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Usefulness of OCT expanding beyond retinal specialty
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Every day in clinical practice around the world, optical coherence tomography is making a significant contribution to the diagnosis and treatment of vitreous and retinal pathology. No retinal specialist practices without this tool, and it is finding its way into the offices of many anterior segment surgeons and comprehensive ophthalmologists as well.
 Richard L. Lindstrom |
We have OCT available at Minnesota Eye Consultants for our 10 ophthalmologists and 12 primary-care optometrists, and this diagnostic tool has enhanced our patient care in multiple ways. At the Phillips Eye Institute in Minneapolis, OCT in the shared diagnostic center serves a community of 150 ophthalmologists, a model worth considering for other cities.
For me, OCT serves as a useful screening tool for subtle macular changes that can reduce vision after cataract surgery, especially in the patient with risk factors such as diabetes mellitus or when refractive cataract surgery with a premium lens such as a multifocal, accommodating or toric IOL is planned. While we still do not presently employ this tool preoperatively in all our patients planning cataract surgery, I see the time coming where that may well become our standard.
In addition, for me it has often helped diagnose subtle macular changes that are resulting in a dissatisfied patient after cataract or other ocular surgery. It has also helped me follow those patients at significant risk of developing exudative age-related macular degeneration or diabetic macular edema, allowing more timely and appropriate referral to my retinal colleagues.
We corneal, cataract, refractive and glaucoma surgeons are also finding anterior segment OCT to be an increasingly useful tool. To mention only a few, it can provide useful insights into corneal thickness and level of pathology, anterior chamber depth, diameter and angle dimensions, postoperative LASIK flap thickness and shape.
In the near future, OCT may well allow the next incremental improvement in the accuracy of IOL power calculation by allowing better prediction of postoperative effective lens position. My view of the future: increasing refinement in OCT to the point where we can make diagnosis at the cellular level, leading to an OCT either present in every ophthalmologist’s office or readily available nearby.