Understanding the SPECTRALIS OCT: Dispelling The Myths with Dr. Chris Lievens

In this episode, we will unpack and dispel common misconceptions about the SPECTRALIS® OCT device, revealing its multifaceted capabilities and applications in the field of optometry. From its roots in glaucoma diagnosis to its outstanding capabilities in retinal imaging, we’ll explore how the SPECTRALIS® OCT can transform how eyecare practitioners deliver patient care. Tune in as we hear from industry experts from Heidelberg Engineering, and break down the myths and realities surrounding this pioneering technology.

In Partnership with Heidelberg Engineering

Introduction and Guest Background:


Dr. Chris Lievens:

Thank you, everyone, for joining us back on the podcast today. Today’s episode will be a bit unique as we’re focusing on a specific area. We have numerous choices when it comes to managing ophthalmic technology, and today we’re discussing how we manage the quality imagery of our patients on all aspects of their eyes.

One of our healthcare partners is Heidelberg Engineering. I have a couple of guests from Heidelberg Engineering with us today. Joey and Cindy, if you don’t mind, Joey, could you please introduce yourself first and tell us about your background in eye care and what you do for Heidelberg? Then we’ll move over to Cindy.

Joey Hatfield:

Certainly. Hello, everybody. I’m Joey Hatfield. I’ve spent roughly 22 years in ophthalmic imaging. I started in the clinic as an imager and eventually transitioned into the industry. I’ve held various roles such as an educator, sales rep, and now I’m the Southern Sales Director for Heidelberg Engineering. I cover the south and southeast.

Cindy Armstrong:

Hello, I’m Cindy Armstrong, the Clinical Application Specialist in the northwest. I started my career in ophthalmology healthcare in 1990 as a technician and an imager. I’ve been a clinical manager and now I work for Heidelberg as a clinical application specialist and educator. So happy to be here !

Unpacking OCT Differences


Dr. Chris Lievens:

The goal is to understand the offerings out there and to distinguish one from another. So, before we talk about your products specifically, does it really matter? Is there a difference between OCT A and OCT B? Are they all the same regardless of how much money I’m spending on them?

Joey Hatfield:

I would say there is a significant difference. That’s why it’s crucial to approach these decisions with an educated mindset. It’s important to review all available products and ask pertinent questions based on your diagnostic objectives. Whether you’re studying glaucoma and seeking accuracy over time, or looking at retinal disease for fine detail and image quality, there’s a variety of platforms. Even though they’re all OCT, there are significant differences that you’ll want to identify to ensure you’re getting the right device for you and your practice.

Cindy Armstrong:

I believe the ability to grow with your device is crucial. When you have a device that limits you to just one scan and one image, with Heidelberg, you’re able to add different modalities over time as your practice changes and grows with new employees, doctors, technicians, etc. I think that’s a huge advantage.

Sure, I can rename the segments according to the myth that’s being debunked in each. Here’s how it would look:

Myth #1: SPECTRALIS® Doesn’t Belong in Optometry


Dr. Chris Lievens:

Our goal for today is to debunk some myths because, as an ECP, these are things that I’ve heard from my peers and colleagues. The first myth that I have heard is that your instrument, the Spectras, doesn’t really belong in optometry.

Joey Hatfield:

That was one of the first things that I heard about the platform as well, that it was very specific to the retina. However, that is a myth. When you look at the origination of Spectras, the Heidelberg Engineering company had a Heidelberg retinal angiography system, the HRA. They realized that OCT technology could be blended with that, hence the HRA OCT was born. It does have a retina-specific functionality because it performs dye-based angiography, etc. However, as Cindy mentioned earlier, upgradeability is key. The Spectras OCT can start at a base level to meet your needs, but you can build off of that as required.

Cindy Armstrong:

I’d like to add that I’ve been in practices where an optometrist uses a full spectrum OCT HRA to its maximum. They use every modality from fundus, autofluorescence, multicolor, and widefield to G M P E. For these doctors, they want to provide the best patient care, and by using these modalities, they can route their patients to the proper channels if necessary. We have many O.D.s working in remote locations who have to offer comprehensive care to their patients because there aren’t other options. Therefore, if they can use their diagnostic tools to deliver the best patient care, it helps maintain their patients’ vision and assists the doctor in determining if the patient needs to be referred to a local specialist.

Myth #2: SPECTRALIS® is Solely for Retina, Not for Glaucoma


Dr. Chris Lievens:

Alright, let’s delve into myth two now. Joey, you’ve already hinted at this one, so I’ll begin by challenging you.

You’ve mentioned glaucoma several times, and a prevalent statement that I often hear, probably due to the outstanding retinal image quality of the Spectras and the fact that many renowned retinal practices have employed Spectras from the outset, is that this technology is exclusively suitable for retina and primarily retina alone. How would you respond to that?

Joey Hatfield:

Indeed, we’re discussing SPECTRALIS® OCT at this moment, but it’s important to remember that Heidelberg Engineering initially started as a glaucoma company with the HRT. Gerhard Zinser, one of the company’s co-founders and scientific components, was passionate about diagnosing and evaluating glaucoma. So, when we transitioned from the HRT to the Spectras platform and recognized the benefits of OCT in glaucoma, that definitely carried over.

However, as you pointed out, we’ve been somewhat obscured. In my opinion, we’re glaucoma’s best-kept secret. When we talk about how effective it is in the retina, my primary focus is on the neurosensory retina and the significance of seeing the details in the neurosensory retina when discussing a neuropathy like glaucoma. So, glaucoma is indeed a key component, one of the main critical components of SPECTRALIS® OCT in my view.

Dr. Chris Lievens:

Indeed, my good friend Mohammad Rafieetary always insists that despite our classification of glaucoma as an optic neuropathy, it’s actually a retinal disease. I understand that the crucial components of the optic nerve are, in fact, layers of the retina.

Joey Hatfield:

True, it’s just that visually, we see this enormous donut shape staring back at us, and then we see the rest of the retina. It’s tempting to categorize them into separate specialties, but these two elements are absolutely interconnected. I’m glad you reminded us of Heidelberg Engineering’s initial foray into eyecare, which began with glaucoma analysis and optic nerve-specific measurements.

The Evolution and Flexibility of the SPECTRALIS® System


Dr. Chris Lievens :

Before we move on from this myth, I want to pose a question to both of you. You’ve walked us through some of the history of your offerings, from the initial HRT one, HRT two, HFA, and then fast forward to the Spectral, which incorporates and utilizes those older methods but consolidates them into one unit.

Joey Hatfield:

We definitely had an understanding, and Chris, you, and I have discussed this in the past about the HRT 1, 2, 3. Whenever you wanted the newest best thing, you had to get the best machine.

Yes, and there was indeed a light bulb moment in the design process of the Spectra platform. We realized that model doesn’t work in the medical industry, especially when we’re considering patient care. That’s where some of this hybridization of modularity and upgradeability evolved with the Spectras platform. We made sure to keep things separate enough so that it was possible if you wanted to reach the next level of the device.

So you started off with just the OCT, but then you wanted to manage patients with Dry AMD in geographic atrophy. You wanted to add autofluorescence to your OCT. That was something that could be incorporated into the platform due to its modularity and flexibility. This approach was a conscious decision about how to view the future of medicine, ensuring that we’re providing the best technology and the best investment for the physicians to provide the level of care that we aspire to be a part of.

Myth #3: The Heidelberg Device is Hard to Use


Cindy Armstrong:

I often tell technicians that if you can use a slit lamp, you can use the Heidelberg. So if you’re familiar with the slit lamp, the Heidelberg should be easy to use.

I ask them, “Do you check pressure?” and they’re like, “Every day.” And I reply, “Then you can use a Heidelberg because the concept is the same.” I emphasize that you must identify the buttons you’ll use for your imaging, depending on your practice needs.

The beauty of it is that as your practice grows or your skill level improves, you can expand your use of the device. I liken it to my new smart TV. There are so many features that I don’t know which buttons to use, but I get used to the ones I need.

Joey Hatfield:

I had the same perspective when I joined Heidelberg. Coming from another company, I was only familiar with what I knew. However, I quickly learned that the device is not complex to use.

One of the things that I occasionally do is bring my son with me to congresses. He’s an inquisitive kid, and the exciting part is that if my nine or ten-year-old son can operate a SPECTRALIS® OCT and produce high-quality images, there’s no reason why your technician or you yourself couldn’t operate the SPECTRALIS®.

It’s as simple as that, and as Cindy mentioned, what you get out of it depends on what you want to do with it. This ties back to the modularity, upgradeability, and all the different things we can do with it. If you’re doing OCTs, it’s no more complex than any other OCT on the market.

Dr. Chris Lievens:

I’m not sure where this misconception originates from, but once someone guides you through the process, it’s clear that it’s not complex at all. It’s incredibly straightforward. Maybe it’s a myth started by competitors that have convinced many, but it’s unfounded.

In my experience, as well as yours, we avoid complexity. We need to be able to train our technical staff and colleagues to employ this technology. If it’s simple to use, that’s a phenomenal attribute. And yours is really easy.

Myth #4: The Cost of the SPECTRALIS® OCT is too Much


Dr.Chris Lievens

However, being conservative in practice and budgeting, I find the SPECTRALIS® to be quite expensive. It may be affordable for larger practices, but for me, it’s a bit too much, even though I’m genuinely impressed by its capabilities, especially in optic nerve analysis.

Joey Hatfield:

Yes, this multi-functional device might appear like a Swiss army knife. However, consider this: a fully equipped system that performs angiography with dye, ICG, and other functionalities on top of basic ones could be pricier compared to systems that only perform OCT.

It’s crucial to identify what you need. Do you need just an OCT today or an OCT along with a fundus camera and an autofluorescence feature? If you opt for an OCT-only device, you must purchase other separate devices. By offering a base OCT functionality, we ensure our system is comparable in price to other OCTs on the market, often only differing by a few thousand dollars.

Cindy Armstrong:

We sell one product and we sell it well, albeit in 31 different ways. From my experience as a clinical manager, I can tell you that space is valuable.

The advantage of Heidelberg SPECTRALIS® is that it doesn’t occupy much space and yet offers a lot of functionalities with a single device. Anytime you can compact numerous features into one device that saves space, it benefits the practice and the doctor. Moreover, adding different modalities over time is a huge plus.

Dr. Chris Lievens

Indeed, the square footage of your practice equates to dollars. Everyone is running out of space.

Dr. Chris Lievens

Excellent. Let’s summarize the four myths we’ve tackled. Firstly, the myth that SPECTRALIS® doesn’t belong in optometry is that it’s too high-quality and predominantly for the retina. This is simply untrue.

This notion ties into the last myth we discussed – that it’s all about the price. The SPECTRALIS® system is customizable and upgradable, offering many functionalities simultaneously. So these benefits debunk these two myths.

The second myth we addressed is that SPECTRALIS® isn’t suitable for glaucoma. But if we look back, Heidelberg was initially designed to examine the optic nerve for glaucoma. Thus, it’s absolutely relevant today.

Lastly, the myth that SPECTRALIS® is hard to use. We all shared personal experiences proving this false, and in my case, I could navigate the system in less than five minutes.

Stay updated on the latest in the optometry world. Enjoy more insightful podcasts and engage with live streams on the Defocus Media YouTube channel. Don’t forget to subscribe to keep learning and growing in your understanding of optical science.

Christopher Lievens
Christopher Lievens
Chris Lievens is the Chief of Internal Clinics and Professor at Southern College of Optometry. Dr. Lievens has been employed in private practice, an ophthalmology referral center and he served in the United States Air Force. Dr. Lievens was the Chief of Aerospace Optometry at the Pentagon before joining SCO. Dr. Lievens is a fellow of the American Academy of Optometry and is a Region Chair of the Academy’s Admittance Committee. He is a distinguished fellow in the National Academies of Practice. Dr. Lievens is the co-creator of the fundus grading card and currently conducts research in glaucoma, dry eye, uveitis and contact lens care. Dr. Lievens has a Master’s degree in Healthcare Administration and is currently enrolled in a PhD program in Cambridge. Dr. Lievens is a member of the American Optometric Association, the British Contact Lens Association and the Association for Vision and Research in Ophthalmology.

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