Feature, Report

More evidence needed before recommendation

The development and now widespread availability of OCT has altered diagnosis and management of ocular disease, particularly age-related macular degeneration (AMD), diabetic retinopathy and glaucoma. Optometry Australia supports OCT as a safe, fast and non-invasive method of ocular imaging. We believe it can play an important part in the diagnosis and management of chronic eye disease. Indeed, imaging technologies have been in part responsible for a shift towards early diagnosis, particularly of glaucoma.

As with any other clinical technology, OA believes OCT should be applied in accordance with an evidence-based approach to diagnosis and management.

To support optometrists, we have developed clinical practice guides on the diagnosis and management of AMD and diabetic eye disease within optometry, and we are currently updating our guide on the diagnosis and management of glaucoma within optometry.

These address the role of OCT in the diagnosis and management of these conditions.

We also support our members in staying up-to-date on recommended management of chronic eye conditions and imaging technologies through our comprehensive offerings of face-to-face and online CPD, current research in our journal Clinical and Experimental Optometry and specific OCT interpretation guides in our Pharma magazine.

As with other clinical technologies, OA cautions that there are limitations and risks associated with the use of OCT. Whilst different OCT instruments offer a range of different scan and analysis options, all remain subject to the same limitation as other approaches reliant on normative comparison, and they can generate false positives and false negatives.

We therefore suggest that OCT output needs to be carefully examined and considered alongside the more fulsome clinical picture arising from a comprehensive examination.

As OCT has become increasingly available within community optometry practices, the question of whether OCT should be incorporated as a standard part of a comprehensive eye examination has arisen.

Limited published data and evidence with respect to application of OCT in a standardised way across the general optometric patient population exists, making this a complex question to answer.

With particular respect to glaucoma, it appears that a move towards earlier diagnosis of this disease may have been in part driven by greater use of OCT.

However, we believe that currently there is no evidence to support a recommendation for the broad application of OCT as part of a standard comprehensive eye examination on the general presenting patient population.

OA believes that if OCT is incorporated into practice as a standard work-up for general patients, or for a particular subset of patients without specific indicators or a relevant diagnosis, that this needs to be done cautiously with due regard to cost-benefit for patients, and with the positioning of OCT as only one element informing decisions about patient eye health and management. Regular reviews of the impacts of this practice are also needed.

From a financial perspective, in recent years OCT devices have become more affordable for many practices, though they continue to rain a substantial technology investment.

While there is not a specific Medicare it that supports optometrists to provide OCT to patients, some practices choose to charge privately for this additional imaging whereas others choose to provide it without a specifically linked patient fee.

About the Author

Luke Arundel, Chief Clinical Officer

Luke has been Optometry Australia’s chief clinical officer since 2014. He has also worked in independent, corporte and specialty practices in Australia and overseas, and in the contant lens manufacturing field.