Since incorporating the Spectralis OCT into his routine assessments, optometrist Paul Adler has identified a number of clinical and non-clinical areas that have benefited. Clinically, Adler feels he is less likely to miss pathology, is better able to monitor conditions, is more confident in reassuring patients about their eye health and makes more reliable diagnostic decisions. Non-clinical benefits include perceived prestige, better patient interest and involvement, and improved staff involvement and motivation.
Potential challenges include the initial cost and Adler emphasises the importance of thinking about finance and developing a business model from the start. ‘Calculate the cost per patient,’ he advises from the word go. Staff training is another essential and, despite extra constraints on time, ensure that the clinical and non-clinical benefits are fully realised.
Monitor or refer?
The bulk of Adler’s presentation involved a sequence of real life examples of patients from his practice with a variety of conditions identified and explained using the Spectralis. Better informed patients and assured management decisions ensure practice growth and reputation. Here are a few of the examples discussed.
Male, 82 years
This asymptomatic patient had good acuities (R 6/6-, L 6/6+) and after bilateral YAG laser iridectomies, reported stable vision for the past four years. A single retinal scan revealed significant vitreoretinal traction in each eye (figure 1) which were referred to secondary care for further assessment and patient reassurance.
Female, 53 years
This patient had reduced acuity in the right eye (6/9 from previous measurement of 6/6-) and annular OCT scanning of the horizontally oval small disc revealed partial vitreoretinal traction and evidence of cystoid fluid change (figure 2). The patient was referred – ‘this was the first of these I had ever seen,’ said Adler.
Figure 2
Female, 55 years
This patient complained of recent right vision loss and ‘red and sore’ eyes, though corrected acuity was still 6/6. Single line scan of the retina reveals a clear elevation indicative of a central serous retinopathy (figure 3). ‘Some say these are stress-related,’ Adler explained and, though treatment is unlikely, accurate monitoring and patient reassurance is useful. Figure 4 shows increased elevation one week later.
Figure 3
Figure 4
Female, 57 years
This asymptomatic patient of black African ethnicity had both a sister and a brother with open angle glaucoma, and had herself had bilateral laser trabeculectomies in 2012 but had since ‘been lost to follow up’. IOPs were 15 mmHg right and left, and threshold fields revealed some paracentral pattern loss in the left eye. Figure 5 shows inferotemporal retinal nerve fibre thinning (left eye) and this information would be useful in monitoring change from previous results.
Figure 5
Female, 74 years
This asymptomatic patient was found to have epiretinal membranes in each eye after an OCT scan (figure 6). They are to be monitored in practice.
Figure 6
Read more
Technology in community practice - part 1
Technology in community practice - part 2
Technology in community practice part 4
Paul Adler is an optometrist with an independent family run community eye care practice in Hertfordshire.
Further information on Spectralis OCT at heidelbergengineering.com