When we surveyed readers last summer about their priorities for new technology purchases, OCT topped the list: 32% of respondents said they planned to buy one within a year. And since 67% percent of those responding said they already had an OCT, it’s safe to say this technology is well on its way to being standard operating equipment in optometric practices.
To help newcomers and experienced users alike, we’ve put together this special issue, which includes a whopping 40 editorial pages devoted to OCT technology and its role in clinical practice. Weighing in at 18,000 words and over 100 images, this special collection of articles is, I daresay, “a keeper.” In the pages to follow, over a dozen expert clinicians will walk you through the buying decisions and countless clinical applications of eyecare’s Swiss Army knife.
One thing to keep in mind, however, as you dig in to this massive collection of material: technology alone is never enough. You’re the one who has to make the call. Much has been written about “red disease” and “green disease” in OCT—those false positive and false negative readings that can lead your clinical judgment astray, usually because the so-called normative database the device compares your patient to lacks appropriate representation of the population’s ethnic heterogeneity and the influence of age differences. In fact, Andrew Rixon points out in his article this month on OCT for glaucoma that those are better thought of as “reference” databases, since “normative” is a loaded and misleading word.
But the devices themselves can also just flat-out produce garbage if scans are done incorrectly or if concomitant pathology obscures the structure being imaged. As Henrietta Wang points out on page 30, “The guiding principle in all of healthcare is primum non nocere, or ‘first, do no harm.’ While we usually think of that in a treatment context, this can also be applied to the diagnostic techniques we employ on a day-to-day basis. If the device itself introduces errors, this can undermine the clinical care we provide by confounding accurate diagnosis.” In the first article of this series, Dr. Wang shares a guide to avoiding OCT artifacts that we encourage you to tear out or download for use in your practice.
Of course, even when everything goes perfectly and you receive a beautiful scan and accurate analytics, the machine doesn’t tell you what to do with it all. Nor should it. People sometimes worry that the increasingly high-tech nature of medicine is going to make doctors glorified techs who administer tests but leave the mental heavy-lifting to computers. Far from it—all that added diagnostic nuance that OCT brings requires you to up your game in how to interpret and make sense of it. There are countless clinical and personal factors you need to synthesize to come up with a management plan that is clinically prudent and also a pragmatic reflection of insurance constraints, patient motivation and other external factors.
So, the OCT may have earned its place alongside the phoropter and slit lamp, but it’s still just there to feed data into the most high-powered computer you’ll ever use: your brain.