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Sunday / June 16.
HomemiequipmentOptical Coherence Tomography

Optical Coherence Tomography

What was once considered an instrument only for large institutions is now starting to become standard in general eye care. Jim Kokkinakis’ business, the Eye Practice, installed a Zeiss Stratus OCT over five years ago. At the time, this state of the art device was a boon for the practice and its patients as they were able to scan the posterior segment with unimaginable resolution. In fact, a few years later Jim invested in the Zeiss Visante OCT in order to image the anterior segment as well.

About 50 per cent of The Eye Practice’s clinical work is referred for specialty contact lens fitting, in particularly keratoconus. Being able to measure global pachymetry was essential once collagen crosslinking became a viable procedure for progressive keratoconics.

Jim is a big supporter of Zeiss equipment, which he has been using faithfully for over 25 years.

Late last year our lease for the Stratus OCT was finally paid off. When I looked at our usage I discovered that we had made a nice profit. On average, we do ten posterior segment scans per week at AUD$150 per bilateral scan, so over the course of every month after all expenses were paid we were banking AUD$3,500. This is not as profitable as my retinal camera but from our perspective as long as the instrument is at least cost neutral the benefit that can be achieved clinically is a win for both practitioner and patient.

Having an OCT in a general eye care practice enhances your efficiency, your diagnostic ability and your profitability

In March this year we decided to upgrade to the Zeiss Cirrus OCT. The Stratus was working perfectly well and now that it had no leasing expenses was more profitable than ever; so what prompted our decision? Superior resolution, superior reproducibility and superior scanning times tipped the balance.

All these advantages are achieved by using Spectral Domain technology as opposed to Time Domain technology. Explaining the difference between these technologies is well beyond the scope of this article, but what is more important when choosing Spectral Domain instrumentation is which supplier to choose.

Zeiss Instruments developed OCT technology nearly two decades ago, so the choice for me was obvious – stick with the market leader. Our confidence in Zeiss instruments dates from 1985, when we installed our first autorefractor. This instrument was only replaced last year after 25 years of faultless operation. Having experienced superb quality every step of the way, choosing the Cirrus was obvious for us, even though there are many other competitors.

What is also critical to understand when investing in any new technology is how it monitors for clinically significant change. After all, it is change over time that dictates intervention in most cases. The Zeiss instrument has by far the most clinically robust progression analysis software that has been approved by the FDA. Recently one of the OCT competitors has been forced to roll back its normative database software, as it was discovered that it had not gone through the appropriate channels. This is a significant concern as the practitioner’s clinical judgment is based on normative data. If this has not been validated properly, it is possible to over or underestimate treatment options.

To really understand how the Zeiss OCT technology has evolved over the years see Table 1 and 2. For me, based on this information upgrading from the Stratus OCT 3 to the Cirrus is obvious.

The number of scans per second went from 500 to 27,000 and the resolution is twice as good from 10 microns to five microns. Having an OCT in a general eye care practice enhances your efficiency, your diagnostic ability and your profitability. Patients are impressed and turning up to work on a Monday morning is something to look forward to.

This amazing technology has application in many areas (See gallery images)

Having routinely used the Zeiss Stratus OCT technology for many years, one tends to take it for granted. Upgrading to the latest Zeiss Cirrus technology I must say I could not possibly practice without it. I am again in awe of this technology.

I’m pleased to say that the upgrade to the Spectral Domain OCT is another quantum leap in the diagnostic and clinical management ability of our practice.

Table 1.

Table 2.

Jim Kokkinakis BOptom FAAO ISCLS is a partner in The Eye Practice, a Sydney-based optometry practice specialising in the use of cutting-edge diagnostic technology including Retinal Digital Photography, Optical Coherence Tomography and Corneal Topography. Fitting specialty contact lenses for keratoconus, post graft, post refractive surgery is also a clinical niche.