HAWAII: RETINA 2012 OPTICAL COHERENCE BIOMICROSCOPY

Dr.Alexander C. Walsh

WAILEA, Hawaii — With the evolution of biomicroscopy and the ability of the optical coherence tomography (OCT) platform to consistently and efficiently store, measure and compare useful images, retina specialists should begin considering shifting away from the slit lamp to OCT biomicroscopy, a speaker here said.

"Slit lamp biomicroscopes should be replaced by protocol-driven tomographers that can be operated by non-physicians, store images of all eye tissues over time, and perform measurements from these images,"

OCT presents numerous advantages over the slit lamp, starting with the fact that everyone approaches their slit lamp exam differently. He also said that a slit lamp exam makes it extremely difficult to make comparisons over time for a large area. "Objective storage and comparisons between visits can take the guesswork out of monitoring progression," he said.

Another advantage of OCT technology is that it will free up the ophthalmologist to spend more time on diagnosis and treatment with the patient.

OCT still poses some limitations, such as not showing hemorrhage, and it is unable to examine the adnexa or palpebral conjunctivae.

On balance, however, Dr. Walsh said that "at the current time, OCT may be the best candidate technology to overcome the limitations of conventional biomicroscopy

In Ontario there is a problem with the College of Physicians and Surgeon (CPSO) so-called "experts" such as Kitchener,Ontario, (popn 210,000), Ophthalmologist Alfons KISKIS MD (Tor.1979) who criticized a Toronto (popn. 4-million) GP for recommending an OCT test to a patient. At the time the state insurance did not pay for an OCT; now it does. The College did not apologise.

(Ontario Standard-of-Care is at a level of medium-sized town medicine; often 10-20 years years behind present International standards. Unless working in an Academic unit , it is dangerous to practice State-of-the-Art medicine. The mainly small town doctors at the CPSO are not evident at Toronto International conferences.)