Expanded urgent care access to automated OCT shows promise in increasing accuracy and timeliness of diagnosis as well as providing immediate documentation of pathology to further substantiate medical decision making, according to a study published in BMJ Open Ophthalmology.
Access to skilled imaging personnel and diagnostic equipment is virtually nonexistent after normal working hours in most clinics, according to study authors.
OCT has the ability to reveal more subtle macular changes, including those in the nerve fiber layer or outer retina, that would be imperceptible on clinical examination.
“Other ophthalmic imaging modalities such as ocular ultrasound and nonmydriatic fundus photography are already being used in emergency settings, performed by non-ophthalmology practitioners, to diagnose ocular pathologies that otherwise would have been misdiagnosed or undiagnosed,” the authors wrote.
Primary Care Optometry News spoke with Richard Rosen, MD, director of Retina Services at New York Eye and Ear Infirmary of Mount Sinai and co-author of this study.
“[One] of the problems that we're still battling is acute stroke in the eye, central artery occlusion. We've had very good success utilizing the assistance of our colleagues in interventional radiology,” Rosen said. “Using the same approach employed in patients who have stroke, in other parts of the central nervous system injection of a clot-busting drug, TPA, may restore central retinal circulation and restore visual function.
“The problem is that the diagnosis of the condition used to rely on fluorescein angiography,” Rosen continued, “which is very accurate, but generally not available at night or on weekends. By the time the diagnosis is made, it's generally too late to do the treatment.”
Researchers analyzed the data procured from the automated OCT device in a high-volume after-hours clinic within an eye institute. Images were gathered over a 15-month period and reviewed within the context of electronic patient records, according to the study. Investigators then surveyed residents and fellows on their overall experience with and perceived value of the OCT in emergency patient management.
“This is how quickly you need to act,” Rosen said. “We've had patients who were referred for urgent interventional radiology, and for some of them we were able to really make a difference in their course. They'd come in, and their vision would be legally blind in their only eye, and ultimately the outcome would be 20/20. It's huge. It's very time-sensitive, these diseases.”
Patient complaints that warranted automated OCT imaging included flashes, floaters, metamorphopsia, decreased vision and scotomas. Over the course of 15 months, 359 eyes of 202 patients were examined. According to the study, diagnoses made using the OCT included vascular occlusion, retinal detachment, macular hole, cystoid macular edema and central serous retinopathy.
With these results, of the 25 residents and fellows who were surveyed, a majority agreed that the OCT allowed for optimal urgent management as well as aided in the triage of patients to specialty clinics.
“We use it on a day-to-day basis,” Rosen said. “This is the third year that we've been using it, and it's become indispensable. The residents who are being trained, they don't really know any different. It's as simple to use as an ultrasound.
“Ultrasound used to be a big production,” he continued. “You had to send the patient to the ultrasonographer, and now we have an ultrasound device in our clinic there. If a patient comes in and they've got a vitreous hemorrhage, you do an ultrasound and you know the patient has a retinal detachment or the patient doesn't, or the patient has a tumor or something like that. And it's in the same sort of cost range. It's a relatively inexpensive modality in that kind of setting, certainly compared to a lot of the other things that we do nowadays.” – by Scott Buzby
Disclosure: Rosen reports personal fees from Allergan, Clarity, Nano Retina, Ocata Medical, Opticology, Optovue and Regeneron. The other study authors reported no relevant financial disclosures.