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Combining spectral-domain optical coherence tomography and fundus camera technology into one tool aids in efficiency and patient satisfaction for the anterior segment surgeon.
By Harvey A. Fishman, MD, PhD, Special to Ophthalmology Times
Palo Alto, CA-Spectral-domain optical coherence tomography (SD-OCT) and a non-mydriatic fundus camera are two of the most important imaging technologies in ophthalmology.
The advent of dual-modality imaging systems that combine both functions provides increased efficiency for the clinician and comfort for the patient.
One such combination system (iFusion, Optovue) recently received FDA 510(k) clearance for its integrated pairing of SD-OCT (iVue) and non-mydriatic fundus camera (iCam) technology in a single delivery platform.
The device lets the clinician obtain two different imaging scans from one system with a shift of the camera head. Both scans can be done sequentially and within minutes of each other, while the patient remains stationary and with little inconvenience to the clinician.
As a comprehensive ophthalmologist and anterior segment surgeon, my retina and glaucoma patients need SD-OCT and color fundus photography scans for diagnosis and management.
Using a dual-modality machine shaves an average of 10 to 15 minutes off each patient’s examination. This can fluctuate in other practices based on the arrangement of examination rooms and the mobility of the patient.
In practices with a high volume of glaucoma and posterior segment pathology, these minutes add up to hours a day.
Not only does the integrated system save time from the standpoint of patient flow, but it saves administrative time as well.
Because SD-OCT and fundus camera images are accessible on a single platform, they can be easily uploaded to an electronic medical record (EMR) system.
Uploading images to an EMR platform from different systems is often a difficult and time-consuming task, but being able to upload scans from one system cuts the administrative tasks in half.
Having a dual-imaging system also aids in accuracy by lessening the chance that staff members upload the wrong image.
Both scans are sent to the EMR system from the same platform and go to a patient’s file simultaneously-as opposed to separately and at different times.
I see a large volume of patients with glaucoma, as well as patients with posterior segment pathology. SD-OCT is an indispensable tool for analyzing the retinal nerve fiber layer (RNFL) and ganglion cell complex in these patients.
With the dual-imaging system’s software platform, I have easy access to two modalities with which to manage and treat glaucoma.
As a cataract specialist, I implant a large number of premium IOLs. I use the dual-imaging system for patients with cataracts preoperatively to assess whether they have subtle epiretinal membranes, macular holes, or vitreomacular traction syndrome-all of which can affect quality of vision with premium IOLs.
It is crucial for quality of care to be able to assess the posterior segment in these patients, as well as determining presence of postoperative macular edema.
For patients with diabetes who have a history of diabetic retinopathy, or those with age-related macular degeneration (AMD), a dual-imaging system is essential for preoperative analysis.
It is crucial for any anterior segment surgeon to discern these patients’ posterior segment to assess the visual potential and to discuss potential issues that may eventually arise based on pathology.
Another added benefit of the dual-imaging system is that OCT can be independently upgraded as technology advances, whereas the fundus cameras can continue to be used unchanged. Having the individual camera head for each modality provides the flexibility to upgrade each imaging system separately without having to upgrade the entire system.
As an example of how the dual-imaging system benefited a particular case, I had a 73-year-old male patient with advanced glaucoma, early AMD, and visually significant cataracts present with a decrease in visual acuity.
SD-OCT of the RNFL and ganglion cell complex showed significant glaucomatous damage to the optic nerve.
High-definition OCT of the retina showed drusen without evidence of subretinal fluid.
The fundus photo showed drusen and retinal pigment epithelium atrophy without subretinal hemorrhage.
The dual-modality system-along with the clinical exam-was instrumental in assessing this patient’s visual potential for cataract surgery, as well as planning for postoperative management.
An anterior segment surgeon cannot practice high-level medicine without SD-OCT or a fundus camera in the 21st century. Combining the two imaging systems into one provides an indispensable tool that aids in efficiency and patient satisfaction.
Harvey A. Fishman, MD, PhD, is in private practice in Palo Alto, CA. He is a research consultant to Optovue Inc.
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