I'm going to go out on a limb here. I've come to the conclusion that every adult patient should have a baseline ONH OCT on their first visit and then routinely going forward unless evidence overwhelmingly shows a lack of need. Why? I've simply had just one too many patients with normal IOP demonstrate NFL loss over time, even though each OCT was in the normal range when evaluated by itself. One OCT simply doesn't tell us what's going on without historical data to refer to.

I understand the implications. We don't get paid extra for tests that are included in our routine exams. Just as we can't separate IOP testings, keratometry, and other routine tests, if we were to include OCT in all exams we've set a precedent that certainly makes no financial sense. But from a patient care point of view, the value is unquestionable. Some may say the same could be said of routine MRI's and CT scans, but it's not the same. Running such tests routinely would be purely shots in the dark, whereas ONH OCT would have a reasonable rate of discovery.

Since I've obviously got a screw loose, perhaps next time I'll take the concept a bit further and outline why OCT's might make more sense for Lion's Club vans and local health fair screenings. I'm sure I'll get 100% agreement from all of you. Uh... sure I will. ~ Walt