Reviews Supplements Carl Zeiss Meditec June 2013 : Page 1

OCT in Today’s Optometric Practice: Diagnosing/Managing Retina Part one of a three-part series on the important role of the CIRRUS HD-OCT and how it may ultimately allow practitioners to provide a higher standard of care to their patients. The development of optical coherence tomography (OCT) stands as one of the most signifi cant medical breakthroughs in all of eye care. Initially thought to be a technology geared mainly for ophthalmology, optometrists have quickly embraced it and are in a perfect position to take their place as the primary eye-care provider. And just in time, as the demand for medical eye care is expected to increase over the next two decades as the population ages. An aging population means more patients with ocular disease then ever before—and consequently, more patients with macular degeneration, diabetic retinopathy, glaucoma and a host of other diseases. The CIRRUS HD-OCT by Carl Zeiss Meditec enables practitioners to visualize disease that is invisible to ophthalmoscopy and helps to diagnose disease earlier and more effectively. At this year’s SECO International meeting in Atlanta, a panel of highly respected optometrists gathered to discuss the use of OCT in the modern optometric practice. A condensed version of this discussion will be presented in a three-part series that offers clinically relevant and practical information on the role of OCT in the diagnosis and management of retinal disease and glaucoma, as well as its practice management applications. Part one, which focuses on retina, begins here. — Mark T. Dunbar, OD, Moderator Mark T. Dunbar, OD: Spectral-domain optical coherence tomography (SD-OCT), specifi cally with the CIRRUS HD-OCT (Carl Zeiss Meditec), has revolutionized how we look at the retina. Not since Helmholtz invented the ophthalmosope in the late 1800s has a technology completely changed the landscape of viewing and exam-ining the retina and optic nerve. Diana L. Shechtman, OD: I agree, Dr. Dunbar. It’s one way for me to dis-sect the retina and evaluate it layer by layer to better understand the pathogenesis behind retinal disease. Dr. Dunbar: When I encounter a pa-tient with vision loss and I’m not sure of the cause, the CIRRUS HD-OCT Moderator invariably provides a perspective that I just can’t get with any clinical examination. We are realizing every day in our practices that there are ap-plications with OCT in ocular disease that we never imagined. I. Ben Gaddie, OD: That is true; however, I speak with many doc-tors around the country who are afraid they don’t see enough macular degeneration or diabetes to justify the purchase of an OCT. I reassure them that once they start using it, they’ll quickly realize the far reach of its utility. I don’t know many doctors who purchased an OCT and didn’t fi nd the utilization. In fact, it actually increases as they gain more experi-ence with the device. Dr. Dunbar: Let’s take a more specifi c look at the role of OCT in one of the major retinal diseases that optom-etrists see on a daily basis: macular degeneration. Mark T. Dunbar, OD, serves as the Director of Optometric Services and the Optometric Residency Supervisor at the University of Miami’s Bascom Palmer Eye Institute. He has authored numerous papers and is the writer for Review of Optometry’s monthly column “Retina Quiz.” I. Ben Gaddie, OD , is the immediate Past President of the Kentucky Optometric Association and President of the Optometric Glaucoma Society. He is the CEO of Gaddie Eye Centers in Louisville, Ky. Diana L. Shechtman, OD, is an Associate Professor of Optometry at Nova Southeastern University College of Optometry, where she serves as an attending optometric physician at the eye institute and diabetic/macula clinic. Kirk L. Smick, OD , is Chief of Optometry Services at Clayton Eye Center and an owner of the facility. He is also Chairman of the Continuing Education Committee for the International Vision Expo Meetings. Sponsored by DETECTING CHANGES IN AMD Dr. Dunbar: Whenever I look at the macula of an age-related macular de-generation (AMD) patient, I try to es-tablish the presence of subretinal fl uid, hemorrhage or exudate. Sometimes this can be relatively easy to determine on clinical exam and quite often, you need to rely on the OCT to provide that information. Even in cases when it’s clear that there is no fl uid, Dr. Shechtman, I have heard you say that you are a big proponent of using OCT to establish a baseline when managing and following macular degeneration patients just as you do your glaucoma patients. Can you provide us some detail as to how you do that? Dr. Shechtman: Quantitatively, especially now using CIRRUS HD-OCT, we can truly identify subtle progression over time. Qualitatively, we can observe secondary associated complications such as retinal thinning or disruption of the photoreceptor in-volvement. In addition, enhanced eval-uation of the choroid is now possible with enhanced depth imaging (EDI). In the past, we used to view things in 2-D, but now, assessment is in 3-D. REVIEW OF OPTOMETRY JUNE 2013 1

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