How much importance do you put on spectral domain OCT findings in comparison to other diagnostic modalities and clinical findings?

POINT

Spectral domain technology is an evolution

Michael S. Ip, MD
Michael S. Ip

Optical coherence tomography, in general, is a very valuable diagnostic tool that can help with diagnosis, but also in management of patients. For example, it can show response to treatment when you follow patients longitudinally and can depict resolution of a condition. OCT is also a lot less invasive than the other commonly used and helpful tools we use in the retinal clinic, and that would be angiography, either fluorescein or ICG. OCT is a faster, less expensive, better tolerated procedure.

The utility of OCT will, of course, depend on the disease. I would say in the assessment of vitreoretinal interface disease, early stage macular hole, epiretinal membrane or even a full thickness macular hole, OCT provides information that you cannot get from any other ancillary test. I put a high level of importance on the findings from OCT with my patients who have retinal disease.

For the majority of patients that come into a clinic on a typical day, OCT has now become an indispensable tool for evaluation, but still, you cannot use OCT in lieu of everything else. In terms of macular degeneration, fluorescein angiography will show you leakage that you cannot see on OCT. In terms of other ancillary tests, function of the retina is best demonstrated by electroretinography, and that is something that you will not get with OCT.

Spectral domain does add a level of resolution to the images, and it gives us a better look at the anatomy than time domain. But I would liken the development of time domain OCT over the era that we did not have time domain OCT as a revolutionary step forward, whereas I would call the change to spectral domain from time domain more of an evolutionary change. In other words, it is a step forward, but it is not as great as the step from no OCT to time domain OCT.

Michael S. Ip, MD, is an associate professor of ophthalmology at the University of Wisconsin.

COUNTER

OCT is only part of the picture

Spectral domain optical coherence tomography is an important clinical and research tool, but results should be interpreted against other clinical tests and observations.

José G. Cunha-Vaz, MD
José G. Cunha-Vaz

I think spectral domain OCT is important for evaluating macular edema, for example, because it provides accurate information, especially with regard to the mapping of retinal thickness and the central 500 µm. Future research should look closer at the implications of retinal thickness and whether the ability to more accurately measure retinal thickness might have clear clinical implications.

OCT findings are fundamental for following patients with macular edema, but results should not be used in isolation. In order to get a complete clinical picture that will allow proper decision making, we need additional data, including best corrected visual acuity; microperimetry; information on leakage, preferably from scanning laser ophthalmoscope leakage analysis; and information on capillary closure, at least from the central foveal avascular zone. The more combined information we will get in the neat future, the more we will rely on the findings from spectral domain OCT.

José G. Cunha-Vaz, MD, PhD, is the chair of ophthalmology at the University of Coimbra, Portugal.

POINT

Spectral domain technology is an evolution

Michael S. Ip, MD
Michael S. Ip

Optical coherence tomography, in general, is a very valuable diagnostic tool that can help with diagnosis, but also in management of patients. For example, it can show response to treatment when you follow patients longitudinally and can depict resolution of a condition. OCT is also a lot less invasive than the other commonly used and helpful tools we use in the retinal clinic, and that would be angiography, either fluorescein or ICG. OCT is a faster, less expensive, better tolerated procedure.

The utility of OCT will, of course, depend on the disease. I would say in the assessment of vitreoretinal interface disease, early stage macular hole, epiretinal membrane or even a full thickness macular hole, OCT provides information that you cannot get from any other ancillary test. I put a high level of importance on the findings from OCT with my patients who have retinal disease.

For the majority of patients that come into a clinic on a typical day, OCT has now become an indispensable tool for evaluation, but still, you cannot use OCT in lieu of everything else. In terms of macular degeneration, fluorescein angiography will show you leakage that you cannot see on OCT. In terms of other ancillary tests, function of the retina is best demonstrated by electroretinography, and that is something that you will not get with OCT.

Spectral domain does add a level of resolution to the images, and it gives us a better look at the anatomy than time domain. But I would liken the development of time domain OCT over the era that we did not have time domain OCT as a revolutionary step forward, whereas I would call the change to spectral domain from time domain more of an evolutionary change. In other words, it is a step forward, but it is not as great as the step from no OCT to time domain OCT.

Michael S. Ip, MD, is an associate professor of ophthalmology at the University of Wisconsin.

COUNTER

OCT is only part of the picture

Spectral domain optical coherence tomography is an important clinical and research tool, but results should be interpreted against other clinical tests and observations.

José G. Cunha-Vaz, MD
José G. Cunha-Vaz

I think spectral domain OCT is important for evaluating macular edema, for example, because it provides accurate information, especially with regard to the mapping of retinal thickness and the central 500 µm. Future research should look closer at the implications of retinal thickness and whether the ability to more accurately measure retinal thickness might have clear clinical implications.

OCT findings are fundamental for following patients with macular edema, but results should not be used in isolation. In order to get a complete clinical picture that will allow proper decision making, we need additional data, including best corrected visual acuity; microperimetry; information on leakage, preferably from scanning laser ophthalmoscope leakage analysis; and information on capillary closure, at least from the central foveal avascular zone. The more combined information we will get in the neat future, the more we will rely on the findings from spectral domain OCT.

José G. Cunha-Vaz, MD, PhD, is the chair of ophthalmology at the University of Coimbra, Portugal.