Stratus Myth: “Stratus is old technology, everyone is telling me I need to step up to spectral domain OCT”…
If I had a dollar for every time I have heard this, I would buy that beach house my wife and I have always wanted. Spectral domain OCT is certainly the best available OCT on the commercial market for an Eye Care Professional. If money is no object, there is no question that a Cirrus HD OCT, Optovue iVue or RTvue, Heidelberg Spectralis or one of the many other SD OCT units would be preferred.
However, if you are not running your business like the government and actually have a budget, money IS an important factor. Consider that as of this writing, even a preowned spectral domain OCT is priced at approximately 3X the price of a newer Stratus OCT. Since a preowned Stratus OCT is priced in the mid teens, that means that the cost savings you get by choosing Stratus over a spectral domain unit would allow you to purchase such things as a second Stratus OCT for another practice location, another full exam lane or two, or a Volvo for your daughter who just got her license.
There are two major and one minor advantage to spectral domain technology…
1. Resolution: Think HDTV vs. standard cable. This resolution may allow you to pick out minute details that Stratus or time-domain technology could not. For example, the RPE layer is thin and I had a doctor call me recently looking to diagnose issues with chloroquine toxicity. THAT would require spectral domain OCT. However, that was one conversation out of thousands, similar to the number of doctors who use the red spot color on a Humphrey Field Analyzer to help diagnose the same issue. For most general ECP’s, particularly those who have not had an OCT in the practice, Stratus resolution is adequate. In addition, one can pick out a suspect area and request a high resolution line scan, which would give you a magnified image of that area.
2. Anterior Segment Imaging: Most of the current SD OCT units have anterior segment imaging as an included feature or an add-on. This gives you the ability to look at the cornea in vivid detail, observing such things as a post lasik flap from 4 years earlier. It also allows you to view the angle and utilize measurement tools to detail any changes from visit to visit. (Stratus OCT is capable of this technology, but the feature was not FDA approved for sale in the U.S.).
3. Space: Some spectral domain OCT units such as the Cirrus OCT and the Optovue iVue have a small footprint, allowing you to place the unit in a corner and not take up a 36” x 24” space for a console with PC, monitor, scan head and printer.
Now the big question, are the advantages above worth 3X the price?
Finally, it is interesting to note that no one is really objective. Consider now, the manufacturers business case for spectral domain OCT. Only Zeiss can offer the Stratus or time-domain OCT because it is still under patent. Spectral domain technology carries no such patent and is therefore available from several manufacturers, with more awaiting FDA approval for their SD OCT entry. Zeiss is now on to their second generation of Cirrus HD OCT and for them and the others who are new in the market, replacing Stratus OCT units makes up a good percentage of their potential business. Even ECP thought-leaders who speak about technology are hired by manufacturers to speak about the latest releases and research the advantages. So, from the market perspective, it is in everyone’s financial best interest to convince you that Stratus is old technology.