Savers Optical, Tanilba Bay NSW
Our husband-and-wife practice is located in a retirement area outside the metropolitan region. A large percentage of our patients are over 60, and some find it difficult to travel to the city. We were looking for an OCT that could be incorporated into the routine clinical examination without taking too much time. We also wanted an OCT that was easy to use and affordable.
The Optovue iScan fits the bill perfectly. It is a pleasure to use and the increased certainty it provides in diagnosis of macular degeneration and glaucoma enables us to make a more appropriate balance between referrals and monitoring. This is appreciated by our patients, as it can save them the trip to the city.
The iScan has a small footprint but a good range of features. It is semi-automated; the machine guides the patient with verbal instructions and lines up the scans.
We use the iWellness scan routinely as it can be done in a couple of minutes and it gives both a macula scan and ganglion cell scan, enabling us to gain information in the one scan about both the macula and possible early glaucoma. There is a range of more detailed macula scans: retinal nerve fibre layer, 3-D glaucoma and anterior angle scans. All are equally easy to use.
CASE REPORT 1
Early dry macular changes
Fred, a 72-year-old white Caucasian male had had regular two-yearly eye examinations elsewhere. There was no previous mention of eye pathology, though there was possibly a family history of macular degeneration. General health was excellent. Corrected visual acuity with a small astigmatic prescription was R 6/7 L 6/6.
Figure 1. iWellness scan
The iWellness scan was performed. It showed retinal pigment epithelial changes consistent with dry macular degeneration (Figure 1). Fred was surprised by this as he was seeing so well, but he was clearly interested in understanding the nature of the changes seen in the images. I showed him the scan images and explained what happens if dry macular degeneration progresses to wet macular degeneration. Fred is now highly motivated to use an Amsler Chart and present for more frequent reviews.
CASE REPORT 2
Figure 2. iCam retinal photos
New normal tension glaucoma diagnosis
Sue presented for routine eye examination. She had mild myopia with astigmatism and achieved corrected visual acuity of R 6/6 L 6/6. IOP was R 13 L 14. Retinal photos with the Optovue iCam revealed increased cupping of the left optic nerve head (Figure 2). The Optovue iScan iWellness scan (Figure 3) revealed a normal macula but the ganglian cell complex scan revealed thinning of the left compared to the right. It took only a few more minutes to perform more extensive RNFL scans which showed marked thinning in the left optic nerve (Figure 4). On referral, the diagnosis of normal tension glaucoma L > R was confirmed.
Figure 3. iWellness scan
Figure 4. RNFL scan
We have found that the ease and speed of using the Optovue iScan means that there is never any hesitation in performing routine OCT which, as illustrated in the two case reports, results in much greater clarity of diagnosis and benefit to our patients. We find the iCam is equally quick, easy to use and affordable.