instrumental strategies

The RTA in Clinical Practice
Diagnose and manage patients who have glaucoma and retinal disease.

I’ve been utilizing Retinal Thickness Analysis (RTA, from Marco) in my practice for four years now. Due to the wideranging applications of this technology from detecting glaucoma to age-related macular degeneration (AMD) and diabetic retinopathy as well as other macular pathologies, it’s become the single most utilized testing device in my practice. The ability to accurately quantify and qualify the posterior segment is critical to proper patient care.

RTA and diabetes
Diabetes and its ocular complications are a mounting problem in the United States. Every day, optometrists and ophthalmologists see patients who either have or will have ocular damage from this disease. Our understanding of the disease process and its treatment has increased greatly over the last two decades. Our ability to measure the structural changes in the disease has also advanced greatly in just the last five years.
Historically, testing, such as flourescein angiography and scanning laser ophthalmoscopy, have been reserved for patients who show funduscopic changes, typically hemorrhage or exudates in the posterior pole. Because the newest generation of scanning lasers is more sensitive to changes in macular thickness than even the best clinical observer, I perform RTA on an increasing number of my diabetic patients. I’ve seen repeatable retinal thickening in far too many patients who don’t show hemorrhage, intraretinal microvascular abnormalities (IRMA), cotton wool spots or other visible signs of retinopathy to not image them early and often in the diabetic disease process. As a result, I scan all my patients who have been diabetic for more than three years. Not only have I been able to detect macular edema earlier, my patients appreciate the care they receive.

RTA and glaucoma
RTA has also changed the way I diagnose and monitor my glaucoma patients. Having optic nerve head structural analysis as well as retinal nerve fiber data is a great adjunct to clinical glaucoma practice. In addition, having dense and accurate macular thickness data is equally and sometimes more helpful and important. Because there’s much less cross over between normal and glaucomatous macular structures than there is with normal and glaucomatous optic nerves, the macular thickness map with the RTA 5, the latest device, is often the first place I see glaucoma-related structural damage or change. With the focus in glaucoma detection and treatment moving more and more toward early detection and treatment, the RTA 5 gives me the data I need to manage these patients.
As I said nine months after adding topography to my practice in 1997, I can’t imagine practicing without retinal thickness analysis.

DR. WARREN, IS IN PRIVATE PRACTICE IN RACINE, WISC. E-MAIL HIM AT JWARREN@EYECODERIGHT.COM.