UPFRONT
Innovation Alive and Well in Retina

Having just returned from the third annual Retinal Physician Symposium held at Sanibel Island Resort in Florida, I am pleased to report that the field of retina is alive and well in 2007.What was obvious throughout the meeting was retinal specialists’ genuine interest in emerging technologies and new approaches to treating disease, as well as a true desire to understand the underlying nature of the conditions that we treat and find better ways to manage them. Perhaps no single diagnostic test has had more impact in the management of retinal disease in recent years than optical coherence tomography (OCT). In just a short time, OCT has come to supplant fluorescein angiography (FA) as the mainstay of monitoring for treatment response in age-related macular degeneration (AMD), as well as in diabetic macular edema. Part of this conversion is due to the fact that the OCT system currently in widespread use, the Zeiss Stratus OCT-3 system, provides both visual and numerical outputs that are straightforward and easy to interpret.Traditional FA has always proved to be a challenge in many situations, with difficulties in distinguishing between classic and occult choroidal neovascularization, identifying areas of staining vs leakage, and even determining whether a lesion was subfoveal or extrafoveal.While many of these factors were important in the management of AMD in the past, the advent of pharmacologic therapy focused our attention on the degree of vascular activity or leakage. OCT obviates these difficulties by presenting an output that is easily readable. On the other hand, we have also come to realize that the OCT systems currently in widespread use have their faults. These include the difficulty with image registration, as well as software interpretation errors that result in inconsistent or inaccurate numerical values for retinal thickness. In addition, FA is still required for diagnosis and documentation of the neovascular lesions.

NEW OCTS ARE ARRIVING
As Alexander Walsh,MD, writes in this issue of Retinal Physician, OCT imaging is undergoing a radical change. The new spectral domain (SD)-OCT systems will dramatically change the way we image the posterior pole. Dr. Walsh thoroughly and completely compares and contrasts the systems that will be on the market over the next year. I am convinced that this information will prove extremely valuable in selecting the right system for your needs. A note of caution, however, should be mentioned. Until now,OCT was nearly synonymous with the Zeiss Stratus unit. As pointed out by Dr.Walsh, at least 6 new systems will be available, with different methods of data presentation. As SD-OCT evolves, retinal specialists must be cognizant of these differences and exercise care in the interpretation of the data SD-OCT presents until standardized or comparative algorithms are developed. Despite this drawback, competition is a good thing and will likely result in improved quality and reduced price — benefits to both us as physicians and to our patients.