What if? Ophthalmology without OCT – Part 3

In celebration of Ophthalmology Times' 50th anniversary, we asked leading experts what the practice would look like today had optical coherence tomography (OCT), one of the biggest innovations in the field, never been invented.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Andrew A Barkmeier, MD:

I well, I think retina physicians would be whipping out their contact lenses a lot more frequently and really scrutinizing the diabetic macula edema and some of the macula degeneration, exudative findings. But as we know, and this is a teaching point to all of our trainees, even the best ophthalmoscopist retina specialist is not nearly as good as OCT at identifying these findings. So we benefit greatly from OCT?

Sally S Ong, MD:

That's a great question. I think optical coherence tomography has really revolutionized how retina specialists, treat, manage diseases, and take care of our patients. Some people will say it's actually a vital sign in retina for every patient. We get an OCT just to really have an idea of how the posterior pole the macula is doing. I think it's really given us this terrific ability to know the fluid status for patients with macular degeneration and diabetic macular edema. So we can treat patients at a very, very detailed, specific level, to really treat them down to no fluid, and we know that that can help them in their long-term outcomes, especially for neurovascular AMD. I think if we don't have OCT, I think we would all be required to be a little bit better in our dilated fundus exam, in our slit lamp exam with our 90-diopter lens to be able to distinguish thickening in the macula. But I don't think we will ever be as good as the OCT in terms of picking up subtle amounts of fluid in the intraretinal or subretinal space, or, being able to detect patients earlier in their disease. So I think OCT has really revolutionized our field, and I'm grateful for it. Thank you to the developers who helped us get here. It's exciting because now we have OCT angiography, and, really better and better prototypes of the OCT with wide fields, so you can go up to the periphery. So it's an exciting time to be in retina and imaging.

Yasha S Modi, MD:

I think without OCT, we wouldn't have the imaging framework to know how to use these drugs. It's so funny when you go back to the history of OCT, there really probably wasn't a lot of up take until all of a sudden, Avastin and Lucentis came out, and now, all of a sudden, we're sort of seeing how we can use this imaging modality to assess treatment response, and that's so integrated into our daily practice that it would be remarkably hard to live our lives without OCT.

Steven G Ness, MD:

We would be doing a lot less injections and treating our patients, nowhere near as well as we're able to now. Really the the kind of the confluence of OCT developing at the same time as these anti-VEGF medication injections is really kind of a marriage made in heaven, and it's really helped a lot of our patients.