July 2019

NEWS

Research Highlight
OCT after hours


by Maxine Lipner EyeWorld Senior Contributing Writer


87-year-old woman complained of painless loss of vision OD; visual acuity = CF for just 6 hours; diagnosis by OCT = CRAO; transferred for emergent treatment with tPA and stroke workup
Source: Richard Rosen, MD

 

When patients experience eye emergencies after regular office hours, they might not get the same kind of testing they normally would. A recent study1 considered how an automated OCT machine could impact urgent care in an after-hours clinic.
“The problem is that a lot of people come in with conditions of sudden vision loss, and the technology we utilize on a daily basis is much more sophisticated than what’s typically available in urgent care,” said Richard Rosen, MD, adding that while the New York Eye and Ear Infirmary was one of the first centers to acquire daily-use OCT, these devices often require a highly skilled technician. After coming across a robotic OCT system known as the iScan (Optovue), he decided to launch a study on how it might be applied in an after-hours, urgent care setting.
iScan uses audio to direct the patient on where to look to line up the scan. It then compares the scan to its database of “normal” images. “When I saw this instrument, I said, ‘This is what we need,’ because often strokes in the eye are difficult to diagnose the conventional way,” Dr. Rosen said, adding that iScan takes only a minute and provides a firm diagnosis.

Urgent OCTs

As part of the study, OCT images of 359 eyes were obtained by 25 residents and fellows. Any patient who came into the after-hours clinic complaining of vision loss that was unexplained was included, Dr. Rosen noted. The residents and fellows were surveyed about their experiences and how accurate the diagnosis was.
“We found that the overwhelming majority thought this was a useful tool to have in this kind of setting and took the care to a much higher level than is typically available,” he said.
If a patient has swelling and bleeding in the eye, for example, it’s obvious that abnormal blood vessels have developed or are blocked, Dr. Rosen said. The retina is transparent, making it more difficult to see what’s going on.
“This technology affords high precision in terms of seeing the retina,” he said, adding that if you’re trained to interpret all the changes that occur, you can make an accurate diagnosis in a short time.
Residents and fellows were able to accurately diagnose conditions such as vascular occlusion, retinal detachment, macular holes, central serous retinopathy, and more, Dr. Rosen said.
Investigators found that using the automated OCT was better than the slit lamp or an indirect ophthalmoscope typically available in this kind of setting, Dr. Rosen noted.
“It’s more efficient because it allows practitioners to make the diagnosis quicker,” he said. “On an emotional level, it was reassuring to both patients and physicians that they were on the right track and allowed us to triage patients if they needed to be.” For example, if a patient came in and was diagnosed with the help of automated OCT with urgent onset of wet macular degeneration, they could be treated with an anti-VEGF injection on the spot, instead of having to wait to see a specialist the next day, Dr. Rosen said.

Considering next steps

Dr. Rosen said he hopes practitioners come away from the study with the realization that the automated OCT is cost effective and an improvement for urgent care.
“This device could be deployed to provide a mesh of telemedicine within the general community in different ways,” Dr. Rosen said, adding that its cost is in line with that of an ultrasound machine, which is already standard in many urgent care settings. Dr. Rosen also envisions having OCT in a public setting, like the blood pressure cuffs in drugstores. Another possible application, though more limited, could be at-home OCT.
While such equipment gives a good baseline study, experts in OCT are still very much needed, Dr. Rosen stressed.
“They can identify special areas and pull out more information,” he said. “But on a day-to-day basis, I think having this readily available is going to make a big difference in how we treat a lot of these diseases.”

About the doctor

Richard Rosen, MD
Pierce Distinguished Professor of Ophthalmology
New York Eye and Ear Infirmary
Icahn School of Medicine at Mount Sinai
New York

Reference

1. Kaplan RI, et al. Impact of automated OCT in a high-volume eye urgent care setting. BMJ Open Ophthalmol. 2019;4:e000187.

Financial interests

Rosen: Optovue

OCT after hours OCT after hours
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