Easy-to-use automated OCT systems can enhance patient care in high-volume after-hours clinics when traditional scans are typically not available, according to a study.
Limited access to diagnostic equipment and skilled imaging personnel can make patient care during after-hours difficult. An automated OCT system available for after-hours use in a high-volume clinic can greatly improve patient care and empower ophthalmologists to make accurate diagnoses, study co-author Richard L. Rosen, MD, ScD(Hon), FACS, FASRS, CRA, told Ocular Surgery News.
Automated OCT is designed to look at specific areas and indicate whether or not there is an abnormality. It is not a replacement for a skilled examiner using manual equipment to look at pathology; however, the imaging quality of the automated OCT “is so good that you can certainly make a diagnosis of vascular occlusive events or a choroidal neovascularization,” Rosen said.
Fully automated image captures
Rosen and co-authors obtained images with an Optovue iScan automated OCT in an after-hours urgent care eye clinic over a period of 15 months. Residents and fellows were surveyed regarding their experience with the system and its value in emergency patient management.
The automated OCT can scan the macula, optic nerve and anterior segment. Training to use the device takes less than 30 minutes. Residents were not required to use the OCT, but the device was available if they believed it would aid in diagnosis and treatment.
Three hundred fifty-nine eyes of 202 patients were examined, and 178 patients underwent automated OCT imaging. The most common complaint that prompted imaging was decreased vision, which was reported by 120 of the 202 patients (59%). Other reported symptoms were flashes/floaters (16% of patients), metamorphopsia (5%), scotoma (10%) and pain (3%). Diagnoses included vascular occlusion, retinal detachment, macular hole, cystoid macular edema and central serous retinopathy.
Easy to use
The automated system instructs patients where to focus their gaze and monitors the position of the retina. The device automatically captures pictures of the retina for the clinician, Rosen said.
Twenty-five residents and fellows who were trained to use the system were surveyed about their experience, specifically if they participated in patient care in which the system was used and if it changed the management of the patient. All residents and fellows found the device helpful. Twenty-one respondents felt the OCT improved patient satisfaction and reduced delayed diagnosis or misdiagnosis, while 19 reported reduced stress in patient care when using the system.
“When you see a patient and can’t give them a definitive answer, it does create a situation of stress for a young trainee or physician. You’re then unable to reassure a patient or give them a plan. Having this system after-hours really does cut to the chase and reduce stress for patients and clinicians,” Rosen said.
Cost of the device is on par with that of an ultrasound machine, which is found in most after-hour clinics, Rosen said. – by Robert Linnehan
- Kaplan RI, et al. BMJ Open Ophth. 2019;doi:10.1136/bmjophth-2018-000187.
- For more information:
- Richard L. Rosen, MD, ScD(Hon), FACS, FASRS, CRA, can be reached at New York Eye and Ear Infirmary of Mount Sinai Icahn School of Medicine at Mount Sinai, 310 E. 14 St., Suite 319SB, New York, NY 10003; email: firstname.lastname@example.org.
Disclosure: Rosen reports he is a consultant for Optovue.