Optos MonacoPro: The Case for Ultra-Widefield OCT in Independent Practice

There are currently around 608,000 people on the NHS ophthalmology waiting list in England. Most of them did not start there. They started at an optometry practice, where someone decided whether a finding was worth referring. The quality of that decision depends entirely on what the clinician can see. The Optos MonacoPro is the most comprehensive retinal imaging device available in a single-practice footprint. This is what it does, what it cannot do, and what it means for an independent practice that is serious about clinical excellence.

Independent practices that have invested in OCT have already made the single most important equipment decision of the last decade. Retinal imaging is no longer an upgrade. It is a clinical baseline. But the OCT market has moved on, and there is now a device that combines two things most practices currently do separately — ultra-widefield retinal photography and OCT — in a single unit, in a single capture, for both eyes, in 90 seconds.

That device is the Optos MonacoPro. And the clinical case for it is stronger than the sales brochure suggests.

What standard OCT does not see.

A conventional OCT captures a field of view of 30°-45° of the retina. That covers the macula and the optic nerve head comprehensively. It does not cover the mid-periphery or the far periphery in any meaningful way — and the periphery is where a significant proportion of retinal pathology either originates or signals disease that is systemic rather than purely ocular.

Optos research has found that 97% of eyes with age-related macular degeneration have peripheral retinal changes. Those changes are invisible to standard fundus cameras and to conventional OCT. They are not invisible to ultra-widefield imaging. An independent practice running a standard fundus camera and a separate OCT is structurally missing a part of the clinical picture for every patient it examines.

That is not a criticism of the clinicians. It is a limitation of the equipment. MonacoPro addresses it directly.

What MonacoPro actually does. No embellishment.

MonacoPro is a scanning laser ophthalmoscope that captures a 200° single-shot Optomap image of the retina in less than half a second. It does this without mydriasis, requiring a minimum pupil size of 2mm. It can image through most cataracts. And it integrates Spectral Domain OCT, providing cross-sectional views of retinal structures at up to 70,000 A-scans per second, with axial resolution below 7 microns in tissue.

Five imaging modalities are available from a single device: Optomap colour (red and green laser simultaneously, capturing retinal structure from the sensory retina through to the choroid), Sensory Retina green laser, Choroidal red laser, green autofluorescence, and SD-OCT. Those five modalities, for both eyes, are captured in 90 seconds.

The OCT scan types available are line scan, raster scan, retina topography, optic nerve head topography, and retinal nerve fibre layer analysis. Active eye tracking and automatic scan positioning are built in. The device footprint is 550mm wide by 570mm deep — roughly half a metre square on the consulting room floor.

AreaAssist, new to MonacoPro, automatically measures continuous areas of matching colour and calculates distance and area in millimetres. Objective, reproducible measurements that can be compared meaningfully across appointments — without the manual marking-up that slows clinical review.

MonacoPro's Reference Database allows OCT findings to be positioned against a population cohort, showing where a patient's scan falls relative to the 1st, 5th, 95th and 99th percentiles. Results are filtered by optic disc size and age—a more clinically meaningful approach than databases organised solely by age, which can misclassify patients at the margins.

Clinically validated data show MonacoPro produces a 29.4% improvement in the identification of macular pathology compared with fundus imaging alone.

What it meant for one independent UK practice.

Edmonds & Slatter Opticians, a UK independent practice, adopted MonacoPro after extensive experience with Optos' earlier Daytona and Monaco platforms. Lead optometrist Vikesh Chauhan had been working with Optos ultra-widefield imaging since 2017. At the time the clinical case study was published, the practice was running an average of eight MonacoPro scans per day.

The challenge Chauhan described is one most independent practice owners will recognise. A busy clinical schedule. Multiple devices. Patient movement between rooms. Staff coordination between imaging steps. The constant pressure of delivering a thorough exam within appointment slots that never feel long enough.

MonacoPro collapsed a multi-device, multi-step workflow into a single room, a single device, and a 90-second capture. The clinical picture did not become narrower as a result. It became wider. Two hundred degrees wider.

The two-device cost that no one adds up properly.

Most independent practices running OCT and separate widefield imaging are carrying two capital cost lines, two service contracts, two sets of consumables, and two footprints in rooms that are never quite large enough. The staff time spent moving a patient between devices does not appear in the accounts. It appears in the appointment schedule, as overruns and as the consulting room that is always one piece of equipment too full.

MonacoPro is a single capital investment that replaces both. The correct financial comparison is total cost of ownership — device cost plus annual servicing plus floor space recovered plus appointment time saved — not the device price in isolation. Optos does not publish list pricing publicly; a direct conversation with their UK team is the starting point for a practice-specific quote. But the framing matters. For most practices already running both modalities separately, this is a replacement decision. Not an addition.

For practices that have OCT but no widefield imaging — or widefield but no OCT — MonacoPro is a consolidation to a clinical standard they have not yet reached.

The independent practice advantage. And why multiples will never use it the same way.

In a corporate optical setting, investment decisions are made centrally. The clinical protocol is standardised across the estate. The appointment is fixed — typically 20 to 30 minutes — and the imaging workflow must fit within it. Findings are reviewed, referred if necessary, and the patient moves on.

Independent practices do not work like that. When MonacoPro produces a finding — a peripheral lesion, an OCT showing early drusen, a choroidal image that requires monitoring — the independent clinician has the time and autonomy to sit with the patient and explain what they are seeing. To show them the image on the screen. To describe what monitoring means. To build the kind of clinical relationship that brings the patient back in six months for the follow-up, not to a secondary care waiting list.

The multiples can buy MonacoPro. They cannot replicate the consultation that makes it clinically meaningful for the patient.

There is also the private revenue dimension. An enhanced examination that includes ultra-widefield retinal imaging and SD-OCT of both eyes in 90 seconds is a premium clinical service with a clear, communicable benefit. Independent practices that invest in that capability and charge appropriately for it are building recurring revenue that compounds. Every patient who experiences that level of clinical thoroughness — and understands what they have been shown — is a patient who does not switch practices the next time they find a cheaper sight test advertised online.

What MonacoPro does not do. Be honest with patients.

MonacoPro is a retinal imaging device. It does not replace a full clinical examination. The 200° field does not replicate a dilated indirect ophthalmoscopy examination in every presentation. Non-mydriatic imaging with a 2mm minimum pupil is a significant clinical advantage — it is not identical to dilated examination for every patient.

AreaAssist automatically measures areas of matching colour, accelerating the workflow. Clinical interpretation of what those areas represent remains the responsibility of the clinician examining the image. The Reference Database provides population context for OCT findings. It does not provide a diagnostic conclusion.

As with any imaging device, the output is as useful as the protocol around it. A practice that captures MonacoPro images regularly but lacks a consistent process for reviewing, documenting, discussing, and acting on findings is not deriving clinical value from the investment. Equipment and clinical governance are different things. Both are required.

The referral context that independent practices should consider.

England has 608,000 people on the NHS ophthalmology waiting list. Every peripheral retinal finding that is identified, monitored and managed appropriately in primary care — rather than referred unnecessarily into a secondary care queue — reduces that number. Every appropriate referral that includes a comprehensive imaging record, with 200° widefield documentation and OCT cross-sections clearly labelled, makes the receiving clinician's job easier and the patient's pathway faster.

Independent practices with MonacoPro are positioned to do both of those things more effectively than practices without it. That is a clinical argument and a community health argument, not only a commercial one. When the expanded scope of community optometry is discussed — and it is discussed more seriously every year — it describes a world where independently owned practices with diagnostic-grade equipment are the frontline of specialist clinical contact. MonacoPro is part of what that looks like in practice.

This is exactly the kind of conversation our Grow Independent service is designed for — investing in the right equipment at the right time, at a scale that makes clinical and commercial sense for your practice. Book a Free 20-Minute Practice Growth Call