“It has made practice more interesting and more complicated”
Optometrist and owner of John Rose Eyecare, John Rose, and marketing manager at Heidelberg Engineering, Emily Malbon, discuss how the additional capabilities of optical coherence tomography (OCT) have increased learning
04 October 2019
When did you first add optical coherence tomography (OCT) to your practice offering?
John Rose (JR): I’ve had several OCT devices. In 2001, I had a Heidelberg Retina Tomograph (HRT), which was the first confocal scanning laser ophthalmoscope. It was ground breaking. When the first OCT machines were starting to come out, I was very excited to try one.
The first one I got, I was comparing it to what I had found with my HRT and I was incredibly disappointed with the results. I was finding things on my HRT but not on the OCT, which wasn’t a Heidelberg device. After a few months, I actually sent it back because it was so unreliable.
Like a lot of optometrists, we see all this gadgetry but don’t completely understand how it works, so I went to an OCT conference in Rome. I did a very intensive training course for four days and realised that what happens in OCT is that the software interpolates or fills in the missing gaps. I realised that some of these lesions that I thought I was seeing on the HRT were actually in-between the lines of the scans.
When Heidelberg brought out its Spectralis, I ordered one and was one of the first optometrists to have one installed in practice. I ordered an OCT Plus, which had a panning head with BluePeak and it was upgradable.
How has it changed your approach?
JR: It has made practice more interesting and more complicated. I’ve increased the time I spend with patients, so it has focused the mind on how optometrist charge for our time. With all the extra information you’re getting, exams now take much longer than they did previously.
Like a lot of optometrists, we see all this gadgetry but don’t completely understand how it works
What modalities have you added on?
JR: I started off with a BluePeak, which was auto-fluorescence, and I’m still using it today. It looks at the fluorescence created by lipofuscin, which is especially useful with macular degeneration and retinal dystrophies. Since then, I’ve added on MultiColor for picking up lesions in the retina. I’ve added widefield and upgraded to OCT2, which is a faster scan. I’ve also got the glaucoma module, which is great for monitoring glaucoma over time, and OCTA. OCTA is a massive learning curve as we’re not always quite sure what we’re looking at or how useful it will be in the future.
What have you learned from the training you’ve received?
JR: The main takeaway is that you never stop learning. At 60 years old, I am spending more time learning and keeping myself up to date than I did when I was at university – as my old tutors will verify. It makes it more rewarding, but the trouble is finding the time when you are running a practice.
What do you think is next for the future of OCT?
JR: I think optometry is at a very exciting place. When I was an undergraduate at Aston University back in the ‘80s, I never dreamed that it would be such an exciting profession to be in. When I started, a fundus photograph wasn’t digital, so you had to get someone to stand there holding a number in front of them – a bit like a convict in a lineup. You took the image, then hoped you’d got a good one because you’d send the film off to be developed and a few weeks later you might have only got a vague image. It is extraordinary how imaging has developed during my career.
At 60 years old, I am spending more time learning and keeping myself up to date than I did when I was at university
What advice does Heidelberg Engineering offer to optometrists who are considering adding a new module to their OCT device?
Emily Malbon (EM): Our recommendation is to start with the base function – OCT and infrared fundus imaging – then go on to upgrade your device. The Spectralis is an upgradable platform, so practitioners can start with the basics and if they feel that they’re ready for the next imaging modality they can upgrade it. There’s a lot to learn if you buy everything at once. Get confident in the basics first and then move on to the next imaging modality.
How does adding modalities benefit patients?
EM: Modalities add another layer of information and with the right training and application of that knowledge, it will increase diagnostic competence and refine referrals, so that the patient is getting better care. There will be fewer unnecessary referrals if this technology is used correctly because optometrists are able to refine what’s going on with the patient.
Get confident in the basics first and then move on to the next imaging modality
What further training is available when purchasing a new module?
EM: When purchasing a module, optometrists will get a training session and we’ll pair them with the right trainer. Within our academy, each trainer has expertise in different modalities. We also provide courses at our training centre in Hemel Hempstead. There are hands-on courses on image acquisition, image interpretation and advanced courses on MultiColor and OCTA. There’s always an ophthalmologist present to provide guidance on referrals. In addition, there’s e-learning on our website with video and PDF tutorials. We’re also continuing development of a certification programme so that optometrists can become certified in using OCT.