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Richard Kaplan, Richard B Rosen, Meenakashi Gupta; Utilization of Automated OCT in a High Volume Eye Urgent Care Setting. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3117.
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© ARVO (1962-2015); The Authors (2016-present)
Optical coherence tomography (OCT) has become integral to the diagnosis and treatment of ophthalmic disease with the ability to reveal subtle anatomical changes with great resolution. Despite its utility, OCT has been available only in the ophthalmology clinic setting. We performed a retrospective, observational clinical study to learn about the utility of OCT in a high volume urgent care setting.
Ophthalmology residents at The New York Eye & Ear Infirmary of Mt. Sinai were trained to operate an automated OCT (Optovue) capable of scanning the macula, optic nerve and anterior segment. The OCT was made available in the after-hours eye-only urgent care. Residents were not required to use the OCT, and performed imaging when they believed the information would aid in diagnosis and treatment. After a period of four months, images obtained were reviewed alongside patient charts in the electronic medical record. Chief complaint, image type, image findings, and diagnosis were analyzed. Additionally, residents and fellows staffing the urgent care were surveyed regarding their experience with the OCT.
102 eyes of 54 patients were examined between August and November 2016. 47 (87%) and 7 (13%) patients underwent OCT imaging of the macula and optic nerve, respectively. Complaints that prompted imaging included flashes/floaters (11, 20%), metamorphopsia (3, 6%), decreased vision (29, 54%), and spot(s) (5, 9%). Imaging was also performed in asymptomatic patients with incidental findings, such as optic nerve head edema (6, 11%). In 13 patients, OCT was used to differentiate macula-on (5, 9%) vs. macula-off (8, 15%) retinal detachment. Additional diagnoses included macular hole (3, 6%), cystoid macular edema (4, 7%), central serous retinopathy (3, 6%), and subretinal fluid with or without choroidal neovascularization (7, 13%). In several cases (12, 22%), the OCT was used to rule out retinal or optic nerve pathology. All residents (14) and fellows (6) found the OCT to be helpful; 11 residents (79%) and 4 fellows (67%) felt that it changed management.
Residents performed OCT scans of the macula more frequently than the optic nerve; no scans were performed of the anterior segment. OCT often assisted care, even when results were normal. More widespread use of OCT in the urgent care setting is likely to improve diagnosis and patient outcomes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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