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Cost inhibits adoption of SS-OCT

Issue: March 10, 2019

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Jay S. Duker

WAIKOLOA, Hawaii — Cost is likely the primary reason swept-source OCT, a technology with a lot of advantages, has not been as quickly adopted as spectral domain OCT by the retinal community, Jay S. Duker, MD, told colleagues at Retina 2019.

Only two SS-OCT systems are available in 2019 in the U.S. — the Topcon Triton DRI and the Zeiss Plex Elite 9000.

Among clinical advantages of SS-OCT over SD-OCT are its higher speed (100,000 A-scans per second vs. 27,000 to 85,000 A-scans per second); less noise; no signal drop-off; longer imaging range (2.7 mm average vs. 2 mm); and deeper penetration into tissue, Duker said.

“The deeper you go with spectral domain imaging, there is more noise. That doesn’t happen with swept source,” Duker said. “You can image the vitreous and the choroid simultaneously.”

As well, the longer wavelength enhances the ability to penetrate choroid, lens opacity, pigment blood and intraocular gas. And, there is less trade-off between image size and resolution, he said.

“It’s been around for 6 years now, so why don’t we all own one?” Duker asked.

Notwithstanding the advantages, Duker said cost remains the major reason.

“They are significantly more expensive than spectral domain,” he said.

While less axial resolution, worse signal-to-noise ratio and worse motion artifact have been drawbacks in the past for SS-OCT, manufacturers worked to improve those issues, he said.

Lack of a normative database, however, remains an issue, which particularly limits its utility in the glaucoma field.

“Commercial pressure” is another reason for the lack of uptake, in that, for companies that already successfully manufacture and sell OCT machines, retooling for the new technology could “cannibalize” the existing business, he said. – by Patricia Nale, ELS

Reference: Duker JS. Practical use of SS OCT and OCTA. Presented at: Retina 2019; Jan. 20-25, 2019; Waikoloa, Hawaii.

Disclosures: Duker reports he receives research support from and is a consultant for Carl Zeiss Meditec and Optovue.