. doctors using the Optomap) are placing too much emphasis on the Optomaps non-mydriatic capabilities. I remember thinking, That's specifically how they sold it to me. Why on Earth would anyone want this if not for its non-mydriatic capability?




> When we had an optomap in the office I tried several times to capture retinal anomalies like microaneurysms with no success. The machine just doesn't have the resolution.


 I agree. When our machine was working at its best, the resolution of the optic nerve head was too poor to be useful for screening for glaucoma and the peripheral retina was always too dark to view any pathology that might be out there. On this second point, Optos suggestion was to increase the illumination during image capture which served only to make viewing the optic nerve head more difficult by washing it out. The Optomap in our office routinely failed to catch peripheral lesions that I already knew existed or was able to view with a BIO through non-dilated pupils. As I expressed to my rep, if the machine isnt any good for detecting peripheral pathology and it isnt any good for documenting the appearance of the optic nerve head, what use is it? He stopped staying in touch shortly after that.




> On a side note: Once we cancelled our contract with them, the machine still sat in our office for months before they sent someone to remove it. I guess there just isn't the demand for these things like they would have us believe.


 Similar experience here. After our contract ended, it took Optos about eight weeks to get someone out to remove their machine from our office. I was not going to be in the office on de-installation day, so I left specific instructions for the technician NOT to disconnect our router and DSL modem (which were near the Optomap). Still, the technician de-installing the machine disconnected all of the cables to our offices internet router (rather than just the cable to the computer used by the Optomap) as well as everything hooked to our DSL modem and everything else on the power cord that the Optomap was using. On top of that, I keep getting monthly bills (with an interesting fee increase) from Optos. Ive left messages, e-mailed them, and faxed copies of my e-mails, but they dont respond.

One final comment: Read the find print before signing. My rep never mentioned that we would be responsible for an annual property tax bill of around $750.

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## scograd

Interestingly enough, we just got a FedEx letter today to purchase the system for $155,000.  My favorite is that they will continue to provide support as long as there is a "service agreement in place".  Well who the hell else is going to be able to service it??  It may not always be the best way to look at a retina, but it's better than only plain old 90D thru undilated pupils.

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## HarryChiling

> Interestingly enough, we just got a FedEx letter today to purchase the system for $155,000.


Was it printed on toilet paper?:D

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## Fezz

> Was it printed on toilet paper?:D



I bet it was written on the back of a Preperation H wrapper.

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## DR.P

> Interestingly enough, we just got a FedEx letter today to purchase the system for $155,000.  My favorite is that they will continue to provide support as long as there is a "service agreement in place".  Well who the hell else is going to be able to service it??  It may not always be the best way to look at a retina, but it's better than only plain old 90D thru undilated pupils.


This is interesting since I personally asked about buying the instrument and they refused. I would love to see the letter.
That said, I must disagree with some of the comments.
Many of the comments come from "master Opticians". Meaning no disrespect, but if you aren't the doctor, it is hard for me to take seriously your opinions as to the validity of the instrument.
Another point....profitability. Since you pay only for the images taken, its a cash cow. If you do 200 per month at 15 dollars profit that's $3000/month with no actual cost of goods sold. 
Property taxes...yep! that's a real sticking point. I asked day one about this since it comes with every lease. I was Lied to by the rep. Oh well...
I still make a ton with it and when someone has a retinal detachment or Branch Vein occlusion following the initial photos, you are pretty happy to show the patient that you didn't miss something.
Finally- Time! We all aspire to see more patient in the same time frame. This instrument really helps in that respect.
Yes, it does miss obvious peripheral lesions, but compared to the patient "refusing" dilation and seeing absolutely nothing, its a breath of fresh air.
Allan J. Panzer, O.D.

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## orangezero

> This is interesting since I personally asked about buying the instrument and they refused. I would love to see the letter.
> That said, I must disagree with some of the comments.
> Many of the comments come from "master Opticians". Meaning no disrespect, but if you aren't the doctor, it is hard for me to take seriously your opinions as to the validity of the instrument.
> Another point....profitability. Since you pay only for the images taken, its a cash cow. If you do 200 per month at 15 dollars profit that's $3000/month with no actual cost of goods sold. 
> Property taxes...yep! that's a real sticking point. I asked day one about this since it comes with every lease. I was Lied to by the rep. Oh well...
> I still make a ton with it and when someone has a retinal detachment or Branch Vein occlusion following the initial photos, you are pretty happy to show the patient that you didn't miss something.
> Finally- Time! We all aspire to see more patient in the same time frame. This instrument really helps in that respect.
> Yes, it does miss obvious peripheral lesions, but compared to the patient "refusing" dilation and seeing absolutely nothing, its a breath of fresh air.
> Allan J. Panzer, O.D.


Its my feeling that most of these positives you speak of can be overcome with a good nonmyd camera.  You can buy it, its many times less expensive, and you can actually take much higher quality images.  Plus, isn't a medically needed photo a little hard to justify with the optos, considering its main goal is screening?  At least with a normal fundus camera you can zoom in and get good detail, and more clearly differentiate that from a screening photo.

And if you really wanted to get fancy, you could always use some image integration program and make those nice looking geographic fundus photos, where 5-15 pictures are spliced together.

I still believe a nonmyd is better in almost all regards...  have you seen the newer models lately?  seriously consider then before you sign the next optos lease.  they make out way better than you do.

Even if you could buy the optos, for the same cost you could get two fundus cameras, a slit lamp photo system, an OCT, a pachymetery, an extra lane, and probably a much nicer car than I currently drive.  Not even a comparison.  IF there is an OD or MD willing to actually buy the optos, give me his name and I bet I could sell him some ocean front land in nebraska :)

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## DR.P

> Its my feeling that most of these positives you speak of can be overcome with a good nonmyd camera.  You can buy it, its many times less expensive, and you can actually take much higher quality images.  Plus, isn't a medically needed photo a little hard to justify with the optos, considering its main goal is screening?  At least with a normal fundus camera you can zoom in and get good detail, and more clearly differentiate that from a screening photo.
> 
> And if you really wanted to get fancy, you could always use some image integration program and make those nice looking geographic fundus photos, where 5-15 pictures are spliced together.
> 
> I still believe a nonmyd is better in almost all regards...  have you seen the newer models lately?  seriously consider then before you sign the next optos lease.  they make out way better than you do.
> 
> Even if you could buy the optos, for the same cost you could get two fundus cameras, a slit lamp photo system, an OCT, a pachymetery, an extra lane, and probably a much nicer car than I currently drive.  Not even a comparison.  IF there is an OD or MD willing to actually buy the optos, give me his name and I bet I could sell him some ocean front land in nebraska :)


I unfortunately know that you are wrong. why? Because for one year prior to "leasing" the Optomap, I did exactly what you say. I got a non Myd fundus camera. I did one thousand photos and made $30,000 on an $8000 investment. I bought mine used. There is no where near the ability to detect pathology with it than the optos. That is speaking from four years of experience with the Optomap. Each year I have had the Optomap I have netted $30000 without having to worry about it breaking. they seem to come and repair mine when there is a problem. The first week I had it, I detected a small retinal hole in a twelve year old patient. Could I have seen it without? Of course! Had I dilated her. But we live in a world where everyone wants convenience. I can't tell you the number of patients who only appear every three years for exams because they "hate" the dilation.
When they realize I am willing to perform the optomap instead they say thank you and that they will be back next year. And guess what? They pay cash for it. My penetration rate is as close to 100% as it can get.
And yes, I actually do know a doctor who just bought two of them. Why? Because he was paying the company $9000 per month in fees. So, it was cheaper to buy it. Since I only do 175 to 200, they aren't as anxious to sell me one. I would have happily bought it day one if they offered. 
In the three and one half years I have had it, I have paid them about $100K, so yes I am one of those stupid doctors you seem to think are so dumb.

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## 1968

> The first week I had it, I detected a small retinal hole in a twelve year old patient. Could I have seen it without? Of course! Had I dilated her. But we live in a world where everyone wants convenience. I can't tell you the number of patients who only appear every three years for exams because they "hate" the dilation.
> When they realize I am willing to perform the optomap instead they say thank you and that they will be back next year.


First of all, I'm wondering how inconvenient it would have been for that twelve-year-old to have been dilated. Did he or she have to drive back to work?

Secondly, it's great that you caught a hole without having to dilate that patient. Given your earlier comment that "it does miss obvious peripheral lesions", I'm wondering how many other holes are being missed. How do you address this with your patients?

Finally, the trouble with the Optomap is that your patients don't know what you're missing. It is difficult for me to take seriously _their_ opinions as to the validity of the instrument.

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## orangezero

> I unfortunately know that you are wrong. why? Because for one year prior to "leasing" the Optomap, I did exactly what you say. I got a non Myd fundus camera. I did one thousand photos and made $30,000 on an $8000 investment. I bought mine used. There is no where near the ability to detect pathology with it than the optos. That is speaking from four years of experience with the Optomap. Each year I have had the Optomap I have netted $30000 without having to worry about it breaking. they seem to come and repair mine when there is a problem. The first week I had it, I detected a small retinal hole in a twelve year old patient. Could I have seen it without? Of course! Had I dilated her. But we live in a world where everyone wants convenience. I can't tell you the number of patients who only appear every three years for exams because they "hate" the dilation.
> When they realize I am willing to perform the optomap instead they say thank you and that they will be back next year. And guess what? They pay cash for it. My penetration rate is as close to 100% as it can get.
> And yes, I actually do know a doctor who just bought two of them. Why? Because he was paying the company $9000 per month in fees. So, it was cheaper to buy it. Since I only do 175 to 200, they aren't as anxious to sell me one. I would have happily bought it day one if they offered. 
> In the three and one half years I have had it, I have paid them about $100K, so yes I am one of those stupid doctors you seem to think are so dumb.


I don't think I ever said anyone was dumb or stupid..

What is the point of the optos?  It is for detecting?  Is it for monitoring?  Is it a dilation replacement?  Does the patient's potential expert witness think it is?

I personally don't think its all that hard to convince patients to be dilated if and when its needed.  IF you have a device that is supposedly a replacement for it, sure, its going to be even easier for a patient to decline.  Patients don't like me flipping their lids for gpc, or putting in drops for goldmann tonometry, or getting next to their cornea with a alger brush, but I don't loose sleep at night doing those things when needed.  I'm sure if you asked most people they hate doing any form of tonometry, doesn't mean we should disregard standard of care.  I don't know if patients not liking dilation is a good reason to embrace the optos.

I understand what you are saying, that doing almost 100% optos is probably better overall than 10% consenting to dilation.  Makes sense, no argument needed there..  But I think legally its a scary position to be in, especially if you profit more from the lower standard and have the entire patient experience set up to "sell" optos and minimize dilation.  Juries tend to look at those things.  Not saying its wrong, but I think some docs put themselves in to a position where the cards are stacked against them should things go wrong.

Do you still take additional photos with your other camera?  For example, when you are following a glaucoma suspect?  Or do you just use the optos as a reference in the future?

just curious

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## DR.P

I do not disagree with you about the twelve year old driving. 
what you still don't realize is the power of showing that lesion to the mother rather than just telling her what you saw. And it was so far out that you could never have photographed it even if seen. 
On the other hand, what I will tell you is that it has discovered numerous peripheral holes that when referred were not treated. It seems that the current thinking is that if there is not sufficient fluid under the hole, its not treated no matter how big or small. As to what they are missing, I can assure you that it is a fact that even in the hands of an experienced competent doctor, some lesions are missed. Expecially retinoschisis...and of course, no one treats retinoschisis....so we have gone full circle from referring everything to referring almost nothing.
Finally I want you to think about the thousands of doctors out there who do not dilate nor do they photograph. folks who graduated only a few years before me. What do you suggest? We hunt them down and take away their licenses? (Don't even answer that one)Do you truly believe that the Optomap is not better than a say....65year old optometrist? One who never learned what a BIO is except in journal articles. I hope to let this topic go now...but I really think that some view, is far better than the direct ophthalmoscope I was taught to use in 1975. In Texas, we weren't even allowed to dilate until about 1991. some states even later...
Its great in 2007 to say what it best....but there are surely lots of folks who were educated many many years ago and don't know any better.
Nuff said...

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## HarryChiling

> I really can't talk about it's effectiveness, not my place, but given your figures you are paying out 48% of what you earn with this equipment and the company shares very little risk for essentially becomeing a 50/50 partner.


Dr. P,

I agree that it is not my place to discuss the validity of the tests, so either you missed the above quote (kinda like what I hear the optomap is doing :D ), or you were just screening the posts ;) .  My point is not one from a diagnostic point of view, but from a business point of view.  Our area just recently got the Optomaps installed in most of the "Franchised Pearle Visions", it is important to note "Franchised" as the corporate office decided it was not good enough for the corporate stores, or was to great of a risk.  It is a grea piece of equipment if it truly is given to you as you mentioned on a consignments basis, which is almost what your post implies, but the machine has a quota that has to be reached on a monthly bassis and small offices need to consider this as they make the plunge.  The slow months may very well end up eating away the profits from the good months.

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## H. Erol

So, what happened to all the images that were captured while you had the machine? Do you get to keep them? 

We are considering our options when our lease ends this year. But, if we lose the images, then all the stuff we were telling our patients about the ability to photodocument, etc will make us look very bad. 

Thanks, 

H. 




> Similar experience here. After our contract ended, it took Optos about eight weeks to get someone out to remove their machine from our office. I was not going to be in the office on de-installation day, so I left specific instructions for the technician NOT to disconnect our router and DSL modem (which were near the Optomap). Still, the technician de-installing the machine disconnected all of the cables to our offices internet router (rather than just the cable to the computer used by the Optomap) as well as everything hooked to our DSL modem and everything else on the power cord that the Optomap was using. On top of that, I keep getting monthly bills (with an interesting fee increase) from Optos. Ive left messages, e-mailed them, and faxed copies of my e-mails, but they dont respond.
> 
> One final comment: Read the find print before signing. My rep never mentioned that we would be responsible for an annual property tax bill of around $750.

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## HarryChiling

You loose the images uless you purchase their software to view it, it has something to do with the way the photos are saved, the software from what I can tell only matches photo file names to patient names from the database, I have cracke the password for the database, but it looks like their is a encryption key as well saved with the photo, it has been forever since I hae messed with encryption so I haven't looked into it any further.

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## H. Erol

> You loose the images uless you purchase their software to view it, ...


Any idea how much this software would cost?

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## HarryChiling

I have heard it costs somewhere in the ball park of $2500, but don't quote me on that.  Our doctor had a trial with the optos and we are going with a retinal camera, and a slit lamp camera instead.

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## bt5050

as for our exp. with optos - it has been just the opposit - we had a new one installed  when we had a od changed - anyways - we where havign some issues - and the yech guy from our region - come out within  FEW DAYS - TOPS

i know they where planning on just putting in a new part - however -the rep went above and beyong - and since the unit was less then 1 yr old - he had another new unit sent - 
the unit was shipped i think from france ? ( maybe wrong but somewhere from over seas - and it was in our store with in a week - 
as for gettign a hold of them - not sure if you just have so-so rep - but we have our guys CEL number - as well as email- and sicne they communicate with black berry's - he alwasy gets right back to us - 

As for the unit in general - OUR PTS LOVE IT !! - although it does NOT replace the dilation - but  it is just another tool - to have to give that excellant pt care- and the PTS LVE THE Tech.. gy  - plus a buisness builder -

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## 1968

> So, what happened to all the images that were captured while you had the machine? Do you get to keep them? 
> 
> We are considering our options when our lease ends this year. But, if we lose the images, then all the stuff we were telling our patients about the ability to photodocument, etc will make us look very bad. 
> 
> Thanks, 
> 
> H.


Be sure to back-up your images on to CDs and carefully log the dates. The U-Revu software can be downloaded free of charge from Optos if you elect to get rid of the Optomap. Trying to find images on the CDs can be hassle.

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## 1968

FYI for those using only the Optomap, VSP's provider manual states:




> Internal/fundus exam including direct and/or indirect ophthalmoscopy with or without dilation and, at minimum, a numerical notation of cup-to-disc ratio*





> *NOTE: Fundus photos and Optomap retinal exams are considered by VSP as separate procedures and are not acceptable in lieu of performing direct or indirect ophthalmoscopy.

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## Russ in Texas

In 2006 I happily ended my 3 year lease with Optos.   In my opinion it is not a good deal and I would advise against leasing it.  The pictures are sometimes fantastic and sometimes terrible which bugs me.  I have caught things that I might have missed on a DFE just because not all patients are cooperative during dilation.  I do not think it is a substitute for dilation even though that is how it was marketed to me 3 years ago.

We paid over $2,000 per month for the privilege of having the Optomap in the office whether we used it or not.  In addition to that we were charged about $2,000 in property taxes last year just for leasing the machine.  We started off using it quite a bit in the beginning which offset some of the costs but we gradually became somewhat disillusioned with it and began using it less and less.  In addition to these expenses you have to maintain insurance on the machine while it is your office.

You have to notify the company *90 days* in advance in writing of not renewing your lease or you are automatically renewed for another year. (1 day late and you get another year, and they stick to it.) Ugh!

To sum it up, they have a good start on a product that is not perfected and is sold using an extremely lucrative pricing model (for Optos that is! :angry: ).   Final opinion: Don't do it! :finger:

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## mmm7m

"Finally, the trouble with the Optomap is that your patients don't know what you're missing. It is difficult for me to take seriously _their_ opinions as to the validity of the instrument."



The quote above seems to be authored by a licensed OD.
A true embarasment to the optometry practice.
I wonder how his patients would feel about his general attitude regarding patient care.
Remind me never to send my family or friends to his practice.

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## 1968

> "Finally, the trouble with the Optomap is that your patients don't know what you're missing. It is difficult for me to take seriously _their_ opinions as to the validity of the instrument."
> 
> 
> 
> The quote above seems to be authored by a licensed OD.
> A true embarasment to the optometry practice.
> I wonder how his patients would feel about his general attitude regarding patient care.
> Remind me never to send my family or friends to his practice.


Perhaps you need to check your premises and get to know me a bit better before you toss around fighting words. I've commented elsewhere in the forums that the quality of the Optomap images were extremely poor and did not allow for a very good evaluation of the peripheral retinal. The Optomap frequently failed to capture peripheral retinal lesions that I had observed previously with BIO through undilated pupils. With that in mind, I found it was actually a _disservice_ to offer the Optomap to my patients. In my opinion, a small pupil BIO in the hands of a skilled practitioner is better than an Optomap.

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## OHPNTZ

> I do not disagree with you about the twelve year old driving. 
> what you still don't realize is the power of showing that lesion to the mother rather than just telling her what you saw. And it was so far out that you could never have photographed it even if seen. 
> On the other hand, what I will tell you is that it has discovered numerous peripheral holes that when referred were not treated. It seems that the current thinking is that if there is not sufficient fluid under the hole, its not treated no matter how big or small. As to what they are missing, I can assure you that it is a fact that even in the hands of an experienced competent doctor, some lesions are missed. Expecially retinoschisis...and of course, no one treats retinoschisis....so we have gone full circle from referring everything to referring almost nothing.
> Finally I want you to think about the thousands of doctors out there who do not dilate nor do they photograph. folks who graduated only a few years before me. What do you suggest? We hunt them down and take away their licenses? (Don't even answer that one)Do you truly believe that the Optomap is not better than a say....65year old optometrist? One who never learned what a BIO is except in journal articles. I hope to let this topic go now...but I really think that some view, is far better than the direct ophthalmoscope I was taught to use in 1975. In Texas, we weren't even allowed to dilate until about 1991. some states even later...
> Its great in 2007 to say what it best....but there are surely lots of folks who were educated many many years ago and don't know any better.
> Nuff said...



First, some retinoschisis are treated.  If then encroach far to the posterior pole, I've know of a few retinal specialists who have treated them.  Second, you must be careful with retinoschisis because they can have inner layer retinal holes which may be part a retinal detachment.

I would advise those who have a difficult time with the peripheral retina (especially undilated) to invest in a Volk VitreoFundus lens.  It will open your world to the retinal periphery...if you cannot find an atrophic hole with it in a 12 yr old, something is clearly wrong.

I question the argument regarding the older "refractionists"...even if they do a Optomap, do they even know what they are looking at???

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## npdr

> "... what you still don't realize is the power of showing that lesion to the mother rather than just telling her what you saw..."


 Reading the NY Times today "Hospitals Look to Nuclear Tool to Fight Cancer" reminds me of the Optomap debate. I think the first  utterance by Dr P regarding the value of the Optomap should be highlighted once more, and clearly indicates his perceived value of the Optomap. It is solely marketing and perceived value to improve marketing. In the end, the outcomes are minimal. 

Whether an ophthalmic surgeon treats or not is also subject to the whims of the surgeon. Some laser or cryo strictly because they can do it and no one will object and some will won't because they know there is no significant sequelae. Some more will do it because the referral asks for it.

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## chip anderson

I find the last post on this thread horrifiying. 
The thought that surgery is done on "the whims of the surgeon." 
The even more horrifying the surgery is being done "because the surgeon felt the referer wanted him to."

Whatever happened to practicing medicine for the sole benefit of the patient? Have we really sunk to doing it for the state of the bottom line at the end of the month? Or for doing it for our friends sake? Or so the referrer will get a "referral fee?" Or so the feffer can get paid in the form of "follow-up care?"

God, I think I will start taking my own physicals, eye exams, etc. At least I can trust me, even if I don't know what I am doing.

Chip

Jesus, It bothers me enough when you guys order un-needed tests, costly needless add-ons to lens packages, placebo drugs, useless drops, and silly shifting further exams to other "professionals in the office, when you know you could handle the problem.  Now the surgeons are as corrupt as the prescribers opticians?

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## fjpod

Chip, don't you know by now.  You're the only ethical person left in all the three Os.

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## chip anderson

Gee and there are those that think I am a racist clan member and burns crosses on Saturday night before going to church on Sunday.

Chip:o

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## dbracer

I’d like to echo Dr. P’s support of the Optomap. I’d also like to agree with those who say it is not the best “camera” out there. 

  When I used a camera I had to find the lesion then arduously try to photograph it, a task usually not worth the time and labor. If the lesion was extremely remote, which many are, the photo was questionable at best. And try to train a tech to do it. Good luck. 

  The issue is not the need for high resolution. The issue is the need for efficient immediate discovery. 

  I’ve done thousands of BIO’s since 1976. 

  For an imperfect being with inadequate time and patience to shine a tiny flashlight in a diminutive dark hole, the opening to a cavity the size of large grape, inside the head of a creature that has limited light tolerance and mental stamina all for the purpose of discovering intricate minutia which is inverted and perverted is like trying to find diamond set in a gravel pit while hanging from a cable by your feet at midnight. Consequently I miss things. I know many of you don’t, but I do.

  That is nothing like looking at 90&#37; of the retina for as long as I want, the essence of which can be captured in a quarter of a second through a 2mm pupil. 

Can I see further out with a binocular indirect? Yes, most of the time. Even though the Optos has on many occasions found what I’ve missed.  

  Optos has repaired my camera at no charge and within 2 days.  They’ve kept my softwear up to date. And, Like Dr. P, I make several thousand every month with the darn thing. 

Yet I really don’t care as long as I break even because of what it finds that I don’t, the PR, and the extra fees I’m able to charge well above the photo. If you want to leave that money on the table go right ahead -- these tiny little details I find then remedy, through the grace God and the deliverance of the Optos, I bloody well earn it. 

  In today’s world any technology you buy will be obsolete in 2 years max. Optos has eliminated that and even allows me to make a little money in a small rural practice, and I can opt out if I don't like

  The Optos is not a camera. It’s a diagnostic instrument. But if you don’t want to use one, that’s fine by me in many ways. 

  Respectfully,
  Dbracer.

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## OHPNTZ

"The Optos is not a camera. Its a diagnostic instrument. But if you dont want to use one, thats fine by me in many ways. "



I would argue that the Optomap is NOT a diagnostic instrument.  Rarely do you get 90% view of the retina.  The image does a good job temporally, but superior, inferior, and nasal isn't so hot.  Factor in eyelahes, ptosis, or dermatochalasis, and you're not seeing much retina.

Additionally, you lose resolution of the macula and optic nerve head.  Are you able to determine elevations, thickening, etc...nope.   

I had a patient with a retinal detachment, that after 5 attempts, we were just able to get a glimpse of the detachment with the patient in EXTREME gaze.  If I would rely on the Optomap as a diagnostic aid, and had the patient focus straight ahead, you wouldn't be able to see it.

Again, invest in a Volk SuperVitreous lens...you will see alot more with more magnification than BIO...

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## dbracer

I admit 90&#37; is rather rare.  83% to 85% is our norm if such estimates are even possible -- if not maybe 90's not unreasonable. But then, Our tech is exceptional and she rarely has an eyelash fringe of any type.  Tape is sometimes necessary. 

I've had my tech find detachments I've missed, but I've virtually never had, even a superior defect, that I found that my tech couldn't provide a better view for diagnosis  

No offense, but it may be that you need someone to help you learn how to use your Optos better.  It's an instrument that takes some attention, and you don't master them with one or two hundred shots. After you and your assistant get your heads together -- your clinic doesn't miss much. 

Still, I would never tell you the BIO is obsolete, dilated exams with laser or Volk lenses can't get way the hell out there, or binocular views don't have a considerable advantage. You are right. But when I'm bumping ciliary body with my Optos, many times I find those instruments unnecessary, and it provides a dozen different ways to get paid for my work that a Volk lens doesn't. Those who think they shouldn't get paid for such things are welcome to their plight. They don't have the right, therein, to begrudge mine. 

I'm just saying lets not let the perfect get in the way of adequate.  I jump to the Optos more than the Volk for the rote. I use the Optos on virtually everyone, even welfare, who pay cash, especially when I've been in there with a BIO for the past 6 years.  I sure-as-hell don't put a laser lens on everyone. 

And I will repeat a paragraph I previously provided: 
_For an imperfect being with inadequate time and patience to shine a tiny flashlight in a diminutive dark hole, the opening to a cavity the size of large grape, inside the head of a creature that has limited light tolerance and mental stamina all for the purpose of discovering intricate minutia which is inverted and perverted is like trying to find with a penlight a diamond set in a gravel pit while hanging from a cable by your feet at midnight. Consequently I miss things. I know you don’t, but I do._


Respectfully,
dbracer.

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## 1968

> The issue is not the need for high resolution. The issue is the need for efficient immediate discovery.





> Additionally, you lose resolution of the macula and optic nerve head.  Are you able to determine elevations, thickening, etc...nope.   
> 
> I had a patient with a retinal detachment, that after 5 attempts, we were just able to get a glimpse of the detachment with the patient in EXTREME gaze.  If I would rely on the Optomap as a diagnostic aid, and had the patient focus straight ahead, you wouldn't be able to see it.


I understand dbracer's point that the need isn't necessarily for high resolution, but my experience echoes that of OHPNTZ's. The problems were not tech related. I found that the resolution of the macula and ONH were SO bad that the scans were practically useless. I believe I mentioned previously that the periphery was very dark... increasing the light levels would just wash out the ONH. This was still after two scan heads and who knows how many service calls.

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## dbracer

> I understand dbracer's point that the need isn't necessarily for high resolution, but my experience echoes that of OHPNTZ's. The problems were not tech related. I found that the resolution of the macula and ONH were SO bad that the scans were practically useless. I believe I mentioned previously that the periphery was very dark... increasing the light levels would just wash out the ONH. This was still after two scan heads and who knows how many service calls.


Good Point '68,

Yes, photo adjustment and the correct hi-tech programming is necessary, and you have to read subtlety. 

Some of the GP's to which I send diabetic bleeds etc. seem either to have inadequate imaging manipulation or fail to understand the manipulation needed. I usually wind up adjusting them before I transmit, but it causes a loss of picture quality to the recipient. 

And we do have to remember, it is a 2-dimensional representation.  Still with serous maculopathies I get a reasonable representation especially with their 3rd level resolution. Optos are not panaceas, but they are a heck of a tool, almost as useful inside as a slit lamp outside. 

Respectfully,
dbracer

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## OHPNTZ

dbracer,

The volk super vitreous lens is not a contact lens.  It is about the size of a 90D, yet through its optics, it does not distort as you look to the periphery?

Could you describe your dilated fundus exam?  Is it with 90/78/etc or with a direct?

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## dbracer

Sure OPHNTZ, 

After entry Optos and anterior inspection. Dilate 1&#37; tropic. & 2.5% phenyl. Proceed with various combos of:

BIO w/ 30D & depression, a 20 D rarely (? because it shows up and I can't lay my hands on a 30 ??) 90D w/SL, 3 mirror gonios prn to ID lesion p. and mid-p. and 4 mirror gonios-> angles and anterior inspctn.  I think I own a direct. Haven't seen'em lately.

Well anyway, off the top of my head, that's about it, I think. 

Oh yea, I own two old Reichert MIO's. No longer made. Some have never got to learn to use'em which is disappointing. Takes about 120 days of persistence. They were the best "directs" ever made. Why'd they quit making those and go to those crazy Panoptics? 

And, why'd they quit making dapiprazole?  Loved the stuff. What was that all about? 

I do not own the lens you mentioned. Maybe I should quit teasing my interests in the laser lenses and consider those vitreous "bubbles."  

That's what I love about this profession. There are so many interesting things, now. I can order anything from narcotics to x-rays. I'm limited by little other than my own willingness to accept responsibility. I get to walk on the edge.

Respectfully,
dbracer

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## dojojoe

After reading this string of messages I think it is incumbent upon me to respond to some of the inaccuracies.

1)  The leasing model is a "partnership".  In any partnership the profits are split.  In the case of the Optos lease, the money that is sent to Optos on a monthly basis covers install, training, service, software upgrades, R&D etc.  The money that the practice keeps is profit.  Since there is no up-front costs, it only appears as though the cost is high.  The truth is that for no money down, most practices earn roughly $3,000 to $4,000 per month of incremental revenue.

2)  Practices can charge the patient any price.  The average is about $40.

3) The software needed to view the optomap images is free and can be downloaded from the Optos website  www.optos.com

4)  If you are having difficutlies getting good images, you should contact the company and they will send out a clinical rep to work with your staff.  This does not cost you anything.  If it is determined that it is not the staff but something in the system, Optos will send out a technician to address the problem.  If you are putting up with bad images you have only yourself to blame.

5)  If you have captured images that you want to archive, you can store them on a hard drive, DVD or remote storage.  You most definitely do not lose them.

6)  Optomap IS NOT a replacement for BIO and dilation.  It is designed to be an adjunct.  It is great for documenting the periphery, seeing through cataractous lenses, cloudy vitreous, small pupils, children, and many other important purposes that are not addressed by other technology.  Many thought leaders in the OD community have the system and would recommend it to suitable practices.

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## OHPNTZ

Spoken like a true sales rep...

Let this thread die...


And please stop with the horrible ads with the pictures of the sharks, too bad it doesn't show the whale that would be found in the nasal portion of the retina.

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## allanon

Leasing technology that changes quickly is a good business plan.  Leasing technology that rarely gets updated is a bad idea.  Optomap is #2.

Second, what's the deal of the day?

Third, at a cost of $22/patient, you can get the same wow effect with a $2k Canon retro'd with a Digital Rebel.  Better value, less staff time, same wow, less hassle.

Fourth, nothing beats stereo imaging.

Fifth, a red-free image is inherently hiding things.

Sixth,  it's not an alternative to dilation and you certainly cannot judge a nerve with optomaps sphere-flattening distortions.

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## fjpod

> After reading this string of messages I think it is incumbent upon me to respond to some of the inaccuracies.
> 
> 1) The leasing model is a "partnership". .


Where do equipment companies get off thinking they can walk into my practice as a partner?  Especially if I have to pay you.  You need me more than I need you.

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## Neophyte Optician

I know that this thread is very old, but I'm looking into getting a non-myd camera versus OPTOS.  Can you tell me how to accomplish your 3rd point below??





> Leasing technology that changes quickly is a good business plan.  Leasing technology that rarely gets updated is a bad idea.  Optomap is #2.
> 
> Second, what's the deal of the day?
> 
> Third, at a cost of $22/patient, you can get the same wow effect with a $2k Canon retro'd with a Digital Rebel.  Better value, less staff time, same wow, less hassle.
> 
> Fourth, nothing beats stereo imaging.
> 
> Fifth, a red-free image is inherently hiding things.
> ...

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## eeyespy

Have you made a decision on what to purchase? I am weighing the same options as well

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