This article is more than 5 years old. Information may no longer be current.
Presenter: Always image both eyes with OCT
Click Here to Manage Email Alerts
CHICAGO – Eye care providers may have the opportunity to identify neurodegenerative diseases earlier through the use of high-resolution optical coherence tomography, according to Robert Sergott, MD, of Wills Eye Hospital.
Sergott participated in the American Academy of Optometry’s plenary session, which was co-sponsored by Primary Care Optometry News.
“In Alzheimer’s disease, 99% of clinical trials fail because there’s nothing left to treat. It’s diagnosed too late,” Sergott said. “This is the case for high-resolution OCT in your practice. It gives you objective vs. subjective data.”
Sergott presented a number of case reports to illustrate his “rules” for using OCT.
Rule No. 1 is: “Always study both eyes, optic nerve and macula. I recommend that you start in the outer retina, because that’s what you don’t see with your ophthalmoscope.”
OCT can distinguish neuropathy from maculopathy, he said.
“Where is the disease, not what it is,” Sergott said is rule No. 2. “Always look at the outer retina. It’s essential for us to diagnose these diseases precisely so when there are clinical trials available, patients have opportunity.”
Sergott’s rule No. 3 is: Follow the thickness grid to find the pathology.
“If it’s thinner or thicker, there’s disease there,” he said.
Signs and symptoms of Susac’s syndrome include hearing complaints, dizziness, a young person with branch retinal artery occlusion, severe headache, confusion, depression, personality changes and slurred speech.
“It mimics multiple sclerosis,” Sergott said, and OCT can help distinguish the diagnosis.
He cautioned attendees to be wary of “confirmation bias.”
“We tend to want to confirm what we think,” he said.
Rule No. 4 addresses white signal and black signal. White signal indicates ischemic, lipid, hemorrhage, exudate and fibrosis. Black signal is edema, he said.
Always correlate the visual field with OCT is rule No. 5, Sergott said.
Finally, for rule No. 6, inner nuclear cysts occur in many diseases.
“Better technology will make you better clinicians,” he concluded. – by Nancy Hemphill, ELS, FAAO
Reference:
Sergott R. How to use OCT to diagnose and monitor neuro-ophthalmic diseases: Multiple sclerosis, diseases that mimic MS and maybe Alzheimer’s. Presented at: American Academy of Optometry; Chicago; Oct. 10-14, 2017.
Disclosure: Sergott reported he is a consultant to Heidelberg Engineering.