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    Affording OCT in your practice

    A review of two new devices and doing the math to pay for it

    There is no shortage of new diagnostic technology at optometry’s disposal. It seems every month a new device is available to enhance our practice and patient care. And with each new device, we will have to ask the same questions: Will it pay for itself? How much does it cost? Can I afford it? Let’s face it, the last thing any of us needs is a piece of equipment sitting idle in the corner collecting dust, and along with it our simmering anger at the fact we're paying through the nose for that white elephant.

    It has been 20 years since optical coherence tomography (OCT) was first introduced for the diagnosis and treatment of eye disease. I became infatuated with OCT while serving as a center director at a comanagement center. The technology is nothing short of amazing: imaging the retina in ways previously unknown. Suddenly I could see things that a fundus photo really didn't do justice. All those layers of the retina I had to learn in optometry school were now actually there to be seen!

    Now, once again in private practice, I’ve often thought how great it would be to have that technology available in my office, but the cost for the device was just simply out of my reach. Another fact that adds to value: OCT technology has moved beyond just imaging the retina. OCT can now image the anterior segment and cornea, opening up new areas of diagnostic possibilities. As Dr. Larry Alexander often says, “OCT is a poor OD’s MRI of the eye.” I recently had the opportunity to test drive two of these new devices in my office.


    Optovue iScan

    With the release of its new iScan device, Optovue has brought affordable OCT imaging to optometry. The device is a self-contained spectral domain OCT that is small, powerful, and portable.

    Optovue iScan uses 26,000 A-scans per second to produce images with axial resolution of 5 μm and transverse resolution of 15 μm.1 The machine’s 3D retina scan with en face analysis enables virtual dissection of the retina by displaying three different reference planes: internal limiting membrane, inner plexiform layer, and retinal pigment epithelium. The device also scans the traditional optic nerve head for nerve fiber layer thickness and the thickness of the ganglion cell complex (GCC). The device’s 3D disc scan shows the optic nerve in cross section and gives a representation of the relative thickness of the selected slices, and the ganglion cell complex analysis aids in identification of ganglion cell loss, which can precede retinal nerve fiber layer loss (Figure 1).

    The device is designed to give OCT images of the retina, optic nerve, macula, and ganglion cell complex in an easy-to-operate system. With the anterior chamber attachment, the operator can gain images of the anterior segment and anterior chamber angle, again useful in our diagnosis of glaucoma patients. The device provides pachymetry mapping with full 6 mm diameter corneal thickness mapping with maximum thickness indicator and angle visualization and measurement.

    The device is designed to be operator friendly—meaning it doesn’t take a highly-skilled operator to obtain quality images. Voice prompts guide the patient through the entire process. My tech enters the patient data, positions the patient at the machine, and presses the start button. Then she can then move on to another task while the system guides the patient through the entire scan.

    Another feature of iScan is iWellness exam, a non-reimbursable scan designed to give a quick retinal image prior to the actual exam, which gives the doctor an initial view of the retina before the patient ever sits in the exam chair (Figure 2). The iWellness scan is very accurate; it boasts 95 percent sensitivity and 99 percent specificity.2

    Optovue iScan is fully self-contained and compact with built-in PC and touch-screen LCD. The only complaint I had with the device is there is no chin rest for the patient. The patient must place her cheeks into the aligned areas on the faceplate and remain there for the short length of the scan.

    Next: Cirrus 500 review

    Ernie Bowling, OD, MS, FAAO
    Dr. Ernie Bowling is Chief Optometric Editor of Optometry Times. He received his Doctor of Optometry and Master of Science in ...


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