Technology-driven care

Since the invention of the technology in the early 1990s, optical coherence tomography (OCT) has redefined the way retinal disease is treated. Indeed, treating non-surgical retinal disease without the use of an OCT has become unthinkable. Thanks to its rapid, non-invasive, real-time nature, a retinal cross-sectional image can be obtained during every patient visit in order to help guide diagnosis and follow-up. It is difficult to overstate the importance of the OCT. It is “a fundamentally new type of medical diagnostic imaging technology†which is now “part of the standard armamentarium in eye care†and “marks the beginning of a new field that might be called structural imaging of the eye.†Indeed, it is reasonable to say that the vast majority of ophthalmologists can read an OCT image, despite its relatively recent introduction into the field of eye care. The four editors of this third edition of “Optical Coherence Tomography of Ocular Diseases†were all instrumental in the conception and development of OCT technology. Published by Slack Incorporated, this text covers OCT in depth over three sections. The first section, “Principles of Operation and Interpretation,†includes two chapters: a 25-page introduction to the technology itself and a 40-page guide to OCT image interpretation. In the following 300 pages, the second section, “OCT in Retinal Diseases,†deals with what are the most common indications for the use of the OCT. The retinal disorders are covered thoroughly over the course of nine chapters. Each chapter begins with a short description of each common disease, such as idiopathic epiretinal membrane, which describes the clinical presentation, biomicroscopic appearance and the role of the OCT in its treatment. The chapters then continue with case studies that include a clinical summary, OCT images and fundus and/or fluorescein angiographic images. The result is a streamlined, efficient learning text that can also be used as a reference text for clinical cases. The second section begins with a chapter on “Vitreoretinal Interface Disorders,†followed by chapters on: retinal vascular diseases; diabetic retinopathy; CSCR; AMD; miscellaneous macular degenerations; chorioretinal inflammatory disease, retinal dystrophies; and such miscellaneous retinal diseases as posterior segment trauma and optic nerve pit. Particularly interesting and informative is the chapter on “Chorioretinal Inflammatory Diseases.†These are the disorders that we rarely see in the clinic, but absolutely do not want to miss. The book’s third section covers the rest of the eye under the title of “OCT in Glaucoma, Neuro-Ophthalmology, and the Anterior Segment.†The section devotes one chapter to each of these three topics. The chapter on the use of the OCT in glaucoma focuses on the questions commonly asked regarding imaging modalities in glaucoma, such as “How well do optic disc abnormalities visualised on OCT correlate with clinical assessment and visual field abnormalities?†and “How can imaging supplement visual field results in patient follow-up?†These questions are addressed in a series of case studies. It is interesting to note that images from nearly every model of OCT machine are used in the case studies, from the grainy early machines to the razor-sharp newer editions. The advantages of this decision are twofold: first, it allows the reader to become accustomed to each image type, and it confirms the notion that the older devices are often adequate for basic diagnosis and follow-up of common pathology. This book is ideal for ophthalmology residents, vitreoretinal and glaucoma fellows as well as general ophthalmologists looking to further refine their OCT skills.

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