Study Finds OCT Proves Its Usefulness in the Operating Room

Cleveland Clinic researchers say the transition of ophthalmic imaging with optical coherence tomography (OCT) technology from the clinic to the operating room has profound implications for best-practice management of ophthalmic diseases.

“In the clinic environment, OCT is one of the primary tests used to determine treatment response, diagnosis and optimal management of numerous conditions, but it’s still an emerging technology in the operating room,” says Justis Ehlers, MD, a staff physician on the vitreoretinal service at Cleveland Clinic’s Cole Eye Institute.

Study results

The two-year PIONEER study, conducted at Cole Eye Institute, found that use of a microscope-mounted intraoperative OCT provided efficient imaging during procedures, plus feedback that informed surgical decision-making in many cases. Results showed that OCT imaging can be performed for numerous anterior and posterior segment surgeries with minimal impact on workflow. During the first two years of the PIONEER study, 531 eyes were enrolled (275 anterior segment cases and 256 posterior segment surgical cases).

“In the operating room, OCT has the potential to transform care in many of the same ways it has in the clinic,” says Dr. Ehlers. “It can give rapid feedback to surgeons regarding the completion of surgical objectives.”

An important question on the use of intraoperative OCT relates to its impact on patient care and surgeon decision-making. In the PIONEER study, surgeons reported that intraoperative OCT potentially altered their understanding and decision making in 40 percent of cases in lamellar keratoplasty. When considering only those cases where the intraoperative OCT demonstrated a finding disparate from the surgeon’s assessment and definitively changed surgical management, 9 percent of cases resulted in alterations to surgical care, the study reports.

For posterior segment surgery, intraoperative OCT potentially enhanced the surgeon’s understanding of the completeness of peel status and potentially impacted management in 40 percent of cases. If considering only those cases where intraoperative OCT information was discordant with the assumption of the surgeon and directly impacted surgical care for membrane peeling, 8 percent of cases were altered based on the intraoperative OCT findings.

Adoption may still be slow

Despite the promising results from this and other studies, however, researchers acknowledge that widespread adoption won’t be an overnight phenomena; too many obstacles stand between the technology’s possible benefits and its use in operating rooms.

“In our clinics, it took about a decade for OCT to become the standard of care in retinal diagnostics for numerous conditions,” Dr. Ehlers says, noting multiple current barriers to the intraoperative use of OCT, including limited available systems, system cost and the need for additional evidence on the technology’s overall value.

In the clinic environment, OCT has been integrated into the clinical workflow to allow for rapid testing and patient throughput. The systems are easy to use and provide a way to increase efficiency and deliver leading-edge care. In the operating room, optimizing surgeon feedback platforms and identifying areas of value for patient outcomes are key factors in widespread acceptance of the technology. It will take further research to address each of these areas, researchers say.

More study is needed

Randomized clinical trials may be needed to better define the impact of OCT systems on surgical outcomes and intraoperative decision-making. In addition, integrative solutions research is required to better understand the optimal platform for using OCT in operating rooms, researchers conclude.

Since the PIONEER study, advances in technology have seen the externally mounted microscope replaced with an integrated system, eliminating the need to stop surgery to capture an image.

Dr. Ehlers says the level of interest in intraoperative OCT is definitely on the rise.

“Two integrated OCT systems have already achieved FDA clearance in the U.S., and additional systems are under development,” he says. “This is clearly moving in the direction of increased utilization and adoption.”