Imagine waking up blind, imagine knowing it was preventable!
One of the biggest fears for someone who has had sight all their lives is to lose it, whether gradually or at once. Yet, more and more people are losing their eyesight due to preventable conditions.
Many issues can contribute to loss of eyesight including age, cataracts, corneal dystrophy, diabetes, glaucoma amongst others. Fortunately, with advances in technology, doctors can detect and arrest the progression of the diseases early enough to save the patients eyesight. The Optical coherence tomography (OCT) is one such technology.
What is an Optical Coherence Tomography (OCT)
The Optical Coherence Tomography (OCT) is a procedure that uses light waves to take detailed 3D images of the retina in a non-invasive manner and provides important information on the state of the eyes. The layers of the retina provide important data that can help in the diagnosis of diseases like glaucoma and retinal diseases. The information received also helps in determining courses of treatment specific to the diagnosed condition. The best part about the whole process is that it takes a very short time; in less than 15 seconds the optometrist will have the 3D image and be able to interpret and discuss the results and way forward with the patient almost immediately.
What should the patient know about the examination?
The doctor will walk the patient through the steps he will take before the eye examination begins with the first being dilating of the pupils to ensure that the light from the Optical Coherence Tomography (OCT) machine does not cause them to become smaller. The doctor will use dilating eye drops to achieve this. You will then ‘rest’ your eyes for approximately 30 minutes to allow the pupils to fully open up. The procedure is painless although there may be an initial sting. Once the pupils dilate, you will experience blurring and have difficulty focusing.
The process may be traumatic to younger children who will not understand what is going on and so the caretaker may not to provide some reassurance. You may need sunglasses to protect your eyes due to light sensitivity for a few hours afterward.
The OCT will scan the eyes for about 5-10minutes.
Are there advantages and disadvantages to the Optical Coherence Tomography
Like any other medical test, there are pros and cons. These include:-
- The OCT scan provides for early detection/diagnosis of eye diseases thereby preventing sight loss.
- The computerized process is quick and produces instant results and large amounts of data.
- It allows for increased efficiency in diagnosis, management, and patient follow-up thus a great benefit for both patient and doctors.
- Communication tool: The OCT is a great tool for doctor-patient education where the doctor explains what is wrong using actual images thus creating a better understanding of the patient. It also aids in doctor-doctor communication and co-management where sharing of information between and among peers by the consulting doctor occurs over emails or smartphones without the need to travel distances for consultation.
- The technology opens up new revenue streams, from, for instance, consultation costs assuring return on investment. It is possible to recover the money used to buy the machine within a year or two making it a worthwhile investment for a business.
- Some companies are offering leasing options or purchase plans for the OCT equipment. This can help smaller practices acquire the machines which are quite costly. With the leasing option, it becomes cheaper for the smaller business as all they need to do is continually update the software.
- The more modern OCT versions are easy to use and do not require extensive training to master.
- OCT technology is on an upward trajectory in terms of improvements including size reduction to make them more portable, the software is constantly evolving and the efficiency of the machines in terms of speed and quality of the resolution is becoming better and better.
- OCT technology is expensive making it nearly impossible to purchase especially for the smaller clinics.
- Due to the fact that it depends on light waves, it is not suitable for use on patients with cataracts or those experiencing bleeding in the vitreous. Children may not understand the process and can become traumatized and therefore difficult to accurately assess because of movement.
- Technology should not be a substitute for a clinical examination of the patient. The fact that it is relatively new and constantly evolving technology means the doctor has to be careful about how he interprets the data received. It is important not to rely too much on the computer generated interpretations of the scans.
What is the latest Optical coherence tomography (OCT) technology available in the market?
Since the introduction of the OCT technology in 1991, the technology has undergone massive improvement and technological updates by the manufacturing companies. We will provide a review of some of the latest OCT technology currently available.
1. PRIMUS 200 from Zeiss- Simple and intuitive
Do you have a small practice that could benefit from owning your own OCT machine? Then the PRIMUS 200 from Zeiss is one you may want to consider. Not only will the machine improve efficiency in your practice as you will no longer need to send your patients to other places for scans. Your communication with your patients will greatly improve. You will enhance the management of your records and best of all you will have a new revenue stream your business.
High definition B-scans and fundus imaging
There are situations when an optometrist will face challenges when trying to examine the eye normally due to obstructions caused by certain conditions like cataracts. The B-scan is able to deliver scans from a closed eye and provides two-dimensional cross-sectional views of the eye and orbit. It is especially useful in diagnosing retinal detachment. The fundus imaging on Ythe other hand provides interior shots of the eye
Minimal chin time
The OCT machine requires a patient to sit facing the machine with the chin supporting the head. Due to its wide refraction range for high myopia patients and the ability to scan as small as 2mm pupil without dilation, the patient sits comfortably throughout the process.
Report driven workflow
The machine allows you to complete the scan in 3 simple steps.
- To get the required scan simply select the desired report and it will generate automatically.
- To get quality scans with real-time feedback, use the system guided navigation
- The machine will automatically pre-select reports that you can scan with the click of a button.
- Automatically locates the fovea using the Auto FoveaFinder™ and AutoCenter™ .
- Joystick operation
- Friendly user interface
2. OCT cirrus 5000 from Zeiss
The OCT Cirrus 5000 has high-resolution capabilities coupled with advanced clinical applications that easily track FastMap™ epithelial integration and ganglion cell analysis. The FDA approved OCT Cirrus has the CE Mark and uses normative data comparison and RNFL analysis in its measurements.
The OCT Cirrus helps doctors make an accurate diagnosis because of the amount of detail and high definition imaging it produces. It also saves on time spent on rescans because it gets it right the first time by accurately focusing on the fovea. The resulting high-resolution image simultaneously highlights detail in the vitreous, retina and choroid.
- FastTrac™ retinal tracking
- Ganglion cell analyses
- Advanced RPE tracking
- Wide-field structural damage assessment glaucoma
3. Compact, space-saving – Topcon OCT 2000
Most OCT machines are big and require a lot of set-up space. The Topcon OCT 2000 is a first of its kind due to its compact design that saves on space. It is suitable for all levels of practice, from a small clinic to a large hospital.
The Topcon OCT 2000 has a user-friendly color touchscreen and a high-resolution 12.3-megapixel automated color fundus camera thus quickening the image acquisition process
FastMap™ software aids in patient comfort
The FastMap™ software is easy to use and provides 2D, 3D and fundus images simultaneously. The compare function allows for side by side comparison of serial exams. It also has a noise reduction algorithm and overlapping scanning technology for high-resolution images that are available almost immediately thereby increased efficiency and enhanced patient comfort due to less chair-time.
Pin Point registration
It features enhanced 50,000-A-scans per second. This produces clear retinal images due to the fact that it minimizes artifacts generated by eye movement. The Topcon OCT 2000 is also easy to use due to its friendly interface.
The 3D OCT 2000 has an Ethernet connection that allows for remote access for software updates and to minimize instrument downtime. Images are virtually accessible anywhere and anytime as long as you have an internet connection and a laptop or smartphone.
Ergonomic Control functions
The machine is so easy to use that even an entry-level technician can comfortably use it. It has ergonomic controls including the directional control stick, capture button, electric chin control, and fixations adjustments.
- Auto center detection of the fovea and optic discs
- IR tracking functions
- Circle scan diameter correction
4. Deeper imaging – DRI OCT Triton from Topcon
The DRI OCT Triton is the first machine of its kind to utilize the Swept source technology.
Swept source OCT
The DRI Triton utilizes the Swept source technology which uses long wavelength scanning light (1,050nm) to give better penetration of the layers of the eye. It can, therefore, cut through cataracts, hemorrhages, blood vessels, and sclera. The scanning light does not distract patients and is especially useful for the elderly and young patients.
The Swept Source technology also visualizes over the vitreous and choroid in a single scan thus eliminating the need for two separate scans.
The DRI Triton is currently the world’s fastest OCT scanner at 100,000 A-Scans per second. This allows for the collection of more data in the shortest time possible.
It offers full color, high-resolution fundus imaging, FA and FAF photography and wide field imaging while using a very low-intensity flash
- SMARTTrackTM New tracking system – detects and compensates for involuntary eye movement.
- Pin Point registration
- Monochrome sensor
- Anterior segment analysis
5. Complete retinal imaging – ivue OCT from Optovue
The Ivue is a portable OCT machine that allows for flexible configurations. You can use it as a stand-alone or together with the icam fundus camera for enhanced access to the retina, never fiber layer and anterior segments of the eyes. To help in disease diagnosis, it can quantify results, track changes and predict trends.
Ease of use
The streamlined interface makes the scanner quick and easy to use. The Optovue academy also offers training online for technicians.
- Epithelial (GCC and RNFL) thickness mapping
- Focal and Global Loss volume analysis
- Slit-lamp design
6. Simplified operations – iScan OCT from Optovue
The iscan OCT provides all the functions of a traditional OCT machine with the added benefit of simplified operations that make it extremely user-friendly.
Looking for a machine that sets the standards in simplicity? The process of operating it is as simple as pushing a button due to the user-friendly interface. The iscan automatically aligns the camera for scanner acquisition due to the pupil alignment technology.
The iscan vocally guides the patient through the process in 12 languages; all you need to do is select your preferred language and let it guide the patient.
Truly portable, the iscan is as small as a desktop computer thus space saving. All you need to do is plug it in, switch it on and start scanning.
This is a standard feature in the iscan. The iwellness retinal exam will help identify signs of disease even before the doctor does a clinical examination. The patient is therefore educated and involved in the treatment and management process. The separate billing will generate a new revenue stream for your business.
- OCT fundus image
- 26,000 A-scan per second
- Minimum pupil diameter 2.5mm
Is the OCT a good investment for my practice?
We would venture a yes to that question. Taking into consideration the pros and cons, the most important should be the need to increase efficiency and efficacy in the diagnosis and management of eye conditions. The fact that you can establish a diagnosis and treatment center for your patients in the comfort of your practice without referring them to another facility is a big plus.
The patient is also able to ‘see’ what is wrong, and better understand whatever it is you are trying to explain to them. Further, not only does it bolster patient confidence in you as the doctor, but it also helps you communicate better with the patients and also impart invaluable knowledge to them. Most patients are more willing to adhere to what the doctor prescribes once they have a clear understanding of what is ailing them.
The OCT technology enhances record which assists in follow-up and the management of the condition.
However, it is important to note that other than the initial cost of purchasing the hardware, you will have to continually invest in improving the software. The team will require expert training on the use of the OCT machine and the continually improving software as well as how to interpret the data and images which take practice and skill development.
So to answer the question of whether the OCT technology would be a good investment for your practice is a decision that you can arrive at only after carefully weighing the pros and cons and whether what you currently have worked for you.
The world is evolving rapidly when it comes to technology and it would be a good idea to keep up with the changing trends.
Conclusion The technology available in the market to help doctors prevent the development of diseases like Glaucoma and other retinal complications are immense. The use of Optical coherence tomography (OCT) is, therefore, a method that has gained momentum and has significantly contributed to the reduction in the cases of loss of eyesight because it allows for early detection and treatment of diseases.
The world cannot overlook the increased efficiency due to the OCT technology. The machine scans and generates reports in seconds, all within the confines of your practice. Gone are the days when a doctor would need to send the patient to an expert to do and interpret the scans. The improved patient-doctor communication facilitated by the use of the machines is also a major plus.
Doctors have to move away from traditional ways of examining eyes and embrace the technology that is available. The use of OCT can help in the diagnosis and care of eye conditions.
Ophthalmicmart blog supports your practice by providing professional perspectives, educational editorials and articles relevant to the profitable advancement of Ophthalmic practice or your practice and will upgrade advice.
Latest posts by Soren Milano (see all)
- Revealing the Retina: Optometry Corneal Topography - February 12, 2019
- Everything You Need to Know About Optical Coherence Tomography - December 2, 2018
- Optometrist diagnostic equipment in the diagnosis and detecting of glaucoma - October 19, 2018