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Spectral domain OCT could change treatment protocol in 10% of cases
WAILEA, Hawaii — Spectral domain optical coherence tomography improves upon the sensitivity of interpolated OCT enough to affect 10% of treatment protocols, a speaker said here.
 SriniVas R. Sadda |
"We found that overall there clearly was an improved sensitivity for detection of various pathologies in spectral domain vs. time domain OCT," SriniVas R. Sadda, MD, said at Retina 2009.
Dr. Sadda conducted a prospective, masked study comparing time-domain and spectral domain OCT used on 50 patients. Overall, time domain OCT showed 83% sensitivity while spectral domain showed 97% sensitivity.
To determine if this difference affected practice, he conducted a retrospective review of 62 eyes of 45 patients receiving Lucentis (ranibizumab, Genentech) or Avastin (bevacizumab, Genentech) injections who also underwent simultaneous time domain and spectral domain OCT imaging within 1 week of injection.
"A significant number of cases, 53% of cases, there was significantly more subretinal fluid evident on the spectral domain OCT compared to time domain OCT. So not only are you not seeing things at all, sometimes you're really underestimating how much there is," Dr. Sadda said. "If you were going to use the presence of fluid in the retina, subretinal fluid or [pigment epithelium detachment] alone as your indication for re-treating the patient, we found that the OCT scans would change our management in 10% of cases."
Newer spectral domain devices offer increased resolution and complete macula coverage, and this will certainly improve our ability to find small abnormalities not visible on time domain OCT (Stratus). As Dr. Sadda points out, this translates into an enhanced ability to visualize leakage in patients with exudative AMD. Whether this will translate into improved outcomes remains to be seen.
– Peter K. Kaiser, MD
OSN Retina/Vitreous Board Member