AVANTI WIDEFIELD OCT WITH ANGIOVUE SOFTWARE REVEALS VASCULATURE

In each installment, the “Diagnostic Focus” column presents the perspectives of several optometrists regarding their firsthand experiences with one new device.

A DIABETIC Hispanic male in his late 50s presented with recent onset vision reduction to Julie Rodman, O.D., M.S., F.A.A.O., of the Nova South-eastern University College of Optometry. In using the Avanti Widefield OCT, with AngioVue OCTA software, from Optovue, Dr. Rodman says she was able to visualize the earliest stages of a choroidal neovascular membrane.

“The fact that we were able to intervene so early in the disease process really helped him,” Dr. Rodman says.

OVERVIEW

The Avanti Widefield OCT, with AngioVue, is an imaging system that can acquire both OCT and OCT angiography (OCTA) images quickly, says Nathan Lighthizer, O.D., F.A.A.O., of Northeastern State University.

According to Optovue:

• Acquisition time per image is about three seconds.
• The device captures widefield OCT images at 12x9mm, using SD-OCT capture method, in addition to the standard 3x3mm and 6x6mm image captures.
• The device is offered with three configurations, (1) comprehensive, (2) essential or (3) retina. The comprehensive and essential packages combine OCTA with structural OCT for retina, glaucoma and anterior segment applications. The retina software combines OCTA with retina-only structural OCT.
• The device offers a wellness exam, similar to iWellness, found on the company’s iSeries products, a non-invasive vascular image of superficial and deep capillary plexuses and a view of choroidal neovascularization.

PRACTICE BENEFITS

• Early disease state identification assistance. The device has helped Greg Caldwell, O.D., of Duncansville, Pa., and Drs. Rodman and Lighthizer in the management of diabetes, AMD, vein occlusion, capillary nonperfusion, ischemia, central serous chorioretinopathy, pigment epithelial detachment and Fuchs’ corneal dystrophy.
  “Everything that is needed for interpretation, including en-face OCT angiograms and SD-OCT B-scans, is on the main working page,” Dr. Rodman says, referring to the software’s one-page printout of the patient’s images.
  “In the past, we had to wait until that membrane leaked,” Dr. Lighthizer explains regarding wet AMD. Now, he says by using OCTA, the anomalous blood vessel can be seen before it bleeds or leaks fluid.
• Enhanced patient education. “It’s nice to be able to show patients what’s going on in macular degeneration, to be able to show them a vessel that’s growing erroneously,” Dr. Lighthizer explains. He says he does this while providing a normal comparison.
• Accurate referral time. Dr. Rodman says the additional information she is able to gather by visualizing the retinal and choroidal microvasculature can help her determine when and if a patient needs to be referred to a retinal specialist.

TRAINING

Company representatives trained students, residents and staff, Dr. Lighthizer says. Dr. Rodman says there is a two- to four-week learning curve for proper scan acquisition and an overall understanding of the technology. However for Dr. Caldwell, who already had experience with Optovue’s iVue, it was a seamless transition.

UTILITY

Dr. Lighthizer estimates a practice could use the device three to four times or upwards of eight to 10 times a day, depending on schedule and patient demographics.

Dr. Caldwell says his practice of four doctors, performed 1,826 wellness screenings (which are an out-of-pocket cost) using the Avanti in about the first nine months of 2017. He says he packages it with other diagnostic devices in a wellness bundle offered to patients.

In total, Dr. Caldwell says the practice will use the device about 20 to 25 times per day, with about 10 of them being wellness exams.

Worth noting: there are instances where OCTA may not be a substitute for traditional angiography, such as evaluation of late stage leakage or in-depth retinal perfusion in the peripheral retinal area, Dr. Lighthizer noted. Also, some studies indicate traditional angiography may pick up “low-flow” microaneurysms better than OCTA.

THE PATIENT

The gentleman mentioned above was treated with an anti-VEGF and is doing great, Dr. Rodman reports. She credits the device with providing that extra piece of information. OM