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    Advantages of OCT for both patient and doctor

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    "One of the major advantages of spectral-domain optical coherence tomography (SD-OCT) is the ability to create three dimensional (3D) samples of the tissue showing us much more detail so we can get a much better insight and understanding," according to Professor Albert Augustin (Department of Ophthalmology, Klinikum Karlsruhe, Germany) during the Carl Zeiss Meditec evening symposium at the 2011 annual ESCRS congress.

    Prof. Augustin focused on several patient examples to demonstrate the necessity of OCT in disease diagnosis and management noting that in certain cases its use is mandatory.

    Planning surgery

    Preoperative judgement of a patient can lead to a correct prognosis and a better treatment protocol being employed, noted Prof. Augustin. To iterate his point he described a patient that had some remaining tissue in the macular hole but no alteration to the retinal pigment epithelium (RPE). In this instance he had used SD-OCT to correctly perform the prognosis.

    "In another patient, we saw some RPE alterations. That's why visual acuity recovery was not as good in this patient," added Prof. Augustin. "So, the spectral domain technology advantage was again prognosis in this patient."

    He also explained the role in which OCT plays to assist in appropriate planning of a procedure avoiding preoperative misjudgement. "OCT technology, particularly spectral domain, enables us to make the correct prognosis and perform the correct procedure as it guides us in a 3D fashion enabling easy planning of the procedure and obtaining a 3D sampling of the patient," he said.

    In cases of vitreoretinal traction Prof. Augustin revealed that OCT can help practitioners decide on which treatment regimen they should employ. "For example, in a case of a patient with vitreomacular traction syndrome it would be better to use a peeling procedure as well as drugs to treat rather than performing monotherapy," added Prof. Augustin.

    He explained, "For vitreoretinal traction syndrome you may want to choose vitrectomy plus drugs rather than anti-VEGF applications alone because the intravitreal drug therapy alone may not work." So, in Prof. Augustin's experience OCT can be used to guide the practitioner to the appropriate procedure in these patients as it is possible to look at the vitreoretinal pathology and interface in more detail.

    "In the future, OCT can also be used as a really realistic biomarker for disease activity," continued Prof. Augustin. "Once the oedema disappears due to anti-VEGF application or surgery, VEGF concentration in the vitreous body may decrease even to zero. If there is a relapse of the oedema, VEGF concentrations in the vitreous will have increased again." Therefore, he noted that OCT is able to detect the physical appearance once the oedema disappears due to anti-VEGF application as well as the fluctuations of VEGF values in the vitreous body. "Maybe in the future if you lose things, you can use this technology as a biomarker for disease activity and also for the control of the respective drug in the vitreous body," he said.

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    Professor Albert J. Augustin

    Professor Albert J. Augustin, MD is Professor and Chairman of the Department of Ophthalmology, Klinikum Karlsruhe, Karlsruhe, ...

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