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Martin Robinson
BAppSc(Optom)
Martin’s Eye Care, Glenorchy TAS

Product
OPTOPOL SOCT Copernicus REVO

Supplier
OptiMed

 

I have read many reviews and discussions about OCTs and their advantages and disadvantages. In my opinion, the pros and cons depend on staffing, consulting room layout and how much a company is willing to spend.

My requirements were for a device that could be operated by trained optical assistants, a side-by-side patient/operator set-up and a price tag under $60,000. The REVO SOCT unit was the device I chose to purchase from OptiMed.

The REVO offers the user a choice of settings: fully automatic operation, partially automatic and fully manual, making it great to train staff to operate. The space in my consulting room is tight with too many toys, so I was faced with replacing my Canon retinal camera with a combination camera/OCT or placing a new OCT on a side desk. The REVO unit was perfect to set on a desk with my patient sitting beside the operator. It also allows easy display and discussion of the scans with patients.

Finally, it was under my price limit. My REVO was supplied with a complimentary upgrade to an Angio module so it was great value.

We all should know by now the value of glaucoma diagnosis and progression analysis with OCTs. The REVO excels at optic nerve head progression scans, ganglion cell complex progression scans, central corneal thickness measuring, and 3-D anterior angle scans. Macular degeneration requires fine resolution to determine choroidal neovascular membranes, and the REVO device has allowed me to scan a patient, email the scan to a surgeon for an opinion and triage my patient in short order.

Angiography

Lately, I have been using the angiography module. Offering a non-invasive way to image retinal blood circulation, angiography is still such a new technology that we are just now discovering what role it will play in optometric care. One area in which it has been of great use is in demonstrating how diabetes can change the microvascular structure of maculae. There is often a general reduction in the numbers of blood vessels and an observable loss of complexity in the micro-vascular structures. The angiography module has proved to be useful in the role of educating patients about the impact of diabetes. Nothing speaks louder than a picture and a comparison to normal.

The REVO SOCT has helped me investigate, diagnose and manage ocular pathologies in unexpected ways. The vitreous-macula interface, for example, has been a source of truly edifying macular views.

How many times have we had a patient who describes central blurring but can still see 6/6 and has normal Amsler grid appearance? When the vitreous-macula interface is examined, I have seen patients with a large amount of traction, some with a simple change to the macula profile, some with cystic changes, some with pseudo-macula holes and some with low-grade macula holes. It has given me a new respect for any patient who says their vision is not right.

For 20 years, I have diagnosed and watched epiretinal membranes and never had a real understanding of how they attached to the retina and how textured they could be. Since I started looking with the REVO SOCT, I have seen many low-grade macula holes and pseudo holes, few of which were symptomatic or visible with direct examination.

When used to investigate undiagnosed conditions, the REVO SOCT has proved to be remarkably useful.

 

CASE REPORT

Possibly the most interesting case I have had involved a patient with an undiagnosed retinal atrophy. Her history showed she had a flat scotopic ERG with stable visual fields. Fluorescein angiogram showed no leak, but narrow blood vessels.

 

EQ-286-FIGURE-1 - Online

Figure 1. A flat scan of our suspect RP patient. Notice how flat the profile is.

 

The REVO SOCT provided a wealth of information to add to my referral for a second opinion. The retinal scan showed a massive reduction in NFL among other retinal layers (Figure 1). The optic nerve head scan showed the extent of the atrophy and cupping (Figure 2). Most interesting was a small vessel fan under her macula, revealed with SOCT Angio (Figure 3).

 

EQ-286-FIGURE-2 - Online

Figure 2. Disc of same patient shown in Figure 1, showing rim absence in 234 degrees

 

EQ-286-FIGURE-3 - Online

Figure 3. SOCT Angio scan. The vessel fan can best seen in the ‘Deep’ panel.

 

Although still unconfirmed, the suspected diagnosis is either general toxic atrophy from an unknown toxic contamination as a child in Africa, or an atypical retinitis pigmentosa (RP). If RP, then the vessel fan takes on new meaning: is this a precursor to central serous retinopathy? We don’t know but it gives a base reference point.



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