Driving developments in OCT

This development has “revolutionised clinics across both ophthalmology and the optometry sectors,” Nicola Bennett, Topcon clinical affairs manager for the UK and Ireland, told OT. “The driving force behind these developments I would believe to be the natural progression, development and revenue that can come from these technologies along with significant clinical prevalence and progression of eye disease.”

The benefit of safe monitoring, diagnosis, referrals and treatment of patients has also had an impact, Bennett said, while the continued demand on eye services in the NHS also enhances the need for the technology to progress.

Claire Martin, business development manager, glaucoma and retina, for Zeiss, has also seen the impact of demand on the sector. She said: “The high volume of elderly patients and NHS COVID-19 backlogs have driven a need for more community-based OCT and for patients to be seen more quickly and closer to home.”

Martin pointed to developments in additional modules, such as anterior segment OCT, widefield scans, OCT-angiography (OCT-A) and ganglion cell analysis, as beneficial in diagnosing and managing glaucoma and other diseases.

“OCT has significantly contributed to better understanding of glaucoma and retinal diseases,” Martin said, as well as helping with monitoring progression.

Reflecting on the uptake of OCT and how this supports the scope of its applications, she said: “As we see more practices embrace OCT and use the technology to its potential, we will see more patients being monitored and managed in community optometry, without the need for hospital review but with continuity of care thus giving optometry practices confidence in managing and referring patients.”

Optos recognised that there were benefits to incorporating OCT with its ultra-widefield retinal imaging, creating multi modalities on Optos devices.

“Our technology enables eye care professionals to discover, diagnose, document and treat ocular pathology that may first present in the periphery,” Gareth Steer, vice president of European sales at Optos, said. “Compared to traditional examination techniques, integrating the two imaging modes can aid quicker detection of disease or disorders in the retina, such as retinal detachments and tears, glaucoma, diabetic retinopathy and age-related macular degeneration.”

Early identifiers

One area in which discussions have been growing is OCT-A, a non-invasive imaging technique that captures the vascular structure.

OCT-A is more commonly used in ophthalmology currently, suppliers agreed. However, practices are expressing interest in the technology.

Bennett shared: “I do find we are being asked more about the benefits of OCT-A in practice by optometrists and there is a definite intrigue to the value of being able to view these deeper structures and the flow within the retinal profile and how this can help aid clinical decision making alongside the many other factors of a patient’s eye examination.”

Considering whether this is something we will see more of within optometry in the community, she posed: “I can’t help but think there may be a potential of more services coming into the primary sector to help the NHS deal with the demand on eye care services, such as age-related macular degeneration or diabetic retinopathy, that this could be the opportunity that drives OCT-A into the optometry sector in the future.” 

Zeiss’ Martin agreed that more optometrists are routinely enquiring about the platform, while one practice in Scotland is already actively using the Cirrus 6000A, an OCT-A device.

Discussing the technology, she told OT: “OCT-A further expands the optometrists’ knowledge in disease recognition, being able to identify early changes for diabetic retinopathy and macular degeneration and allows for earlier referrals or monitoring patients already on the NHS pathway.”

 

Artificial intelligence

While it seems futuristic, artificial intelligence (AI) already surrounds us in many aspects of everyday life. Likewise, we are already seeing AI used for certain features in optometry, including OCT.

Martin told OT that AI is already embedded into its ultrawidefield (UWF) Clarus retinal camera. The camera uses deep learning to automatically find the optic nerve head, enabling clinicians to accurately derive the patient’s gaze, rather than relying on internal fixation. This can be particularly beneficial in cases where a patient has poor fixation.

“We will be having AI modules available for the Cirrus in the very near future,” Martin added.

Asked if there are further developments that could support clinical confidence in interpreting scans, Martin explained that Zeiss already has guides in the Forum glaucoma workplace to show if there has been progression with the retinal nerve fibre layer, visual field, ganglion cell analysis.

“With the advent of AI, there will be more to help the optometrist with interpretation of scans,” she said.

As OCT becomes more widely used within the optometry sector, the benefits that come from applying this enhanced technology to the patient’s eye examination are continuously growing

 
Optos unveiled Optos AI, which has achieved CE marking in the UK and European Union, in spring 2022.

Using optomap UWF images, the system provides automated evaluation of life-threatening diseases, including more-than-mild diabetic retinopathy and diabetic macular oedema.

Revealing the platform earlier this year, the company suggested that with the technology, healthcare practitioners “can improve access to diabetic retinopathy screening whilst quickly and efficiently determining whether diabetic patients should be referred for further evaluation and management.”

Detecting and monitoring

All three companies identified the role of OCT, and the increasing enhancements to the platform, in detecting disease.

Bennett said: “As OCT becomes more widely used within the optometry sector, the benefits that come from applying this enhanced technology to the patient’s eye examination are continuously growing.”

Faster, non-invasive and widefield scans enable efficient workflows, while detailed imaging allows clinicians prompt analysis and the potential for earlier diagnosis of eye disease. The enhancement of swept source OCT enables clear visualisation of vitreous, retina and choroidal structures, Bennett added, supporting clinical interpretation.

With the benefits of OCT becoming more widely discussed, this has helped more patients to understand the importance of repeat scans as part of a regular eye check.

“This is becoming more of the norm,” Bennett said, adding that this, in turn, means clinicians are able to safely monitor patients using enhanced progression and comparison tools.

Steer suggested that the ongoing development in OCT, UWF and retinal imaging enables clinicians to better detect and diagnose early stages of eye conditions and disease.

Using optomap as an example, he shared that the technology enhances pathology detection, disease management and practice flow. The Monaco and Silverstone also have integrated OCT to allow for multimodal imaging.

In recent years, Steer said, there has been a growing recognition of the importance of imaging the peripheral retina: “That’s why we are increasingly seeing our technology being adopted by hospital eye clinics, with many using our devices as a routine part of their patient consultation.”

He shared: “Being able to routinely view the peripheral region is vital in protecting patients, and ultimately saving sight.”

OCT has proven to be a valuable diagnostic tool, and there is strong evidence for widespread use in optometry

 

Part of the clinical picture

Areas for further development remain, along with considerations that must be kept in mind as technology evolves and its use grows in the community.

Steer highlighted that both OCT and UWF imaging are important “in their own right,” but when used together, “form an essential diagnostic tool.”

Martin agreed: “OCT has proven to be a valuable diagnostic tool, and there is strong evidence for widespread use in optometry,” adding that it will “play an increasing role in the management of glaucoma and other ocular conditions within clinical practice.”

There are always considerations when introducing new developments and technologies, she acknowledged, emphasising that education on interpretation “will always be key” for competent and confident use of the technology.

Bennett highlighted that OCT and the development of the technology in clinical practice, as well as its growing use in community optometry, “continues to be extremely important and beneficial whilst caring for our patients.”

However, she emphasised: “It is important to remember that this technology is part of a much bigger clinical picture with all aspects of the eye examination and patients medical and family history being paramount in the making of clinical decisions and patient management.”