REVO OCT

Aug 26, 2023

With OCT machines now considered essential in modern optometric practice, practitioners are seeking devices that offer multiple functions helping save money and space. The REVO OCT fits this description and has found a home in several independent practices across Australia.

Sydney optometrist Dr Jim Kokkinakis can usually rely on his instincts to make a split-second decision on new technology investments, but when it came to his OCT machine earlier this year it was something he agonised over for months.

On one hand, there was his existing system from a reputable manufacturer that had many years of crucial patient data and statistical analysis, but the service contracts and reliability of the machine left him unsatisfied. On the other, he was considering the REVO OCT, from Polish manufacturer Optopol, which performs the standard functions optometrists come to expect from an OCT, plus advantages in anterior segment imaging for his scleral contact lens work, and more.

Kokkinakis was at a crossroads. Should he relinquish the data that enabled him to track his patients’ macular and optic nerve changes for up to 10 years in favour of the functionality of a new system, or stay with what he knew.

“Normally I see an instrument and know right away whether I’ll buy it or not. But in this case, it took me many months because there was a lot to consider. Everyone’s got different preferences – the individual maybe cannot forego the historical database and I can understand that – but in the end I chose functionality,” he says.

“It means I’ve effectively got to now rebuild a new database, but at the end of the day, I don’t want to be prevented from obtaining better equipment because of an issue like that. It was the best decision for my practice going forward.”

Earlier this year, Kokkinakis installed the REVO FC 130 model, the most advanced of Optopol’s five OCTs in the REVO range, available in Australia through distributor OptiMed. At his business – The Eye Practice in Sydney’s CBD – it’s the sixth OCT upgrade over the decades.

According to Optopol, the REVO OCT is an all-in-one device eyecare professionals can use in several ways. This includes high quality OCT imaging (with up to 130 000 A-scan/sec scanning speeds) and OCT-A. What makes it unique is a full colour fundus camera (12.3 megapixels), and the ability to combine simultaneous OCT and fundus images.

It also comes with optional ‘modules’, such as T-OCT which provides detailed corneal curvature maps, and True Net Curvature information (ideal for specialised contact lens practitioners like Kokkinakis). This module provides axial maps, tangential maps, total power map, height maps, epithelium and corneal thickness maps.

There’s also a B-OCT module for biometry for myopia management and intraocular lens calculation, capturing axial length, central cornea thickness, anterior chamber depth, lens thickness, pupil size, and white to white.

“It’s an instrument that can be used in so many ways, it’s unbelievable,” Kokkinakis says.

“I do a lot of scleral contact lens work (around 25% of total workload), and from that perspective the REVO shone because we can scan and view a much bigger portion and see how the cornea and contact lens are interacting in a far more accurate way – that was one of the tipping points when deciding which OCT to purchase.”

Kokkinakis says the fundus camera is also something he hasn’t experienced with an OCT, and he’s been impressed by Optopol’s ability to innovate a built-in anterior lens allowing the user to perform anterior segment imaging without installing an additional lens or forehead adapter.

According to Optopol, it means practitioners can display the whole anterior segment using a radial scan to view 18mm wide and 6mm deep for various angles. This is a standard feature in each of the five REVO models.

“I also do a lot of keratoconus management these days and with keratoconus being a contraindication for laser surgery, we’re able to perform screening with the REVO using topography and corneal thickness. The system then combines these to give you a risk factor for keratoconus,” he says.

“It takes a matter of seconds and next thing you know, you’ve got data overload. At the end of the day, you can’t have too much data; if you’ve got it, you can use it.”

When Kokkinakis was canvassing the market for a new OCT, he trialled around four options before landing on the REVO. Workflow is a major consideration for him. When patients enter his rooms, each undergo three initial tests: an ultra-wide field Optos scan, intraocular pressure tonometry test, and then a REVO OCT scan that assesses their optic nerve, macula and screens for corneal irregularities.

“For me, it’s important a device is easy-to-use and can be delegated to other staff, and delegated with confidence. I found this was the case with the REVO OCT which my staff could use well with a short period of training,” he says.

Technology that indicates quality care

Merimbula Vision, located on the coast of southern NSW, opened eight years ago as a greenfield independent. With no patient base and trading history, along with fitout costs, it was a leap of faith to invest heavily in technology early on.

“But the reality is that we simply could not practise the way we wanted to and our patients needed us to, without it,” principal optometrist Mr Bayd Rosenbaum says.

The practice opted for a REVO Copernicus, an earlier model, which remains in the practice today and hasn’t required any technical assistance over the years which vouches for the design build. Initially Rosenbaum sought an OCT so he could confidently monitor his patients’ macula.

“To meet the needs of our patients, their GPs, and the ophthalmologists we were referring to and co-managing with, we simply had to be confident in our detection of wet age-related macular degeneration and diabetic macular oedema, along with many other conditions, of course, and get our referrals correct and accurate,” he says.

“When looking at the different machines available we considered the additional features of each and how they might benefit us. The REVO unit at the time was one of few machines to have an anterior function for pachymetry and contact lens fitting, a widefield lens for angles, and an option for biometry for axial length measurements. These features added to our diagnostic capabilities and met needs that were missing from the practice at the time.”

Today, the REVO OCT remains crucial to Merimbula Vision’s glaucoma detection and co-management, and provides confidence in macular disease.

Rosenbaum was surprised initially how often what he thought was a simple hyperopic shift was in reality a vitreo-macular traction.

“It has come in handy for assessing clearance in rigid contact lenses and for axial length measurement in myopia control. Patients like to see the anterior scans of their cataracts or IOLs, and I like to monitor the cornea scans for oedema in our cataract surgery aftercare regime,” he says.

“But when you ask where it shines the most, I would have to say as a regional optometrist it is the ability to send the images we capture to the ophthalmologists we are referring to for an opinion on the urgency of a referral or when reporting back to them following treatment that they have done.”

In terms of the OCT’s functionality, ease-of-use is also a standout.

“It has an automatic capture function so the imaging can be performed by anyone in the practice,” Rosenbaum says. “The instrument gives instructions to the patient to follow such as where to look and when not to blink. I have found the software that allows you to monitor for progression to be reliable and easy to use.”

System shines on multiple fronts

Optometrist father-daughter combo Mr Gavin Boneham and Ms Sarah Boneham operate across two distinct practices. Boneham Peters Optometrist, known as a destination for boutique frames, and Boneham Optometrist Sydney CBD (Eyecare Plus) that is more well known for its rigid contact lens work.

Both practices function with an Optopol REVO as their OCT machine. It serves each practice in slightly different ways, with Boneham Peters Optometrist relying mostly on its OCT functionality and biometry, while Boneham Optometrist Sydney CBD uses it for this, as well as its anterior imaging for scleral contact lens fitting.

After relocating in 2017, Boneham Peters Optometrist sought an OCT upgrade in 2019 and chose the REVO for several reasons. One of those was for axial length measurements for myopia management, as well as the ability to add modules for different functions in future, such as topography.

“The servicing was also very reasonable, and when it comes to upgrades, we don’t have to necessarily upgrade the entire machine each time,” Sarah Boneham says.

“It’s also easy-to-use and customise; I’ve used a lot of different OCTs in my time, but I’m able to use this one in particular to get far peripherally to look at different lesions. I use it to see if there’s a retinal tear sometimes or show a patient how their tear appears. I’m able to do that effectively on this machine, whereas I’ve tried it on others and can’t really obtain it as easily.

“During the decision process, we were provided papers assessing the validity of the biometry and OCT modules which gave us the confidence to go ahead. All in all, it’s been a great investment for our practice.”

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