Article Date: 2/1/2011

Enhance Your Image
instrumental focus

Enhance Your Image

Ultrasound device provides high-resolution images of intraocular anatomy.

Craig Thomas, O.D.

The B-Scan Plus, from Accutome, is an important part of my diagnostic arsenal for two main reasons: (1) It enables me to manage retinal patients until surgery is warranted, and (2) it helps protect me from malpractice lawsuits, as it provides an in-depth look at the eye.

Overview

The B-Scan Plus is a portable hand-held ultrasound device that provides images of both visible pathologies, as well as those obstructed by other intraocular structures or conditions. Specifically, it's a cigar-shaped probe that contains a tiny transducer, which oscillates to deliver sound waves once the probe touches the ocular surface. In addition, it contains a foot switch to allow image acquisition.

I primarily use the B-Scan Plus to look for pathology obstructed by other in-traocular structures or conditions. For instance, when a patient presents with flashers and floaters that suggest a tear or detachment and binocular indirect ophthalmoscopy appears normal, I use the device to “find what I'm looking for.”

In addition, I use the B-Scan Plus on patients who present with dense cataract to ensure the reason for their vision decrease, is, in fact, the cataract, rather than a developing macular hole, for instance.

Testing procedure

To use the device, first place a drop of anesthetic in the patient's eye. Then, place a fingertip of gel on the probe's tip, and gently apply the probe to the eye's surface. Next, instruct the patient to look in various positions of gaze. Every time you identify pathology, step on the device's foot switch to acquire an image.

(As a brief, yet important aside, the B-scan Plus contains a USB port, so you can directly store images to your laptop. This enables you to immediately share and review the images with your patient. I transport my laptop and the device on a cart between exam rooms to further simplify the process.)

The B-Scan Plus offers three imaging features: high-image resolution (0.015 mm), two-times zoom (which, incidentally does not degrade image quality) — and film loops, which capture real-time image sequences, ensuring you don't miss crucial views and/or angles.

To obtain the best results:

You must have a steady hand. If you have difficulty performing gonioscopy, for instance, this device is not for you.
You must have a base knowledge of ocular anatomy. This means you must be familiar with the location of the optic nerve and extraocular muscles.
You must maintain orientation. The probe presents the ocular anatomy as inverted. It's essential you keep this in mind as you move the probe and scan the different parts of the back of the eye.
You must read up on B-scan interpretation and reports prior to purchase. Interpreting the scans themselves can be tricky. Therefore, you want to know what you'll be looking at and for prior to use. An ophthalmology textbook can be invaluable here.

Testing takes about three minutes, while the prep time (e.g. typing the patient's name in your computer, applying the anesthetic and gel) takes roughly five minutes.

“Any optometric practice can support this technology once they reach a threshold of 15 patients a day.”

Staff training

Accutome delivers the device along with its manual. I read the manual and gave it to my top two techs to read. (Accutome offers accessible technical support, and my staff and I have found them easy to work with.) Anyone can train their techs to use the B-Scan Plus. However, if your staff is medically oriented, they'll have an edge in terms of the learning curve. My partner and I see roughly 30 to 40 patients a day, and we have practically every diagnostic device created. As a result, my staff is used to using high-tech equipment. This, obviously, helps when teaching them how to use a new device, such as the B-Scan Plus.

Return on investment

The CPT code for the B-Scan Plus is 76512. The approximate reimbursement is $100 per eye.

I think practically any optometric practice can support this technology once they reach a threshold of about 15 patients a day. That's my unofficial cut-off. So, if you're working five days a week, that's 75 patients a week. Statistics suggest that at least one patient out of that 75 is going to present with floaters or a cataract. That equals using the device, at minimum, twice a month. This will not only pay the lease for that month, but enable you to make a profit. Speaking from personal experience, I can tell you you're going to get a return on your investment very quickly.

In addition to cutting down on my referrals to retinal specialists and protecting me from malpractice lawsuits, the B-Scan Plus' delivery of accurate and high-quality images has enhanced my reputation as a tech-savvy eyecare practitioner who provides a high level of care — something that both retains and attracts patients. OM


DR. THOMAS HAS PRACTICED IN DALLAS, TEXAS FOR ALMOST 30 YEARS. HE EARNED HIS DOCTOR OF OPTOMETRY DEGREE FROM THE UNIVERSITY OF HOUSTON IN 1983, AND HE WAS NAMED OPTOMETRIST OF THE YEAR BY THE TEXAS OPTOMETRIC ASSOCIATION IN 2001. E-MAIL HIM AT THPCKC@YAHOO.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.

Optometric Management, Issue: February 2011