Summary Of Proficiency In Ophthalmologic Clinical Arena: Particular Expertise In Optical Coherence Tomography For Clinical Application & Investigation

Kiran Aman, MS; Cell Phone: +92-333-403-0049; Email: kiranaman786@gmail.com

I am a ‘’Diagnostic Oculist’’ by training as far as clinical expertise. I possess nearly 8 years’ experience cutting edge knowledge of the operation of all ophthalmologic diagnostic tools. As an Optometrist and Orthoptist, I perform an essential role in our current clinical practice. My degree of skill surpasses any technician/consultant. I can perform my duties with utmost precision and accuracy that is unmatched.

Present Exclusive Responsibilities:

I am employed by an investigative research and eye-care medical center, where we address diverse pathology of disease and challenges daily. My responsibilities include acting as a lead OCT operating professional, with extensions like UW-FFA, Visual Fields, B-Scan and Galilei Orbscan along with reporting to the supervising ophthalmologist. I prefer to perform OCT and UW-FFA SPECTRALIS myself: the key attributes of the procedure performed entails:

Swept Source DRI-OCT at the moment which has far better image quality than the 1st and 2nd generation OCT modules. Its high resolution and enhanced wavelength selection aids every single layer of retina readout in a better fashion thus disease identification is much easier and more accurate.

I perform both macular and glaucoma modes at present. In macular mode, I further go for 3D-Macular Scan, Radial Scan and 12 line scan whereas in Glaucoma mode I am taking ONH scan, GCC scan and 3D macular scan. These scans cover disc area, retinal layers and choroidal structures from every direction that help me to point out minor abnormality in reporting

Anterior segment OCT is also available specifically for those patients who do not feel comfortable with UBM (Ultra Bio Microscope)

Fundus imaging, (FAF and FA) done on senior consultant recommendation

Keeping record of OCT scans in order to review them on and off to keep myself up-to-date, particularly of those cases which I have not seen before

Latest Trends:

Fourier Domain and Spectral Domain OCT no doubt were the biggest evolution of their time. But after getting experience on DRI-Swept Source OCT, my concepts are more stringent than before. Consultant’s trends are more towards OCT now. Out of 50% of the outpatient

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population that qualifies, 20% are recommended for OCT, whereas the other 30% covers all other procedures, respectively.

Personal Observations:

OCT provides detail and wider view of retinal and choroidal structures

Perfect visualization of anterior segment, echogenic vitreous [1], retinal and choroidal thickening, thinning and edema helps consultants in clinical decisions.

Its longest wavelengths easily dealt with cataracts and hemorrhages.

It took 5 minutes to complete the whole procedure on elderly patients, young children and pts with Age-related Macular Degeneration

Research papers on anterior segment and choroid are more frequently available on scientific sites than before by using DRI-OCT. [2-3]

My paper has recently published in TVST ‘Assessment of Vitritis on OCT for patients suffering with uveitis ’’. I collected data using Spectral Domain OCT. In future, I will prefer to use DRI-OCT for data collection to analyze choroidal area as well for the assessment of uveitis.

Ultra Widefield-FFA Heidelberg Spectralis as future trend:

Fundus photography was one of my favorite procedures during my student life. It helped me a lot to understand normal and diseased retinal and choroidal vasculature.

I have performed FFA (on my own) for almost 3 years during my stay at a renowned Public sector institution and research center in Pakistan. I used to give FFA teaching and training to medical and allied health students. Furthermore, students were given special lessons to overcome fluorescein side effects on patients.

Presently, I am working on Ultra WideField Imaging-FFA Heidelberg Spectralis. I still remember, I used to discuss with my professor 4 years back, that many common diseases remain underestimated from lack of peripheral angiography. The advent of UW-FFA has solved this serious matter. It delivers evenly illuminated and undistorted, high contrast images even in the far periphery.

I also had an experience on Optos in Moorefields Eye Hospital, Dubai. It is no doubt, a very good attempt but I feel more comfortable working at UW-FFA. UW-FFA has far better image quality. It gives real image and fine peripheral view. The presence of 3 lasers (Blue Green Red), OCT, IRA, BAF, lenses (300, 510, 1020) helps the clinician to identify abnormality from all aspects.

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The only drawback I have noticed so far in UW-FFA that it doesn’t take color images at 1020 field of view, whereas Optos takes color images even at 2000 level.

Presently, Ophthalmologists prefer UW-FFA in majority of diabetic and hypertensive cases. From my vantage point:

Wider fundus view provides convenience to clinician to detect abnormality in extreme peripheral areas

Simultaneous FA and ICGA can also be performed easily

Video recording is another positive feature of this technique

Researches show that now angiography is possible in infants using UW-FFA without giving anesthesia. [4]

Bibliography

1. Itakura, Hirotaka, et al. "En Face Imaging of Posterior Precortical Vitreous Pockets Using

Swept-Source Optical Coherence Tomography." (2015).

2. Alasil, Tarek, et al. "En face imaging of the choroid in polypoidal choroidal vasculopathy

using swept-source optical coherence tomography." American journal of ophthalmology

159.4 (2015): 634-643.

3. Fung, Timothy HM, et al. "Heidelberg spectralis ultra-widefield fundus fluorescein

angiography in infants." American journal of ophthalmology 159.1 (2015): 78-84.

4. Gora, Michalina, et al. "Ultra high-speed swept source OCT imaging of the anterior

segment of human eye at 200 kHz with adjustable imaging range." Optics Express 17.17

(2009): 14880-14894.