The ABC of OCT

OCT scans enable clinicians to identify and manage ocular pathology early – helping to prevent avoidable sight loss.

While optometrists are responsible for reviewing and interpreting OCT scans, the broader practice team is key to ensuring the successful implementation of this technology.

From education to image capture, OT explores the important role that support staff can play in offering OCT with Bansri Shah – a dispensing optician and director of Hakim Group independent practice, Eyelink Opticians, in London.

The vital role of support staff

Shah told OT that support staff play an “increasingly important role” in capturing OCT scans at Eyelink Opticians.

“They undertake key elements of the imaging process, including patient preparation, positioning at the instrument, and selection of the appropriate scan protocol,” she said.

Shah noted that team members also help to ensure high-quality images by checking signal strength, confirming correct centration and identifying artefacts – such as blink or motion distortion.

“Where scan quality is suboptimal, repeating the capture before the patient leaves the imaging station helps ensure optometrists have reliable images available for assessment,” she shared.

The practice director observed that manufacturer-led training is often the starting point for practice staff to become familiar with the technology, with in-practice training then reinforcing this knowledge.

“Our optometrists supervise team members while they practise capturing scans. This stage focuses on developing practical competence, including achieving good alignment, ensuring adequate signal strength, and recognising when a scan needs to be repeated. We also use step-by-step protocols to ensure consistency,” Shah explained.

New practice team members initially observe experienced colleagues performing OCT scans before progressing to performing scans under the supervision of optometrists.

Shah noted that this process enables staff to develop confidence while ensuring that image quality standards are maintained. The practice also has short reference videos that team members can use for guidance.

“Competency assessment and ongoing supervision are important,” Shah highlighted.

“We document when a team member has demonstrated competence in image acquisition, and have supported a culture where everyone is empowered to ask questions to ensure continued development,” she said.

Hakim Group

Bansri Shah, dispensing optician and director of Eyelink Opticians (on right), has seen the benefits of OCT in practice

Practice benefits

Shah observed that training non-clinical staff to perform OCT scans has “significantly enhanced the efficiency and effectiveness of our practice.”

She noted that one of the main benefits is improved clinical workflow within the practice.

“When trained team members capture OCT scans as part of the pre-testing process, our optometrists can review the images during the consultation rather than interrupting the examination to obtain them. This helps streamline appointments and makes better use of clinical time,” Shah said.

The dispensing optician highlighted that having a structured training programme and clear protocols around OCT scans results in more reliable imaging – improving the quality of information that is available for clinical interpretation.

“Integrating OCT capture into the pre-testing stage enables our optometrists to focus on image interpretation, clinical decision-making, and discussing the images and management plans with our patients, rather than the technical aspects of operating the instrument,” Shah said.

She added that providing team members with additional responsibilities enhances staff engagement and development.

When describing OCT technology, Shah shared that team members often describe OCT scans as a quick, non-contact scan that takes detailed pictures of the back of the eye.

The practice director added that a common analogy staff use is that OCT is an ultrasound for the eye that uses light instead of sound.

“During the explanation, patients are typically reassured that the test is painless, takes only a few seconds, and does not involve touching the eye,” Shah said.

She noted that having OCT scans to refer to is a useful visual aid during the eye examination.

“Being able to show patients cross-sectional images of their ocular structures can help explain eye conditions more clearly, improving understanding and engagement with their eye health as part of our patient-centred care,” Shah said.

Navigating OCT capture challenges

Reflecting on challenges when it comes to capturing OCT scans, Shah noted that elderly patients with poor posture can sometimes be difficult to position correctly.

“Team members need to ensure that chairs, tables, and chin rests are adjusted to the correct height for both patient comfort and to achieve a good-quality image,” she said.

Shah added that blinking can cause issues as it creates blank areas in the scan. If the blinking is linked to dry eye, then instilling a lubricating eye drop before taking OCT scans can help to improve image quality.

“Poor fixation can also affect scan quality. When team members explain the process clearly and guide the patient through what they need to do in a methodical and easy-to-understand way, this can help reduce both blinking and fixation issues,” Shah explained.

Cataracts can also present challenges for capturing OCT images. Shah noted that Eyelink’s OCT device includes a cataract function.

“If this does not work, manually adjusting where the OCT scans through the pupil – effectively peering around the cataract – can often help achieve a usable image,” Shah observed.

Shah shared that while the OCT device normally adjusts for high prescriptions, if this is ineffective, there is a manual function where the focus can be adjusted by inputting the patient’s prescription.

AOP insight

AOP clinical and policy director, Dr Peter Hampson, highlighted the valuable role that support staff can play in spotting poor quality OCT scans where the patient has moved or blinked.

“Repeating them before they see the optometrist saves time for all involved,” he said.

Hampson also emphasised the importance of support staff ensuring that the scans are linked to the correct patient record.

“It’s easy to think ‘I’m just taking the scan – the optometrist will review it,’ but the task of capturing and recording is really important,” he highlighted.

“Alongside this, I always think it’s helpful to have a discreet way for the support staff to flag to the optometrist if they have seen something,” he said.

Hampson emphasised that this gives the optometrist a chance to prepare ahead of reviewing the image in front of the patient and potentially having to deliver bad news.