OCT moves into every aspect of eyecare, as OCTA proves a game-changer just like the first OCT technology
The third National OCT Conference took place at the Hilton London Paddington last November, attracting in excess of 300 delegates. The conference programme was filled with thought-provoking lectures and clinical workshops, all of which were fully booked, despite a significant increase in the number of workshop places over last year.
A wealth of new workshops were made available, covering topics such as optimising imaging of tricky patients; using OCT angiography in primary eyecare; and anterior OCT imaging to identify chronic closed angle glaucoma. Other workshops included assessment of the vitreomacular interface, and the ever-popular OCT for glaucoma detection.
The conference was preceded by the ‘Starting Out In OCT’ course, to allow those with little or no experience of OCT to learn the basics and benefit from the conference. 26 delegates attended the course and when asked what they would change in practice following it their comments included: “it’s changed the way I will interpret the OCT; I will be able to look at results and interpret them - understanding the basics; I feel so much more confident in use of the OCT – Thank you!”
We know that OCT technology continues to develop at a rapid rate, but so does its sphere of use. This year’s National OCT Conference program looked very different to previous years, as OCT in optometric practice has progressed from being just a good tool for assessing beneath the surface of the retina, to a useful diagnostic tool for an ever-increasing range of conditions.
The early detection of glaucoma featured heavily, with the opening keynote from Professor Donald Hood of Columbia University, New York. In his headline address, Professor Hood showed the usefulness of OCT for early detection and confirmation of very subtle 10-2 visual field loss, but with the proviso that modern analysis and data presentation techniques are used, rather than relying on the old segment charts and conventional RNFL graph. The new ‘Hood’ report optimises presentation of all data relevant to suspect glaucoma, in a way that is easy to compare with visual field plots, including probability maps for circumpapillary RNFL thickness and macular analysis. He pointed out the importance of looking at NSTIN rather than TSNIT, so that the areas of macular vulnerability could be properly examined.
Professor Chris Hammond also spoke about glaucoma along with other neurodegenerative diseases such as Alzheimer’s. His call to action for primary eye care practitioners, was to capture OCT data in normal patients to allow the establishment of a valuable baseline. His research suggests that retinal nerve fibre measurements may be useful, not only in early glaucoma, but also the early detection of Alzheimer’s disease, a condition where early detection and intervention is likely to be key. He suggested starting to scan normal patients at age 40, followed by a 5 yearly scan. Other signs and symptoms may of course suggest more frequent scans are required.
Summarizing how far OCT Angiography technology has come in just one year, Dr Catharine Chisholm, Head of Topcon University commented: “A year ago, OCT Angiography was looking like a technique that might come to fruition in 5 years’ time. It was clear from the start that non-invasive imaging of the tiny capillaries of the retina along with abnormal vessels, would be useful, but the results were poorly understood. Frenetic research activity is allowing us to understand this clinical data and the fact that it can tell us even more than Fluorescein Angiography.”
Mr Nishal Patel and Mr Konstantinos Balaskas both talked about how OCTA is changing the understanding, detection and monitoring of eye disease, along with discussing how to interpret images. The number of delegates already performing OCTA in optometric practice to follow up patients, was impressive, although perhaps not surprising, given the pressure on hospital eye departments, and the fact that OCTA is non-invasive and can be repeated whenever required. “Although there is still a lot to learn and OCTA is unlikely to completely replace fluorescein angiography, it promises to be as much of a game changer for eyecare as OCT was when it first came out 20 years ago” continued Dr Chisholm.
“Sadly, the overstretched hospital eye service is still inundated with referrals for suspect papilloedema, despite the fact that the Rose case has now been overturned” highlighted Mr Ali Yagan, who spoke in detail about disc swelling and using OCT for differential diagnosis. As a consultant ophthalmic surgeon at Manchester Royal Eye Hospital, he urged Optometrists to improve their referrals and include disc imaging (colour picture and OCT), colour vision testing, visual acuity, visual fields and history, in order for the Hospital Eye Service to make sensible decisions about the urgency of referrals. The danger is otherwise that patients are put at risk.
Swiss ophthalmologist Dr Peter Maloca, winner of the Wellcome Image Awards for the Best of Medical Science Imaging in 2016 and 2017, showed off the mind-blowing capabilities of his virtual reality software. At least 20 delegates had the chance to experience the 3D virtual reality fly through the eye sessions and were all left inspired by the prospects of this new technology.
Professor Sunil Shah, consultant ophthalmologist at the Midland Eye Birmingham, gave a moving presentation during an interlude in the conference dinner. Sharing his experiences of Khmer Sight, a charity in Cambodia that he is now leading, providing cataract surgery and eye care in a country where only 38 ophthalmologists service a population of 15,000,000. Professor Shah has managed to staff the clinic simply by reaching out to his friends and colleagues around the world, with ophthalmologists, nurses and optometrists donating a week or so of their time to support the work of the charity. He has now succeeded in building a hospital for the charity, which will train eyecare professionals as well as perform surgery. Anyone interested in helping, or wishing to donate to the charity should visit https://www.gofundme.com/GiveCambodiaSight
Professor Shah’s talk was followed by a fun quiz – Fib or Fact? – Tails of the unexpected. OCT scans captured over the years by Durham optometrist, Mr Simon Berry, were presented to the audience, with each team providing a plausible clinical scenario. Delegates voted via the conference app, with each team trying to convince the audience they were telling the truth. The twist was that a number of Simon’s scans were of animal eyes, despite looking like rather obscure human ocular conditions – they were actually eyes of a bee, gecko and a dragonfly.
Simon, who has recently won the RNIB Pioneers Award for his work lobbying government to ensure that all children and young people who require specialist frames be given the same level of care throughout the country, has a fascination with animal eyes, and with his practice located next door to a friendly vets, he has plenty of opportunities to examine non-human eyes.