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👨‍🏫How does HRA operates with patient's eye?

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👨‍🏫How does HRA operates with patient's eye?

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Confocal scanning laser ophthalmoscopy (cSLO) is the method for Heidelberg Retina Angiography (HRA). This method gives the patient comfort and safety by using low light exposure to produce a high resolution of the retinal and choroidal vasculature.

Confocality is used to create images with enhanced contrast, details, and sharpness. With a confocal aperture (pinhole) placed in front of the detector to block out-of-focus light, this method uses a focused laser beam to scan the retina point by point. With this configuration, only light from the focal plane reaches the detector, improving image contrast and the resolution.

By examining the retina point by point, the laser allows for the reconstruction of high-quality two-dimensional and three-dimensional pictures.

The Heidelberg retina angiograph (HRA) classic supports fluorescein angiography (FA) and indocyanine green angiography (ICG-A) of the retina and choroid.

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The technique that used in HRA is confocal Scanning Laser Ophthalmoscopy (cSLO).

A laser beam spreads the fundus in a raster pattern, illuminating consecutive retinal components point by point at speeds of up to 24 milliseconds.

A confocal aperture is placed in front of the image detector at a focal plane that corresponds to the retina. The aperture filters out non-image-forming light to reduce scatter and chromatic aberration.

A photomultiplier captures the light that each retinal spot reflects. The photomultiplier's output is recorded and shown as digital video.

As a result, tiny vessels that were previously undetectable in white flash light photography are now visible in remarkable detail. Unlike standard fundus cameras, the cSLO lacks an optical viewfinder, making aerial-image focusing easier.

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🔎What are the innovative technologies of HRA?

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🔎What are the innovative technologies of HRA?

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👀 What it is:

The latest advancement in Heidelberg retina angiography is the SPECTRALIS® OCTA Module with SHIFT technology, which received FDA clearance in July 2024.

An advanced retinal imaging system developed by Heidelberg Engineering that uses Optical Coherence Tomography Angiography (OCTA) to view blood vessels in the eye without injecting dye. This technology is available exclusively on third-generation Spectralis devices.

✨Key Innovative Features:

1. Faster Scans

•SHIFT technology allows for faster OCTA image acquisition, potentially reducing exam time by up to 50%. This is achieved through a more powerful OCT engine, updated graphics processing technology and software optimization.

2. High-Resolution Images
• Shows tiny blood vessels and detailed layers of the retina clearly.

Helps detect eye diseases like diabetic retinopathy and macular degeneration early.

3. Motion Tracking

• Built-in eye tracking keeps images clear, even if the patient moves slightly.

•This feature helps to minimize artifacts caused by natural eye movement, further enhancing the clarity and accuracy of OCTA image.

4. Cleaner images

• Remove unwanted reflections from upper layers so deeper blood vessels can be seen more clearly. While faster, SHIFT technology maintains image quality, enabling clearer visualization of retinal microvasculature, including fine capillaries.

5. All-in-one system

• Combines multiple imaging methods (like OCT,OCTA and laser scanning) into one device.

• Give doctors a full picture of the retina in one exam.

6. Advanced software

• use a powerful imaging engine and improved software to ensure reliable, consistent results. The increased speed and improved image quality make OCTA with SHIFT technology a more versatile tool for diagnosing and managing various retinal diseases.

7. Customizable Slabs

• The system allows for customized slabs within the superficial and deep vascular plexuses, enabling a more comprehensive clinical evaluation.

8. Projection Artifact Removal (PAR)

• This tool utilizes information from the superficial vascular plexus to remove artifacts, leading to a more precise visualization of vascular structure and pathology.

9. OCTA with SHIFT Technology

• The 125 kHz preset for OCTA with SHIFT technology allows for visualization of flow, even in miniscule vessels, while minimizing artifacts.

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🌐Does HRA plays a crucial role in the future of optometric diagnostics?

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🌐Does HRA plays a crucial role in the future of optometric diagnostics?

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In conclusion, the HRA is an crucial imaging tool used in optometry and ophthalmology to examine the back of the eye, particularly the retina and the choroid. It combines high-resolution imaging with different types of angiography such as fluorescein and indocyanine green angiography. These technologies helps in monitor diseases like diabetic retinopathy, macular degeneration, and other retinal disorders more effectively.

By allowing for earlier and more accurate diagnosis, the HRA supports better treatment planning and helps protect patients’ vision. Understanding how to use and interpret HRA imaging is a valuable skill for anyone entering the eye care field.

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optometrist and Heidelberg Retina Angiograph (HRA) nowdays

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Heidelberg Retina Angiography (HRA) is a high-tech eye imaging system that helps us see the tiny blood vessels in the back of the eye (retina) in very fine detail. Created by Heidelberg Engineering, this tool is used by eye care professionals to check for problems in the retina, especially those that affect blood flow.

🌟 Why is it Important?

HRA plays a big role in spotting serious eye diseases early. It’s commonly used to diagnose and monitor conditions like:

Diabetic Retinopathy

Age-related Macular Degeneration (AMD)

Retinal Vein Occlusion

Central Serous Chorioretinopathy

By helping doctors catch these issues early, HRA can prevent permanent vision damage and make treatments more effective.

🤷‍♀️ How Does HRA Help in Eye Care?

Unlike traditional imaging that can be uncomfortable or blurry, HRA gives super sharp and high-contrast images using laser scanning. It’s non-invasive (no pain) and even works well with dark or hazy areas in the eye. It’s often used together with OCT (Optical Coherence Tomography) to give a full picture of both the structure and blood circulation of the retina.

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The company's illustrious history in the design, production and sale of ocular diagnostic tools is complemented by its significant experience in the creation and use of sophisticated image and data management systems.

Involves more than 5 country such as USA, UK and Finland but they base in USA.

Have 3 types of the Spectralis Modules:

1.      OCT Spectralis

Scanning laser fundus imaging and concurrently collected OCT are combined in the SPECTRALIS® OCT imaging technology.
Being a platform that can be expanded, it can be enhanced with more scanning laser fundus imaging modalities like MultiColor and BluePeak autofluorescence, as well as cutting-edge modules like OCT2 and the Glaucoma Module Premium Edition.

2.      HRA + OCT Spectralis

The SPECTRALIS® HRA+OCT imaging technology combines simultaneous OCT imaging with scanning laser fundus imaging modalities, including as dye-based Fluorescein Angiography (FA). It is an extendable platform that may be enhanced at any time with new modules, including the Widefield Imaging and Ultra-Widefield Angiography Modules, the OCT2 Module and the Glaucoma Module Premium Edition.

3.      HRA Spectralis

The SPECTRALIS® HRA imaging platform has several scanning laser fundus imaging modalities and is specifically built for dye-based angiography, including Fluorescein Angiography (FA). Since the platform is scalable, it may be enhanced at any moment with other scanning laser fundus imaging modalities, such MultiColor, Ultra-Widefield Angiography Module or ICGA imaging.

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The SPECTRALIS HRA-OCT is based on a Confocal Scanning Laser Ophthalmoscopy (cSLO) platform that is very sensitive to fluorescence to fluoresceine or ICG dyes. This offers excellent contrast and targeted imaging in still images or Heidelberg's special high speed imaging (videos).

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1. High-Resolution Imaging

Function: Provides crystal-clear views of the retina and choroid layers. Making it easier to detect even subtle eye problems that might go unnoticed with older imaging systems.

2. Fluorescein Angiography (FA)

Function: Uses a yellow dye to track blood flow through the retina and helps find leaking, blocked or swollen blood vessels, especially useful in diseases like diabetic eye disease and macular degeneration.

3. Fundus Autofluorescence (FAF)

Function: Captures the natural fluorescence of retinal tissue without the need for dye. Reveals early signs of damage to the retinal pigment layer, making it easier to catch diseases like AMD early.

4. Blue Reflectance Imaging (Red-Free)

Function: Uses a 488 nm blue laser to generate detailed, high-contrast images of the retinal nerve fiber layer. This technique is especially valuable for early diagnosis of glaucoma and detecting optic nerve abnormalities.

5. Confocal High-Contrast Imaging

Function: The HRA Classic uses confocal scanning laser technology to block scattered light, enhancing image clarity. It provides sharp, detailed images and enables optical sectioning, making it easier to distinguish between different layers of the retina.

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Mostly supplied in Canada ophthalmic communities.

Heidelberg's original HRA angiography platform in its current version. The SPECTRALIS HRA is based on a Confocal Scanning Laser Ophthalmoscopy (cSLO) platform that is very sensitive to the fluorescence of fluoresceine or ICG dyes and was intended for angiographies. This offers high-contrast, focused imaging in pictures or Heidelberg's special high-speed imaging (movies).

Features of the HRA

High Resolution Angiography Imaging:

The SPECTRALIS HRA's cSLO imaging technology provides exceptional detail.

High Speed Angiographies:

SPECTRALIS HRA's cSLO technology allows for the acquisition of many pictures in a second since it is not constrained like flash imaging technology. This makes it possible to obtain videos in which every frame is a full-resolution picture.

Dual Imaging Capabilities:

FA and ICGA angiographies may be performed side by side thanks to SPECTRALIS HRA's dual imaging capabilities. These many imaging modalities offer useful insights because to these special capabilities.

Auto composite Imaging:

Any technician may simply expand the field due to the SPECTRALIS HRA's panning head and live composite imaging.

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One of the largest optometric suppliers in Asia.

For simple acquisition and customization, the Heidelberg Spectralis HRA + OCT may be equipped with an external touch panel control and an optional panning camera headset. The system is capable of widefield and ultra-widefield imaging thanks to a number of image modules.

Also provide one system of HRA + OCT as this technology gives more benefits to users compared to the single one.

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The indocyanine green angiography images of a 78-year-old male neovascular age-related macular degeneration patient. (a and b). Early phases of angiography (c). The mid-phase of the angiography (d). The late phase of the angiography; white arrow shows the hot plaque formation secondary to occult choroidal neovascularization.

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6. Indocyanine Green Angiography (ICGA)

Function: Uses a near-infrared dye to image blood vessels deep beneath the retina. Ideal for diagnosing issues like hidden choroidal conditions and tumors that can’t be seen with fluorescein alone.

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1. Trutrack Active Eye Tracking

The system uses two beams of light at the same time:

The first beam scans and captures the retina while tracking over 1,000 points to monitor any eye movement.

The second beam uses this tracking information to stay focused on the exact same area, even if the eye blinks or moves suddenly (saccades).

This feature is important when patients return for follow-up scans, the system can automatically scan the exact same area again, eliminating differences caused by the operator. It can detect and measure changes as small as 1 micron, making it ideal for monitoring disease progression or treatment response with great precision. This technology helps reduce errors, improves consistency, and saves time for optometrists.

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The HRA 2 is a small, multimodal confocal scanning laser ophthalmoscope that can take sharp pictures of the choroid and retina. Compared to previous models, it provides better image quality, increased diagnostic precision and increased user comfort.

1. Simultaneous FA + ICGA Imaging

This technique uses two lasers to simultaneously capture fluorescein angiogram (FA) and indocyanine green angiogram (ICGA). It allows for the simultaneous presentation of choroidal and retinal circulation, which saves time and increases diagnostic accuracy and beneficial for diseases such as diabetic retinopathy, AMD and CNV.

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2. Heidelberg Noise Reduction

The system takes multiple images of the same area. It filters out random "visual noise" (unwanted speckles or static) and keeps only the parts that are consistent across all the images—which come from real, physical eye structures.

The result is a much clearer and sharper image with finer detail. It helps optometrists see tiny changes or structures in the eye more accurately, improving diagnosis and patient care.

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3. Multicolor Imaging

The SPECTRALIS MultiColor Module uses a special laser scanning method instead of regular white light and optics to capture detailed images of the retina. This technique uses three different laser wavelengths—blue, green, and infrared—at the same time to highlight different layers and structures in the eye.

A study titled “Identifying features of early and late AMD” found that MultiColor imaging is more sensitive than traditional Color Fundus Photography (CFP) when detecting early signs of age-related macular degeneration (AMD), using data from 105 eyes.

High-resolution images are produced that highlight minute characteristics missed by fundus shots or routine eye exams. The pictures can be seen as a single color image or divided into separate images of infrared, green, and blue reflectance, each of which provides distinct information.

🔵Blue reflectance: Ideal for observing surface-level alterations, like abnormalities in the nerve fiber layer or epiretinal membranes.

🟢Green reflectance: Emphasizes exudates, blood, and vessels.

🔴 Infrared reflectance: Displays deeper layers, such as the choroid and retinal pigment epithelium.

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2. High-Resolution & High-Speed Imaging

Provides dynamic video acquisition (up to 16 frames/sec) and image resolutions of up to 1536 × 1536 pixels. It makes early-phase angiography videos possible, which are ideal for spotting minute details like RCA/RAPs or feeder arteries.

Retinal and choroidal diseases can be seen in three dimensions due to optical sectioning (64 focus planes) and high resolution (5 μm).

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3. Stereo and 3D Imaging Quickly

It captures stereo picture pairs without requiring the patient to move or feel uncomfortable by light flashes.

Clear 3D reconstructions are made possible by depth scanning of up to 8 mm, which is particularly useful for cancers like choroidal melanomas.

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1. Hassenstein, A., & Meyer, C. H. (2009). Clinical use and research applications of Heidelberg retinal angiography and spectral‐domain optical coherence tomography – a review. Clinical and Experimental Ophthalmology, 37(1), 130–143. https://doi.org/10.1111/j.1442-9071.2009.02017.x

2. Heidelberg Engineering. (2021, March 5). Research Timeline - Heidelberg Engineering GmbH. Corporate INT | Corporate Website Heidelberg Engineering GmbH. https://www.heidelbergengineering.com/int/research-timeline/

3. Mennel, S., Schwendinger, R., Hausmann, N., & Peter, S. (2007). Accessory optical device for the Heidelberg retina angiograph ( HRA classic ) to perform angiography of the vitreous cavity and the anterior eye segment. Indian Journal of Ophthalmology, 55(4), 295. https://doi.org/10.4103/0301-4738.33043

4. Ophthalmology Web. (2025, April 10). SPECTRALIS Diagnostic Imaging Platform from Heidelberg Engineering, Inc. - Product Description and Details. Ophthalmologyweb.com. https://www.ophthalmologyweb.com/6001-Spectral-Domain-OCT-Optical-Coherence-Tomography-SD-OCT/55059-Spectralis-Diagnostic-Imaging-Platform/?pda=5641%7C55059_1_0%7C%7C%7CHRA

5. OCT Angiography Module with SHIFT Technology - Non-invasive imaging | Heidelberg Engineering. (n.d.-b). https://business-lounge.heidelbergengineering.com/us/en/products/spectralis/octa-module-with-shift-technology/

6. Ryan Tourt. (2017, June 1). Heidelberg HRA spectralis AF/FA camera [Video]. YouTube. https://www.youtube.com/watch?v=gjNTyUb-HSM

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4. Low Light Exposure - Enhanced Patient Comfort

The HRA 2 uses precise laser scanning instead of bright flashes, reducing light exposure to just 1% of what traditional fundus cameras require.

This makes the procedure safer and far more comfortable, especially for patients who are sensitive to light, such as children or those with eye conditions.