Optos vs Zeiss Clarus: Which Widefield Retinal Imaging System Is Right for Your Practice?

The Shift to Widefield Retinal Imaging

Retinal imaging has evolved far beyond the traditional 45° fundus photograph. Today's ophthalmology and optometry practices are moving toward widefield and ultra-widefield (UWF) systems that reveal pathology well beyond the posterior pole — capturing the mid-peripheral and far-peripheral retina where disease often begins.

Two platforms dominate this space: Optos (by Nikon) and Zeiss Clarus. Both deliver dramatic improvements over conventional imaging, but they take fundamentally different technological approaches. Understanding those differences is critical when selecting a system for your practice.

This comparison breaks down the key distinctions in imaging technology, clinical performance, workflow, and total cost of ownership to help you make an informed decision.

Imaging Technology: How They Capture the Retina

Optos: Scanning Laser Technology

Optos systems use scanning laser ophthalmoscopy (SLO) with red and green lasers to capture up to 200° of the retina in a single shot. This is achieved through an ellipsoid mirror that sweeps the laser across the retina in a fraction of a second.

The result is an ultra-widefield image captured in under a second — faster than virtually any competing system. However, Optos produces pseudo-color images rather than true-color. The red and green laser channels are combined to approximate natural color, but subtle color distinctions — particularly those involving blue wavelengths — can be lost or misrepresented.

That's about to change. The upcoming Optos Silverstone RGB (expected October 2025) introduces true-color RGB imaging using a third laser channel, addressing the primary criticism of Optos' color fidelity.

Zeiss Clarus: True-Color LED Illumination

Zeiss Clarus takes a different approach, using broad-spectrum red, green, and blue LEDs to produce true-color fundus images that closely replicate what a clinician sees during direct ophthalmoscopic examination. This is a significant advantage when color nuance matters — identifying subtle hemorrhages, drusen characteristics, or epiretinal membranes.

The trade-off is field of view per shot. A single Clarus image captures approximately 133°, compared to Optos' 200°. However, Clarus supports image montaging: two images yield ~200°, and up to six images can be stitched for a 267° ultra-widefield view — wider than Optos' single-shot maximum.

The Clarus 700, the latest model, also received FDA clearance for ICG angiography (ICGA) in April 2025, expanding its diagnostic capability for choroidal vasculature assessment.

Image Quality and Clinical Performance

Resolution and Detail

Zeiss Clarus captures detail down to 7 microns across the entire ultra-widefield image, maintaining high resolution even at the periphery. This makes it particularly strong for evaluating posterior pole pathology where fine detail matters.

Optos offers excellent depth of focus and better visualization of temporal retinal vasculature, but its resolution can be slightly lower at the far periphery due to the scanning laser architecture. The pseudo-color rendering may also obscure subtle findings that depend on accurate color reproduction.

Diabetic Retinopathy Screening

A 2024 prospective study comparing the Zeiss Clarus 700 and Optos California for diabetic retinopathy (DR) screening found:

• Sensitivity for any retinopathy: Clarus 94.2% vs Optos 91.9%
• Specificity: Clarus 87.3% vs Optos 78.1%
• Additional DR lesions detected beyond conventional imaging: Optos 11.5% vs Clarus 4.3%

Both systems produced DR severity grades comparable to traditional 7-field stereo photography within the standard 7-field area. Optos detected more peripheral lesions outside this area, reflecting its wider single-shot field of view.

Macular Pathology and ERM Detection

For conditions where color fidelity at the macula is critical, Clarus has a clear edge. A 2025–2026 study found that Clarus significantly outperformed Optos in epiretinal membrane (ERM) detection, achieving superior sensitivity. This advantage is directly attributed to Clarus' true-color blue channel, which enhances visibility of retinal interface lesions that Optos' pseudo-color system may miss.

Similarly, for neovascular AMD, the Zeiss Clarus 500 was found superior to older Optos models in detecting smaller lesions at the posterior pole, while Optos showed better peripheral lesion detection.

Fundus Autofluorescence (FAF)

A 2024 real-world study in medical retina virtual clinics found that FAF acquisition success was significantly higher with Optos compared to Clarus, suggesting that Clarus FAF imaging may be more user-dependent and technique-sensitive.

Workflow and Patient Experience

Speed and Ease of Use

Optos is widely regarded as the faster system for image acquisition. A single 200° optomap can be captured in under a second, making it ideal for high-volume screening environments. The non-mydriatic capability means most patients don't need dilation, and Optos can image through cataracts in approximately 85% of cases.

Clarus requires slightly more time per image due to manual positioning for alignment, but its Live IR Preview feature helps technicians optimize alignment before capture, reducing the need for recaptures. The montaging workflow for widefield views also adds time compared to Optos' single-shot approach.

Software and Integration

Both platforms offer comprehensive software suites for image review, annotation, and longitudinal tracking. Key differentiators:

• Optos: AreaAssist software provides automated measurement of retinal areas. The MonacoPro integrates spectral domain OCT directly with UWF imaging, allowing simultaneous structural and photographic assessment.
• Zeiss Clarus: FORUM integration enables seamless connectivity with other Zeiss instruments and EMR systems. The Clarus 700's ICGA capability provides a single-platform solution for fluorescein and ICG angiography.

Head-to-Head Comparison

Which System Fits Your Practice?

Choose Optos If:

• You run a high-volume screening practice and need fast, single-shot 200° capture
• Your patient population has a high prevalence of diabetic retinopathy requiring peripheral lesion detection
• You need integrated OCT in a single device (Monaco/MonacoPro)
• You frequently image patients with cataracts or small pupils
• Peripheral retinal pathology (retinal detachments, peripheral neovascularization) is a primary concern

Choose Zeiss Clarus If:

• True-color imaging is critical for your diagnostic workflow
• You frequently evaluate macular pathology — ERM, AMD, subtle hemorrhages
• You need ICG angiography capability for choroidal assessment
• You want the widest possible field of view (267° via montage)
• Your practice uses other Zeiss instruments and FORUM integration is valuable

The IT Infrastructure Consideration

Whichever imaging system you choose, don't overlook the IT infrastructure required to support it. Modern widefield imaging systems generate large, high-resolution image files that must be stored, backed up, and made accessible across your practice network.

Key IT considerations for retinal imaging deployment:

• Storage: UWF image files are significantly larger than standard fundus photos. Plan for 2–5× your current storage capacity.
• Network bandwidth: Multi-site practices need sufficient bandwidth to transfer images between locations without workflow delays.
• HIPAA compliance: All imaging data must be encrypted at rest and in transit, with proper access controls and audit logging.
• Backup and disaster recovery: A robust backup strategy — including offsite or cloud backup — is essential to prevent loss of irreplaceable diagnostic images.
• EMR integration: Ensure the imaging system's software integrates cleanly with your existing electronic medical records platform.

At UX Genius, we help healthcare practices design and maintain the IT infrastructure that modern diagnostic equipment demands — from network design and HIPAA-compliant storage to seamless EMR integration and ongoing support.

The Bottom Line

Neither Optos nor Zeiss Clarus is universally "better" — they excel in different clinical scenarios. Optos dominates in speed, single-shot field of view, and peripheral pathology detection. Zeiss Clarus leads in true-color fidelity, macular detail, and expanding angiography capabilities.

For many practices, the decision comes down to case mix: if you see a lot of diabetic patients needing fast peripheral screening, Optos is the natural fit. If your practice focuses on macular disease, surgical planning, or conditions where color accuracy drives diagnostic confidence, Clarus is the stronger choice.

And regardless of which system you deploy, make sure your IT infrastructure is ready to handle it. The best imaging technology in the world won't deliver its full value if your network, storage, and security can't keep up.