OCT Protocol utilizing the Heidelberg Spectralis for AMD pts

Wed, 22 Jun 2022 19:56:44 GMT

Hello fellow OPS members!

Hope you are all doing well!

I am reaching out seeking information on OCT protocols in AMD patients. The physician I work for has asked me to research some topics and I am trying to find information in every avenue I can.

The main question is OCT protocols utilizing the Heidelberg in AMD patients. Many offices use multiple settings and each physician asks for different protocols as we all know.

I hope you can help answer some of these questions-

1. Utilizing the Heidelberg- what is your standard protocol for ARMD patients- wet and dry?

How many sections do you use? What degree 20,25,30 degrees? Do you use HS or HR?

Seeking information in thickness map as well as radial scans. How many vectors?

Do you have any information on a study that states a standard protocol?

Whenever we have a new patient or a patient labeled with dry AMD, I scan with our normal protocol of 61 sections @ HS, 9 ART for a thickness map, 12 radial scans HS @ 9 ART and I then add the maximum of 48 radial sections to look for small areas of possible leakage. I may also add a smaller horizontal and vertical map to seek any fluid as well as an OCT-A.

The physician I work for has asked me to seek what is a standard protocol ( I have reached out to multiple reading centers- has been helpful) as well as any information on the quantitative data on pathology missed within 1, 3, 5, 10 um between each scan protocol and what is acceptable in a retina practice.

2. Any studies on OCT-A? Vessel patterns in dry AMD and when they turn wet?

3. When do your physicians start treatment in AMD? What percentage of leakage do they start treatment and if started earlier does this mean less treatments for patients?

4. Any articles on the longevity of ARMD anti-VEGF treatments? After 4-6 week injections for 5-7 years, than injections needed less often- reasons?

Thank you so much for any guidance on any of my questions!

I'm looking up all of these questions in multiple resources and it is quite a task!

Thank you OPS members!!

Most sincerely,

Julia Monsonego

Thu, 23 Jun 2022 17:36:47 GMT

Hello Julia!

Good question and thank you for using OPS Forums to seek an audience!

We are a private practice so our rules may not apply to the larger university settings.
We use many of the same, but not to many of the deeper, high ART setting scans.

Our HE Device is certified thru DRCR, WISC RC, DARC, and DUKE.

In our clinical practice though, for macular studies, we use a 20 x 20 degree, HS, 97 section, ART 1, 60 um is done on everyone because it is a good reference and does not require a lot of image rendition to build the line before the line shifts, it's practically continuous.
For a first time patient, we set that reference almost immediately and perform everything else in follow up mode.
We use a HS, Fast Scan, 20 x 20 degree, 25 section, ART 9, 240 um and do the same, set the reference immediately and perform everything else in F/U mode.
Then to cover the info heading to the ON, we do an RNFL scan, in circle mode, 20 degree, so we can perform a RNFL Analysis over time and see if there is any thinning there in the RNFL Layer.
We adjust as necessary of course.
If I see that there is choroidal involvement, and I've scanned them using EDI in the past, I'll repeat that scan and raise the beam a little.
All of these pull up nicely in the review station for the MD, and the comparison studies are usually spot on, and we will click Review and use the Display Function, and look at
'compare two scans of a progression series' function when we are in the exam room for comparison.
And for the others in your inquiry.
No OCT-A here.
Anything that is wet is Treat, or Treat and Extend.
I don't have any feed back on percentages of leakage.
Longevity is a complicated topic, and needing less,
but have you see the data on 'Vabysmo' yet?
[No Financial Interest]

https://www.vabysmo.com/wamd/learn-about-wamd.html?c=vab-17e986b17ad&gclid=Cj0KCQjwntCVBhDdARIsAMEwACkJPZeJqCYuH996YXPQeIiUUCRZcMnN2dt2xgf-_b8opRWc6hv7QnQaAg2sEALw_wcB&gclsrc=aw.ds

Thanks for your inquiry and let's see whom else contributes from our OPS community.

Keep us posted!

All the best,

Jim

Thu, 23 Jun 2022 20:50:34 GMT

Hi Jim,

Thank you so very much for your response! I sincerely appreciate it!
It's very interesting. I'm curious about the 20 x 20 degree scan as we have often found CNVM's in the area the macula/nerve meet. I don't think the 20 degree reaches quite that far. And ART of 1. I usually only choose an ART of 1 or less with my most difficult patients- nystagmus, etc. Do the reading centers use ART of 1 or is that for private patients?
Do you perform any radial scans?
Again, I thank you soooooo much for your response! I'm looking for all the information I can find!
Hope you have a great summer!!
Always great to talk with you, my CRA practical exam buddy!!
Most sincerely,
Julia

Wed, 4 Jan 2023 20:19:39 GMT

Julia,

We have been using the Spectralis since before there were any presets for the OCT (2006 IIRC). When we had an OCT1, we used a 49 line 9 ART, HS, 20 x 20 cube. We would have liked more ART, but for our office, the bang for the buck for more ART wasn't there for us. Compared to the Stratus we were using, this was a much better scan. Now that we have the latest generation Spectralis units, we now use the Dense preset since 16 ART is so fast on the newer devices. All of the other settings are the same. When we first started doing clinical trials with the Spectralis, several reading centers that we dealt with were using Dense preset as well, but many have now changed from HS to HR and increased the number of lines from 49 to 97. IMHO, again I think this is because the newer machine are so fast, that more detailed data can be obtained from the patient without too much of an increase in "chin time" for the patient.

Fri, 27 Jan 2023 14:11:15 GMT

At my first and second practice the specs were about the same, volume scans at ART 9, HR, with 19 sections. If there was a mac hole or VMT we'd get a custom scan, 9um separation and minimum width/height, and put the bottom of the scan at the start of where the retina was showing change. Particular to my first practice we started getting peripheral scans on any patient with new flashes/floaters, because with a 55* OCT set to about a 10* width you can pinpoint holes that are imperceptible to physician examination and traditional fundus imaging. When we started getting that going really well we saw patients stop coming back a week or two later with apparent retinal tears or detachments, and had much greater success with laser treatment while things were still really early on. It takes more time though, and isn't capable to be done with the S2000 series of Spectralis, you have to have a pan/tilt head to get those well, so high volume clinics might not be ideal candidates despite it possibly being a higher quality of care.