Dr. Steensma was the first optometrist in Ventura County to do routine retinal photographs on every patient as part of their annual eye examination. This was a significant tool in detecting early eye disease. Over the last several years the retinal photographs have helped Dr. Steensma to detect eye disease much sooner than the traditional examination techniques used by most optometrists.
Now there is something better. Ocular Coherence Tomography (OCT) is a CT scan for your eyes. This new technology allows Dr. Steensma to see early eye disease months to years earlier than before. It can actually image tissues below the surface and detect health changes before they are visible with traditional examination technique's. It can detect early macular degeneration, hypertensive retinopathy, diabetic retinopathy, retinal detachments, macular holes and wrinkles, glaucoma, and corneal diseases.
Early detection results in more prompt treatment and a better visual outcome for the patient. Dr. Steensma feels that this is an important test for all patients and can be especially important in patients over 35 and those patients with a family history of eye disease.
“OCT technology is the most important advancement in optometry that I have seen in my 40 years of pracatice. It allows us to provide the most comprehensive exam possible, and gives us confidence that we have provided the best service to our patients, and has kept us at the cutting edge of medical eye health care. Patients really like being able to see that everything is within normal, or if there is a problem, being able to actually see it and be involved in their own care.”
This cutting-edge technologic screeening is not yet covered by insurance plans, but Dr. Steensma thinks its value is hundreds of times more valuable to the patient’s health than the $30 fee for the scan, and he encourages all patients to take advantage of this service.
Dr. Steensma's Cases:
The OCT scans 7 cross-sections of the retina 28,000 times and creates 7 cross-section images of the retina tissues. The top left image is one of the 7 horizontal cross-section images. The 6 images in the middle of the screen are the other 6 horizontal cross-sections. The top-right image is a vertical cross-section.
The circular image at the bottom is a measure of overall retinal thickness. Some eye diseases make the retina thicker and some make it thinner. In this case the thickness is as expected for that patients age and is color coded green. If it was thicker than average for that patients age it would be yellow or red, indicating possible eye disease. Blue or violet indicates a thinner retina than expected retina and possible eye disease.
The image on the right side and the table below it are measures of the top 100 microns of the retinal thickness. These are the tissues damaged in glaucoma, so loss of thickness here may indicate glaucoma. Recent research indicates that this layer is also damaged in Alzheimer's disease, Parkinson's Disease and Multiple Sclerosis, so this test may be important in managing those neurological diseases in the future.
This iWellness OCT scan shows an RPE detachment. The RPE is shown in the OCT as an orange line near the bottom of the scan. In this case you can easily see the RPE detachment where it bows upward away from its normal position. The blue areas in the overall thickness image indicates a peripheral retinal thinning also.
This iWellness OCT scan shows a serous (meaning watery) detachment above the RPE. Note that the orange RPE line is not bowing up, but the tissues above it are bowing up.
This eye also has a significant macular membrane (sometimes called a macular wrinkle or macular pucker). Note that the thickening of the innermost layer (top of the image) and its seperation away from the tissues below it.
Also there is significant retinal thining indicated by the blue and violet areas in the overall thickness plot.
This iWellness OCT scan shows an extreme disruption in that normally straight orange RPE layer. Notice how thick it appears right in the center. This is Geographic Macular Degeneration, which is the most severe for of "Dry" Macular Degeneration.
When the iWellness OCT scan shows a retinal problem a more detailed OCT scan is performed. The following two scans are Retinal Maps.
This Retinal Map shows a large macular hole . A normal OCT shows a gradually thinning of the retina into the central macular center. This OCT shows a large hole in the center of the macula. This is a very serious condition that requires surgery to repair it. Before the OCT macular holes were not even seen untill they became very large and were probably not repairable with surgery at that point. Now, with the OCT they can be detected very early and be repaired with good visual outcome.
This Retinal Map OCT shows vitreous traction . Note the thin line bowing up above the retnal surface. As we age the vitreous (the gel like substance inside the eyes), becomes more watery and eventually cannot support itself. When that happens it loses its structure and pulls away from the retinal surface. This is called a Posterior Vitreous Detachment and usually creates floaters that people see as grey spots in their field of vision.
Usually it easily pulls away from the retina, but sometimes it adhears to the retina and pulls on the retina as it is trying to collapse. This is called vitreous traction, and sometimes causes the patient to see flashes of light. It can also distort the retina blurring vision.
This eye also has a condition called Synchesis Scintillans, in which multiple opacites are scattered throughout the vitreous. Note the colored globs at the top of the image. These opacities actually block the OCT scan creating gaps (shadows) in the OCT retinal image.