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Study: New retinal imaging techniques have altered French retina practice
Retinography and OCT together represent 85% of imaging procedures for AMD in France.
 Olivier Lebreton |
The introduction of increasingly sophisticated diagnostic tools, focus on prevention and early diagnosis, and new therapeutic options that require repeated treatments and close surveillance have produced significant changes in the practice of posterior segment specialists in France in the last decade.
A study examined consultations for retinal pathologies in four ophthalmology units in France: the Centre Ophthalmologique d’Imagerie et de Laser in Paris, Lariboisière Hospital in Paris, and two university hospitals in Orléans and Nantes. The researchers found that between 2000 and 2009, the number of consultations for age-related macular degeneration had increased by 46%. The total number of retinal imaging examinations related to this disease has grown by as much as 317%.
“The total number of visits in the four centers progressed from 65,606 in 2000 to 95,777 in 2009. Consultations involving the use of imaging techniques were one in five patients in 2000, growing to two in three patients in 2009,” Olivier Lebreton, MD, said at the meeting of the French Society of Ophthalmology in Paris.
Imaging modalities
Looking at individual imaging modalities, the numbers are even higher.
“We are performing 1,600% more retinographies and 1,500% more [optical coherence tomography] scans,” Dr. Lebreton said.
Older techniques are on the decline, with 33% less demand for fluorescein angiography and 18% less for indocyanine green angiography. Angiography, which represented 87% of imaging procedures used for AMD in 2000, decreased to 15% in 2009, while retinography and OCT increased to 34% and 51%, respectively.
Dr. Lebreton suggested that these changes are partly related to therapy. If the success of angiography was linked to the advent of laser, the increased use of OCT came as a consequence of the introduction of the new anti-VEGF treatments.
Another key to the success of new imaging techniques is that they are safe and minimally invasive. Finally, they have aided in the diagnosis of several retinal conditions besides AMD.
AMD in future
OCT will maintain a key role in AMD consultations in the future, with a wider diffusion of spectral-domain technology, Dr. Lebreton said. Fluorescein angiography and ICG, on the other hand, will be specifically and exclusively used for the observation of aspects that are not in the domain of OCT, such as chorioretinal vascularization, and for autofluorescence imaging in the treatment of atrophic AMD.
The extensive use of imaging technology has brought significant changes in the day-to-day practice of ophthalmologists. – by Michela Cimberle
For more information:
Olivier Lebreton, MD, can be reached at Service d’Ophtalmologie, Hôtel-Dieu, CHU Nantes, 44093 Nantes Cedex 2, France; email: olivier.lebreton@chu-nantes.fr.
Disclosure: Dr. Lebreton has no relevant financial disclosures.
Perspective
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As the author says, noninvasive imaging of the retina in the follow-up of wet AMD patients has increased dramatically in the last decade. Retinography and OCT are now used on a regular basis.
Because the increased number of visits and imaging procedures requires time and human resources, we are witnessing radical changes in the organization of the clinical practice. Most objective tests are now performed by orthoptists or technicians before the patient is seen by the ophthalmologist. This helps improve patient flow and increases the capacity to match demand.
We always need research to improve the treatment of our patients. Hopefully in the future we might have new imaging technologies to document atrophy of the retinal pigment epithelium (fundus auto-fluorescence) or to count photoreceptors (adaptive optics), but the validity of these new methods needs to be assessed in clinical trials.