Optical coherence tomography

Abstract

Despite advances in biomedical imaging, neurologists and ophthalmologists doggedly insist on examining patients. This is because, in spite of state-of-the-art imaging techniques, our examinations are informative and guide our clinical workup and management. We rightly question radiologic reports when they do not conform to our examination findings, because we trust our art after years dedicated to cultivating our skills. Still, evidence-based medicine argues for demonstration of a clinical test's utility before adopting it widely. We may forget that this standard ought to extend to our clinical examinations. Beyond the intangible (and valuable) human interaction that occurs as part of the examination, clinical examinations are a conglomeration of diagnostic tests. Yet we rarely subject the elements of our bedside examination to the same scrutiny that we reserve for new technologies. In this issue of Neurology ®, Cettomai and colleagues1 compare some of the most cherished clinical signs from neuroophthalmology with the new-kid-on-the-block technology, retinal nerve fiber layer (RNFL) optical coherence tomography (OCT). They find that in the hands of nonexperts our standard tests have relatively poor sensitivity for detecting abnormal RNFL thickness (pallor) or asymmetric RNFL thinning (relative …