OCT is considered standard-of-care for the management of most retinal diseases. Despite the myriad of imaging technologies available to retinologists—including fundus photography, fundus autofluorescence (FAF), and fluorescein (FA) and indocyanine angiography (ICGA)—spectral-domain OCT may be the most heavily relied on, non-invasive imaging tool in clinical practice. While once considered a luxury item, OCT has become a mainstay in ophthalmic practice, and an indispensable tool in our practice.
East Bay Retina Consultants relies heavily on integrated imaging as part of the workflow for every patient, and we are actively participating in various clinical trials and imaging research. OCT imaging has enabled our offices to better manage a greater number of patients with more diagnostic accuracy and efficiency. Among the additional imaging technologies utilized in our practice, advancements in ultra-widefield imaging such as the ZEISS CLARUS 700 have made it possible to capture high quality, true-to-color images while combining multiple imaging modalities like FAF, anterior segment external photography and FA all in one device.
Ultra-widefield imaging allows for imaging of the far periphery outside of the standard 7-field Early Treatment Diabetic Retinopathy Study (ETDRS) field of view, elucidating the extent of disease of peripheral pathology such as predominant peripheral lesions or ischemia in diabetic retinopathy. In our practice, diagnostic tools like the spectral-domain CIRRUS OCT and OCTA have enabled us to improve our clinical decision-making—particularly in determining the level of macular ischemia in diabetes or retinal vein occlusion that may be affecting visual acuity and when to, or not to, treat in cases of subtle pigment epithelial detachment suspicious for indolent quiescent macular neovascularization.
As retinal specialists, we regularly utilize imaging: these tools are essential for a retina practice for diagnosis, education, and treatment planning. During the pandemic, we found that ultra-widefield imaging was an extremely useful supplement to the clinical exam, allowing us to diagnostically evaluate our stable patients while minimizing the amount of exposure . Most imaging devices including the CLARUS 700 today are non-mydriatic and are able to capture high quality images in a non-dilated pupil.
However, while the latest advancements in ophthalmic and ultra-widefield imaging technologies continue to push the limit on what is possible, none should be considered a direct substitute for a thorough dilated fundus evaluation with scleral depression. This is especially true when assessing the peripheral retina for symptomatic patients with suspected holes, tears or detachments. Yet for retinal physicians, this technology provides crucial supplements to exam findings, where we gain a better understanding of those elements of the retina that cannot always be seen with the naked eye.