Virtual optical coherence tomography (OCT) and photography AMD clinic

Why have I been sent to this clinic?

The hospital has received a referral from your optician or your GP asking for further investigations of your eye. A retinal photograph and OCT (see below for information) has been requested to help the team make sure you are on the correct pathway for your condition. The photograph and OCT scan will quickly allow the ophthalmologist reviewing your tele-ophthalmology “virtual” clinic encounter to make sure you are seen in the most appropriate follow-up clinic and in the correct timescale.

What does virtual mean in a macular clinic?

Virtual (aka tele-medicine) clinics have been developed for a range of medical conditions. The virtual aspect of the AMD clinic is where the face-to-face part of the appointment with the ophthalmologist and patient interactions has been removed.

You will attend your hospital outpatient appointment and your ocular clinical data will be collected on the day by trained specialist allied healthcare professional. This includes visual acuity and the ocular images mentioned. Once all the relevant clinical data is collected, it is then reviewed by the ophthalmologist and the outcome of the results are sent to the patient via post or MyChart.

What is optical coherence tomography (OCT)?

Optical coherence tomography (OCT) is a non-invasive imaging test, a lot like a photograph, which is widely used in the field of ophthalmology. It is used for the diagnosis and ongoing treatment of several ophthalmic conditions.

The OCT scan provides the ophthalmologist with a high resolution, cross-sectional image of the ocular tissues at the back of the eye. This information enables the ophthalmologist to evaluate the eye in order to make management and treatment decisions.

The scanning technique uses light waves to achieve high resolution pictures which the ophthalmologist can review at a later date.

Why would I need these tests?

Your optician or GP has seen changes or suspects changes in the retina at the back of the eye. This diagram shows the basic structure of the eye and where the retina is in the eye.

The photograph and OCT scan performed within this virtual clinic focuses on the macula (a small area in the retina that deals with fine, detailed vision). The scans will be reviewed, at a later date, by an ophthalmologist.

What can you see with OCT?

OCT imaging can be particularly useful in detecting and monitoring multiple macula conditions such as age-related macular degeneration (see below). This technology allows us to explore treatment options more efficiently and effectively.

Many patients are referred to the “virtual” clinic with suspicion of wet age-related macular degeneration, but only a third of patients require treatment.

This “virtual” clinic aims to ensure that those who do need treatment are prioritised and seen as quickly as possible.

What is age-related macular degeneration (AMD)?

There are many forms of macular disease, but age-related macular degeneration (AMD) is the most common, usually affecting people over the age of 50. The condition affects the central part of your vision. There are two forms of AMD – dry and wet.

Dry age-related macular degeneration (AMD) is a slow deterioration of the cells of the macula as the retinal cells die off and are not renewed, often over many years. The term ‘dry’ does not mean the person has dry eyes, just that the condition is not wet AMD (see below). The progression of dry AMD varies, but in most people it develops over many months or years. People often carry on as normal for some time.

Wet age-related macular degeneration (AMD) develops when abnormal blood vessels grow into a weakened macula. These leak blood or fluid which leads to scarring of the macula and can cause rapid irreversible loss of central vision. Wet AMD can develop very suddenly but it can now be treated.

What happens in clinic?

You are advised not to drive to your appointment as you may have dilating drops, which are required to obtain the best scan possible.

On arrival, you will have your vision (how well you can see) checked. Please bring all your current glasses to use in this test.

A specialist allied healthcare professional will guide you through the appointment and the medical photographer or ophthalmic technicians will explain the scanning procedure.

You will not see a doctor. After the photograph and OCT scan, you will be free to go home.

What happens next?

The consultant will review the data including the OCT scan following the “virtual” clinic. The consultant may want other ophthalmic tests done, to define the diagnosis, which will be performed at another appointment. The consultant will make a clinical decision for the next stage of your clinical pathway, for example treatment or a future review, and you will receive notification of this by letter or telephone.

How long will I have to wait before I hear about a follow-up appointment?

This will depend on the outcome of the clinical data and OCT scan. If the OCT scan cannot fully diagnose the condition or if it shows significant abnormalities, you will normally be called for another appointment in between one and four weeks’ time. If not, you will be seen more routinely. You may receive a telephone call from the booking team or the ophthalmology clinical team.

If you notice a deterioration in your vision while you are waiting for an appointment, please contact us below:

Emergency contact telephone numbers

Emergency eye clinic : Monday to Friday 08:30 to 16:00 on 01223 217778

(Leave a message with your name, date of birth and hospital number, and a brief description of your concern, and one of the nurses will call you back.)

Out-of-hours main hospital switchboard: 01223 245151 and ask for the on-call ophthalmologist

Additional ophthalmology contact telephone numbers

AMD clinic coordinator: 01223 254662

Medical retina specialist nurse: 01223 256672

Clinic 14 reception desk: 01223 216401

Consent

Although you consent to this treatment, you may at any time after that, withdraw such consent. Please discuss this with your medical team.

Further information

The organisations below can provide more information and support for you. Please note that Addenbrooke’s Hospital is not responsible for the quality or accuracy of any information or advice provided by these organisations:

Macular Society (opens in a new tab)

Crown Chambers,
South St,
Andover,
Hampshire,
SP10 2BN

Helpline: 0300 3030 111

Email Macular Society helpline

General enquiries: 01264 350551

Email Macular Society (general enquiries)

Diabetic Retinopathy Organisation (opens in a new tab)

Dr David Kinshuck, Good Hope Diabetic Clinic.

National Institute for Health and Clinical Excellence (opens in a new tab)

MidCity Place,
71 High Holborn,
London,
WC1V 6NA

Tel: 0845 003 7780

References/sources of evidence

Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014 (opens in a new tab)". WikiJournal of Medicine 1 (2). DOI (opens in a new tab):10.15347/wjm/2014.010 (opens in a new tab). ISSN (opens in a new tab) 2002-4436 (opens in a new tab). [image]

Jackson, T.L., 2014. Moorfields Manual of Ophthalmology. 2nd ed. London: JP Medical Ltd.

Macular Society, 2020. Understanding macular disease. [online]

Available at: Macular Society website (opens in a new tab) [accessed 02.10.2020]