Let’s talk about… OCT
Experts share their tips on how locums can harness optical coherence tomography to provide excellent patient care
10 June 2022
Any optometrist who has seen the look of wonder on a patient’s face when they are shown the depths of their retina for the first time understands the impact of optical coherence tomography (OCT).
The technology provides optometrists and other eye care providers with more information about their patients’ eyes than ever before.
But how can locum optometrists sift through this data to make the most appropriate decisions about patient care? OT spoke with OCT experts about how optometrists can refine their use of the technology.
OCT product manager for Haag-Streit UK, Jacqui Kenyon, highlighted that one of the most challenging aspects of OCT for locums is that they may be switching between different devices depending on what practice they are in.
She emphasised the importance of practice staff providing guidance to locums on the equipment that is available.
“All OCT devices offer different software packages, so the locum needs support from the practice to ensure they are achieving good quality scans,” she said.
Topcon Healthcare clinical affairs specialist, Laura Pigula, also emphasised the importance of locums being able to capture high-quality scans when using OCT.
Confidence in patient positioning and instruction, as well as understanding the benefits of each type of scan for different patients, is key.
“Use a methodical approach to interpreting the scans,” she recommended.
Pigula highlighted the benefits of becoming familiar with the retinal layers and where specific pathologies are located within the retina.
Locum optometrists should consider OCT scans in the broader context of other clinical findings, such as patient history, visual acuity and visual fields
“Always use the OCT results as guidance – never refer just based on OCT findings,” Pigula advised.
Both Kenyon and Pigula recommend that locum optometrists keep their OCT knowledge up-to-date by making use of the diverse range of education platforms on offer.
Different OCT manufacturers provide practices that purchase their equipment with online platforms where optometrists can assess and improve their skills – such as the Optovue Academy and Topcon Healthcare University.
Optometrists can gain insight on the latest developments and hands on experience with OCT devices at optical conferences, while the Ophthalmic Imaging Association also holds an annual conference.
“Continuous learning in both advances in imaging techniques and new ways to diagnose different pathologies is of benefit to ensure you make the most out of your machine and use it to its full potential,” Pigula highlighted.
The benefits of OCT
For Pete Sharma, a locum based in Maidenhead and Windsor, OCT machines offer an extra tool for diagnosis and management.
“It helps us to monitor pathology and enables me to provide better referrals going forward,” he said.
Locum optometrist, Rebecca Rushton, noted that OCT devices help clinicians to pick up pathology that might otherwise be missed.
“Just today I found an epiretinal membrane and vitreomacular traction, both of which were asymptomatic,” she shared with OT.
“It can be useful for confirming visual field defects or queries about optic nerve heads too,” she added.
Rushton highlighted that OCT images are useful when explaining ocular health to patients and helps to reinforce the idea that they have had a thorough eye examination.
“I really believe that OCT empowers patients and increases loyalty to the practice,” she said.
When Rushton first started using OCT, she had a phone call with the supplier to learn about the technology.
“They explained some features which I'd never have found on my own. A lot of optometrists seem nervous about using OCT but most of what you see is common sense,” she emphasised.
Pigula highlighted that taking OCT scans is a non-invasive and quick procedure that has the potential to provide a better understanding of potential pathology than fundus photography or Volk.
“It can assist with a referral as evidence and guidance, but it can also prevent a referral due to being able to clarify a non-urgent reason why a patient’s vision has deteriorated,” she explained.
Clinical and regulatory head, Henry Leonard, highlights the importance of locums receiving training before using OCT
The General Optical Council standards for individuals require practitioners to recognise, and work within, their limits of competence, taking into account their knowledge, skills and experience. Many optometrists have received little or no training in OCT and require further training before they are competent to use these machines and correctly interpret the scans they produce. If a practice has asked you to interpret OCT scans, and you do not feel competent to do so, you should make this clear in advance.
Locum life: words of wisdom
Locum optometrists share a piece of advice that has served them well
Sam Phillips: “The best advice I have been given is to treat every patient as if they were my relative.”
Stephanie Kearney: “Establish a good working relationship with the resident optometrists in the practice you are locuming in. As a locum independent prescribing optometrist, I don’t often get to see patients returning for follow-ups and patients would rather not be referred to the hospital when they can be managed ‘in house’. Thankfully I have a great working relationship with the resident optometrist in the practice I locum most often in and they are happy to work with me when it comes to co-managing these patients.”
Pete Sharma: “The work will always be there. Join the locum groups, apps and agencies. Be flexible.”
James Brawn: “Don't be afraid to say no. It is very easy to be agreeable, to work at a rate you aren't happy with, and in working conditions you find uncomfortable. As a locum, you have no obligation to work for any practice, so don't feel obliged to do so. It is your choice what work you do.”