It took me nearly two years to garner the courage needed to order my first optical coherence tomographer (OCT) because, as I started looking at the options, it quickly became clear that not all of the machines are made equal.
After much deliberation, I eventually chose the Heidelberg Spectralis OCT, accompanied by the MultiColor module, BluePeak autofluorescence, Glaucoma Module Premium edition software and anterior segment adaptor.
I reached this decision after taking advice from a Moorfields Eye Hospital ophthalmologist who told me that if I wanted the best OCT, an upgradable platform, with the best technical support and clinical back up, there was no choice but the Spectralis OCT. On learning this, I became certain which OCT I wanted, but I admit that I was reluctant to spend such a lot at first.
It is true to say that it has changed the way I practice. I have learned to spot what is present in patients, but previously invisible without OCT, and I now understand ocular anatomy and physiology with respect to structure and function far better.
I am also more confident in recognising, diagnosing, managing, monitoring and explaining conditions to patients.
If there is any doubt about the reasons for unexplained symptoms, or slight reduction of vision, a macula scan can rule out subtle and very early changes, and can help diagnose cystic macula oedema, central serous retinopathy, vitreous traction syndrome and drusen. It can also help me to distinguish between early, wet macular change and progressive dry age-related macular changes.
I have even spotted several cases of serious choroidal retinopathy with small pockets of fluid in areas near to the optic disc after patients reported subtle, but transient, and poorly described intermittent visual disturbances, yet dilated fundus examination had revealed no evidence of abnormalities.
"I reached this decision after taking advice from a Moorfields Eye hospital ophthalmologist who told me that if I wanted the best OCT...there was no choice but the Spectralis OCT"
The Spectralis OCT, with Multicolor and BluePeak autofluorescence options, allows me to display and compare images of the same lesion using different colour lasers, thereby allowing visualisation of exquisite detail and depth.
For those with an increased risk of glaucoma, ‘funny-looking’ discs or borderline suspicious cupping, the Spectralis OCT with Glaucoma Module Premium Edition software will measure the minimum rim width of the optic nerve at Bruch’s membrane opening, the nerve’s most vulnerable point. It will also measure the standard retinal nerve fibre layer.
With this technology, recognising retinal nerve fibre layer sector defects is far easier, and the posterior pole analysis and hemisphere symmetry plots can be effortlessly compared to the full threshold automated perimetry results, to provide more accurate and earlier identification of glaucoma suspects.
The function offering repeat imaging over time is amazing. With an accuracy of between 1–2 microns, the active eye-tracking TruTrack system takes monitoring of progression to a new level, which gives me confidence that there is no disease progression.
Patients are always impressed with the technology and can understand why more regular reviews are in their best interest if there are any doubts.
"Patients are always impressed with the technology and can understand why more regular reviews are in their best interest if there are any doubts"
A place in practice
The Spectralis has become a key component of our eye examination for many patients and has a number of hidden benefits.
Many of the practice staff have been trained on the tool and love being involved in the clinical process. They have grown in confidence, feel more valued and really enjoy using it. Our OCT has become a key part of the practice team to the extent that ‘she’ has been named and is affectionately referred to as ‘Heidi.’
‘Heidi’ is not only a delight to have around, but positively creates more work as every image needs to be analysed and reported on in the patient’s notes. Despite the extra work, ‘she’ has added a new dimension to the practice and allows us to provide better care of our patients to the extent that I most certainly could not do without ‘her.’