Rosenfeld: Spectral-domain OCT could raise standard of care for patients with AMD

KOLOA, Hawaii — The advent of spectral-domain optical coherence tomography could signify a better standard of care for patients with age-related macular degeneration and other retinal diseases, Philip J. Rosenfeld, MD, PhD, said here.

During his presentation at Retina 2007, held in conjunction with Hawaiian Eye 2007, Dr. Rosenfeld said the newest generation of optical coherence tomography (OCT) offers better image quality, segmentation of the macula, fundus reconstruction, image registration and other features that will enable specialists to become more familiar with the disease and its clinical manifestations.

"We're going to have a better understanding of the disease so we can provide better care for our patients," he said, adding that the technology provides "beautiful anatomy."

"We're going to get a great appreciation of how patients respond to therapy using this technology," he said. "Everything I'm telling you of spectral-domain is true for all the devices out there. It's how the information is processed that is going to distinguish the different companies."

One of the virtues of spectral domain is that you can combine all scans and to reconstruct a virtual image of the fundus, he said.

"You know exactly where you're cutting. It's remarkable that you can register exactly where the cuts are on the fundus image," he said.

He added that spectral-domain OCT also provides a clear resolution of epiretinal membrane, and the ability to view drusen topographically on the level of retinal pigment epithelium.

"I'm looking forward to doing some longitudinal studies using this technology," Dr. Rosenfeld said.

In a separate presentation, Jay S. Duker, MD, discussed another advancement to OCT technology, the ultra-high resolution OCT. While this is not commercially available because of the high cost of building it, he said for research purposes the advancements in imaging represent a "promising research tool."

He also said he is "a little less optimistic than [Dr. Rosenfeld]" that spectral-domain OCT and ultra-high resolution OCT will be a "revolution in our field."

"There is no evidence that it is improving our ability to treat disease, although it is helping us visualize better," he said.

Although the three-dimensional images are dramatic, he said he is not sure how clinically relevant they will be when it comes to treating a patient from visit to visit.