Do you routinely perform OCT with or without dilation?

Wed, 24 Oct 2018 16:45:10 GMT

Hi fellow OPS'ers! I would like to ask you all what the standard is in your practice regarding dilation and OCT. Do you routinely perform OCT undilated and find the quality acceptable? Or do your practices dilate first, prior to OCT? Obviously dilation is needed for other imaging modalities and exams, but I would specifically like to know about your OCT work flow. We are trying to streamline our injection process/work flow that involves a lot of OCT imaging. I would love your input to take back to my meeting.

Thank you!

Margaret Whelehan

Retina Associates of Western New York

Wed, 24 Oct 2018 16:52:51 GMT

Hi Margaret,

We do OCT's in our clinic both with and without dilation. Patients having OCT's after seeing the providers are typically dilated. Those having OCT's prior to seeing the providers usually are not dilated.

Most OCT devices use an infra-red light that the human eye is not sensitive to so dark adaptation provides adequate access for acquiring an image of the retinal tissue.

We notice very little difference in quality between the two.
Hope this helps,
bob

Wed, 24 Oct 2018 17:01:18 GMT

At our office we usually dilate everyone (since the Dr is going to look in through the slit lamp later anyway) and then they get OCT's either right after or about 5 mins post drops. Like Bob said most OCT devices use the infra-red that doesn't affect pupil size much if at all so it really depends on what's going on with the patient. Many of the patients we see have cataracts and sometimes you may need that dilation just to give you more options when your looking for a clear field of view.

Hope that helps. Good luck,
Gary

Wed, 24 Oct 2018 17:24:53 GMT

I prefer and strongly encourage dilation for OCT, one set is fine. However, it depends on the patient, their situation and the doc they're seeing. Thankfully, nearly all do come to us with a set of drops in. But we will do them without.

I always try to get the best image I can, drops or no drops. If all I can get is a so-so image, I do explain that the images would have been better had the patient been dilated. (never pass up an opportunity to enlighten others!)

Gary

Sat, 27 Oct 2018 07:52:38 GMT

I can't tell you how many times in the past four years that having a patient dilated has helped us catch a retinal detachment in the "non-problem eye" in patients who weren't yet sympathetic.

Furthermore when the patient is properly dilated you can see around worse cataracts, dense PCO's/PCH's, corneal abrasions, vit hem's, etc.

The biggest downside for a patient is a small (comparative to their life span) time of inconvenience from dilation.

When patients ask me if I would get my eyes dilated if I was coming in to see our retina doc's my reply is usually "I only dilate the eyes I want to keep seeing with".

Sat, 27 Oct 2018 07:59:48 GMT

I should add, that when obtaining OCT's you're able to see if you need to get BR, FAF, multi-color or true color of specific pathologies. For 3 of our 4 retina specialists I see the new patient before they do. A lot of the time our referring doc's don't include locations of issues, etc., so when a patient is dilated I can save the MD time by catching scans of whatever the issue is without them needing to bring the patient back for a second go.

This being said, we scan out to the edge of the retina to find retinal tears, lattice degeneration, CHRPE lesions, melanomas, nevi, you name it. Without dilation it's much more difficult on the patient, and it's more time consuming.

Why OCT through those areas rather than just obtain a super-duper-wide-angle-everything's-funky fundus image? A fundus image doesn't show the RPE in cross section. Some tears are self-sealed and don't need laser, the OCT can show that. Some tears aren't apparent and under examination look to be "white without pressure", where the OCT can show a micro-tear.

Is there harm in dilation? In my own personal theory I feel that there's less potential harm in dilation than in not dilating. What's worse than having an issue, is having an issue that was overlooked because we were trying to save 2 minutes of time.