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SLO VS. OCT STANDOFF: WHICH IS RIGHT FOR YOUR OPTICAL STORE?

Published on
17/05/2019

Posted by Erik van Dijk

Erik has previously worked for 10 years at Philips in various parts of the business and in different roles, most recently at Philips Healthcare in R&D management. Since his start at EasyScan in 2015 he headed the operations (supply chain/technical support) and R&D team. In 2017, Erik became the CEO. Erik has a PhD in Physics from the University of Twente.

In today’s era of online eyewear retailers, retinal scans are one way that brick-and-mortar optical stores seek key differentiation. We’ll argue that just having an SLO or OCT machine in your office won’t set you apart — but what you do with it will.

Therefore, the decision to buy an SLO or OCT should be accompanied by a plan. Define how you want to use your new scanner not only for detecting retinal abnormalities, but as a strategic tool that drives customer affinity and loyalty.

As contributing editor of Optometric Management Virginia Pickles reminds optometrists contemplating a new technology purchase, “Bringing in a new screening/diagnostic instrument often requires adjustments to existing equipment, the office layout and customer flow, as well as technical training for staff and doctors.” Each of these changes has the potential to be a positive one for your optical store, but it’s important to first analyze and plan for each one. If you are reading this and nodding your head — but shrugging your shoulders regarding which retinal scanning machine is best for you — read on.



Understanding the Differences Between SLO and OCT

First, let’s get beyond the acronyms. The SLO and OCT machines are different in how they work, which means they’re also different in what they’re good at.


Technically, how is SLO different from OCT?

When it comes to retinal scanning, there are two key technological approaches. confocal laser scanning microscopy (SLO) technology utilizes confocal laser scanning microscopy to create a high quality image of the retina. It is described as confocal because it employs a filter to block any out-of-focus light and produce a high-resolution image. This allows SLO to record clearer images than those captured using fundus photography, where the fundus camera utilizes a person’s own pupil as an access point for the camera’s light rays to help image the retina. Most adults have experienced this type of camera during an eye exam as the “chin in the chinrest, forehead against the top” routine.

To obtain an image using SLO, a near infrared laser is directed at the eye, illuminating a specific part of the retina. The confocal filter helps view the tiny part of the retina that is illuminated by the laser without other light reflections or scatter. By rejecting the scattered light, the filter allows for a high quality, high contrast image. SLO can be combined with images obtained using lasers of blue, green, and/or red wavelengths, each of which penetrates to a deeper layer of the retina, to create a colored (not monochromatic) image. And since an SLO image can be captured through pupils as small as 1.5mm, the scan doesn’t require dilation (much to every patient’s delight).

Optical coherence tomography (OCT) technology uses a single infrared laser to illuminate the retina and create cross-sectional images of each of its layers. These cross-sections allow you to measure the thickness of each retinal layer to carefully analyze any abnormalities. The field of view (between 2 and 10 degrees) captured by an OCT is limited compared to SLO. OCT also requires an overview image, which is often obtained as a white light image captured by a fundus camera. So unfortunaly, this means that for the overview imaging the usual limitations of classical fundus images still apply: Pupils need to be at least 3.8 mm and the image quality quickly deteriorates even with earliest stages of cataract.



Clinically, what can each device be used for?

The technological differences between SLO and OCT distinguish their use in a optical care setting. SLO offers you tremendous value in screening for a variety of conditions of the retina and observing the health of the optic nerve head. The high-resolution images of a broader field of view also make SLO ideal for screening for common conditions such as diabetic retinopathy and macular degeneration.

OCT, on the other hand, holds more value in the diagnosis and monitoring of retinal disorders. The complexity of the images created by OCT is ideal for OCT is ideal for identifying quantifying and monitoring retinal diseases.

If your store’s customer universe skews towards older adults or if there is significant history of diabetes, retinal scanning in the form of SLO can help you help your customers before a serious medical complication occurs. OCT acts more as a second line detection system, since its images are more deep than broad. This is what gives OCT superior diagnostic capabilities.

But there’s another lens to inspect (pun intended). As Pickles points out: “A retinal evaluation is a critical component of a comprehensive eye examination, yet some customers avoid having their pupils dilated for the traditional examination… because of the inconvenience.” What customers prefer and how you will serve them are essential factors in the equation of what one of these machines can do for your optical business.



Business Points to Consider with SLO and OCT

Now that you have a sense of the two primary scanning technologies currently available, it’s time to talk business. “Before I adopt new equipment in my office,” writes optometrist Ken Jeffers in a Review of Optometry article, “I make sure it meets two criteria: It must benefit my customers in some way, and it must be able to pay for itself and, at some point in time, become profitable.”

Either the SLO and OCT can enhance your value to customers and make them count the days until their annual eye exam (well, maybe not quite). But given the unique demographics and preferences of your customer base, which machine is best for you?

You might start to analyze this by asking yourself: How do I plan to use the scanning machine in my optical store? How will this technology impact my profit margin and return on investment? How will the machine I choose influence my customers’ experience and loyalty? There’s a lot to think about, so let’s break it down.



Which customers will be offered a scan?

A retinal scanning machine is undoubtedly a beautiful piece of technology, but you need to think about what you’ll actually do with the thing. An SLO scan can be offered as a routine screening service for any and all customers during an annual eye exam. This is because:

  • Any member of your staff can be trained to collect SLO images in the pre-screening area of your store.
  • Pupil dilation is not required, making this an easy, quick, one-step exam.
  • It only takes 3 minutes to capture an SLO image.


Meanwhile an OCT, while robust, is a bit more constraining in terms of space, time, and staff resources:

  • OCT images need to be captured by an optometrist or ophthalmologist, and in the examination room.
  • Most customers will need to have their pupils dilated in order to acquire an OCT image, requiring about 20 minutes of wait time.
  • It takes up to 10 minutes to capture an OCT image.


In a Review of Optometry article, optometrist Jessica Steen brings up a good point: “For asymptomatic customers undergoing routine eye examination, we may ask ourselves if dilation is really necessary.”

Dilation wait time, optometrist time, and image capture time all translate to this: The workflow for capturing images using SLO is more efficient than the OCT workflow. For this reason, OCT is just not practical for use with every customer. Offering OCT to everyone would be like making fancy cafe macchiatos for a bunch of people who would be happy with some caffeine in the form of coffee from a pot.

OCT is more appropriate as a higher level scan for customers known to have retinal abnormalities — just like fancy macchiatos are more appropriate for coffee snobs. Even if your optical store has an OCT scanning machine, it is highly recommended that you also have an SLO for quicker screening purposes.

And as with any business decision, you also want to ask: Who’s paying for this and how much? You’ll need to come up with a pricing structure that works for both you and your customers. If you plan on charging separately for a scan, forecast how many customers will want one, and which scan they are more likely to pay for. Someone with great eye health will balk at a high price tag on something they don’t need. Meanwhile, someone with eye disease will see the value of a more advanced scan.



Who will perform and review the scans?

Images collected by both SLO and OCT machines are reviewed by an optometrist in the exam room, during the customer’s appointment. However, OCT scanning machines must be operated by an optometrist in an examination room as well. The reason for this is that the retinal region of interest for this scan can only be determined after the optometrist reviews the preliminary fundus image and its broader field of view.

Because any store staff member can operate an SLO and take images, and because the SLO scanning machine can be placed in the pre-screening area of your business, you keep both your optometrist and your examination room free. This means that two customers can be seen at the same time: For example, one customer can get a scan with an optician in the pre-screening room while another customer consults with the optometrist in the examination room. The result is more efficiency for you and less foot-tapping for the customers — everybody wins.

Although both require optometrist time to review the scans and explain findings to the customer, OCT scans require more time because of the various cross sections provided by the machine. While some customers may appreciate an ophthalmology class at every visit, others prefer to be on their way after getting a basic explanation that assures them they’re getting high quality attention. It’s also important to note that after you review OCT images with a customer, you may need to refer them to an ophthalmologist for further review of the scans, diagnosis, and treatment.



What will my customers like better?

To answer this question, consider two primary factors: workflow and efficiency. Both can contribute to — or detract from — customer satisfaction as well as your store’s profit margin. The nature of SLO technology proves to be superior in keeping wait times to a minimum and improving customer experience. Here’s why.

Because of the larger pupil size required for an OCT scan, this exam often requires dilation. And as optometrist Ken Jeffers rightly states in a Review of Optometry article, “We all know dilating is probably the biggest bottleneck in our office flow.”

The OCT is also more bothersome for the customer, who needs to:

  • Sit and wait while the dilation drops take effect
  • Spend 10 minutes in the exam
  • Take several hours off work while their vision is altered
  • Avoid driving and arrange for alternate transportation
  • Wear protective glasses for several hours to protect their dilated pupils from light


Believe it or not, something as simple as dilation can really affect your sales revenue. Since an OCT needs to be performed by an optometrist and the images also take longer to review, your optometrist will be just as busy with the OCT technology as with supporting your number one profit generator: your eyeglasses and lenses dispensary. And because the scan may result in a longer visit to your office than a customer anticipated — when they couldn’t even see well enough to read a magazine in the waiting room — many customers may lose interest in discussing lenses after the exam. So you could find yourself with really great retinal images and a really empty glasses order queue.

Those are just the adult customers. What if you’re also checking children’s eyes in your store? “Drops traumatize kids because they sting,” optometrist Ryan Parker relates to Optometric Management. “Take eye drops out of the equation, and you’ll make the experience a lot better for them.” Not to mention a better experience for adult customers when you take screaming kids in the waiting room out of the equation, and a better experience for parents because their kids are smiling.

Since SLO is capable of taking high-resolution images through a small pupil, there is no need for dilation and no down time (or tears) for the customer. After the scan, you should still have ample time to talk about purchasing new lenses. And with better efficiency, your optometrist can spend more quality time with each customer and you can even book more appointments in a single day.



How does scanning allow you to educate your customers and sell more lenses?

Reviewing SLO scan results with your customers can prove to be a useful jumping-off point for educating them about eye health. How so? The optometrist has an opportunity to explain what he or she is looking for on the scan and discuss any retinal abnormalities that are detected, even if they are not leading to problems yet. This makes it clear to customers that your team is investing time in their eye health. The bonus is that by learning this information, your customerrs also become aware of important reasons to take preventative measures and return to your optical store each year.

While an OCT scan creates an opportunity for customer education as well, the impact is smaller because this scan usually isn’t offered to all customers. And somewhat ironically, because OCT results are usually geared to diagnosing more advanced eye conditions, the OCT may provide information that takes customers’ attention away from purchasing eyeglasses and lenses. It may turn their attention to clinical care that, while important, is not what you are providing them.



How does all of this translate to standing out among competitors?

Technology in and of itself does not differentiate one optical store from another. What sets an optical store apart from the rest is the overall customer experience, including wait times, convenience, and personal treatment.

As Director of Optical Success Academy Conor Heaney writes in an Optician article , “There are not many people laying awake at night wishing their optician had an OCT — but lots are frustrated with the service, the experience, the hassle… by focusing on these areas we can win.”

If you’re tempted to invest in retinal scanning because you’ve heard that other nearby optical stores have it — but you’re not sure how to you’ll use the data obtained from the images or how you’ll profit from the investment — you might want to take a step back to define these aspects first.

Once you’ve decided to move forward, the right technology chosen and implemented with impact and experience in mind can be a gamechanger for you. For many optical stores, an SLO machine will be an investment that allows you to focus on your main income generator — providing the right lenses for your customers — while taking an active role in their eye health and respecting their time. And as optometrist and CEO of a 16-store optometry business, Gregg Ossip, tells Optometric Management, “The ability to instantly obtain retinal data without inconveniencing the customer… is awesome.”

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Published on
09/01/2018

Posted by Erik van Dijk

Erik has previously worked for 10 years at Philips in various parts of the business and in different roles, most recently at Philips Healthcare in R&D management. Since his start at EasyScan in 2015 he headed the operations (supply chain/technical support) and R&D team. In 2017, Erik became the CEO. Erik has a PhD in Physics from the University of Twente.

In today’s era of online eyewear retailers, retinal scans are one way that brick-and-mortar optical stores seek key differentiation. We’ll argue that just having an SLO or OCT machine in your office won’t set you apart — but what you do with it will.

Therefore, the decision to buy an SLO or OCT should be accompanied by a plan. Define how you want to use your new scanner not only for detecting retinal abnormalities, but as a strategic tool that drives customer affinity and loyalty.

As contributing editor of Optometric Management Virginia Pickles reminds optometrists contemplating a new technology purchase, “Bringing in a new screening/diagnostic instrument often requires adjustments to existing equipment, the office layout and customer flow, as well as technical training for staff and doctors.” Each of these changes has the potential to be a positive one for your optical store, but it’s important to first analyze and plan for each one. If you are reading this and nodding your head — but shrugging your shoulders regarding which retinal scanning machine is best for you — read on.



Understanding the Differences Between SLO and OCT

First, let’s get beyond the acronyms. The SLO and OCT machines are different in how they work, which means they’re also different in what they’re good at.


Technically, how is SLO different from OCT?

When it comes to retinal scanning, there are two key technological approaches. confocal laser scanning microscopy (SLO) technology utilizes confocal laser scanning microscopy to create a high quality image of the retina. It is described as confocal because it employs a filter to block any out-of-focus light and produce a high-resolution image. This allows SLO to record clearer images than those captured using fundus photography, where the fundus camera utilizes a person’s own pupil as an access point for the camera’s light rays to help image the retina. Most adults have experienced this type of camera during an eye exam as the “chin in the chinrest, forehead against the top” routine.

To obtain an image using SLO, a near infrared laser is directed at the eye, illuminating a specific part of the retina. The confocal filter helps view the tiny part of the retina that is illuminated by the laser without other light reflections or scatter. By rejecting the scattered light, the filter allows for a high quality, high contrast image. SLO can be combined with images obtained using lasers of blue, green, and/or red wavelengths, each of which penetrates to a deeper layer of the retina, to create a colored (not monochromatic) image. And since an SLO image can be captured through pupils as small as 1.5mm, the scan doesn’t require dilation (much to every patient’s delight).

Optical coherence tomography (OCT) technology uses a single infrared laser to illuminate the retina and create cross-sectional images of each of its layers. These cross-sections allow you to measure the thickness of each retinal layer to carefully analyze any abnormalities. The field of view (between 2 and 10 degrees) captured by an OCT is limited compared to SLO. OCT also requires an overview image, which is often obtained as a white light image captured by a fundus camera. So unfortunaly, this means that for the overview imaging the usual limitations of classical fundus images still apply: Pupils need to be at least 3.8 mm and the image quality quickly deteriorates even with earliest stages of cataract.



Clinically, what can each device be used for?

The technological differences between SLO and OCT distinguish their use in a optical care setting. SLO offers you tremendous value in screening for a variety of conditions of the retina and observing the health of the optic nerve head. The high-resolution images of a broader field of view also make SLO ideal for screening for common conditions such as diabetic retinopathy and macular degeneration.

OCT, on the other hand, holds more value in the diagnosis and monitoring of retinal disorders. The complexity of the images created by OCT is ideal for OCT is ideal for identifying quantifying and monitoring retinal diseases.

If your store’s customer universe skews towards older adults or if there is significant history of diabetes, retinal scanning in the form of SLO can help you help your customers before a serious medical complication occurs. OCT acts more as a second line detection system, since its images are more deep than broad. This is what gives OCT superior diagnostic capabilities.

But there’s another lens to inspect (pun intended). As Pickles points out: “A retinal evaluation is a critical component of a comprehensive eye examination, yet some customers avoid having their pupils dilated for the traditional examination… because of the inconvenience.” What customers prefer and how you will serve them are essential factors in the equation of what one of these machines can do for your optical business.



Business Points to Consider with SLO and OCT

Now that you have a sense of the two primary scanning technologies currently available, it’s time to talk business. “Before I adopt new equipment in my office,” writes optometrist Ken Jeffers in a Review of Optometry article, “I make sure it meets two criteria: It must benefit my customers in some way, and it must be able to pay for itself and, at some point in time, become profitable.”

Either the SLO and OCT can enhance your value to customers and make them count the days until their annual eye exam (well, maybe not quite). But given the unique demographics and preferences of your customer base, which machine is best for you?

You might start to analyze this by asking yourself: How do I plan to use the scanning machine in my optical store? How will this technology impact my profit margin and return on investment? How will the machine I choose influence my customers’ experience and loyalty? There’s a lot to think about, so let’s break it down.



Which customers will be offered a scan?

A retinal scanning machine is undoubtedly a beautiful piece of technology, but you need to think about what you’ll actually do with the thing. An SLO scan can be offered as a routine screening service for any and all customers during an annual eye exam. This is because:

  • Any member of your staff can be trained to collect SLO images in the pre-screening area of your store.
  • Pupil dilation is not required, making this an easy, quick, one-step exam.
  • It only takes 3 minutes to capture an SLO image.


Meanwhile an OCT, while robust, is a bit more constraining in terms of space, time, and staff resources:

  • OCT images need to be captured by an optometrist or ophthalmologist, and in the examination room.
  • Most customers will need to have their pupils dilated in order to acquire an OCT image, requiring about 20 minutes of wait time.
  • It takes up to 10 minutes to capture an OCT image.


In a Review of Optometry article, optometrist Jessica Steen brings up a good point: “For asymptomatic customers undergoing routine eye examination, we may ask ourselves if dilation is really necessary.”

Dilation wait time, optometrist time, and image capture time all translate to this: The workflow for capturing images using SLO is more efficient than the OCT workflow. For this reason, OCT is just not practical for use with every customer. Offering OCT to everyone would be like making fancy cafe macchiatos for a bunch of people who would be happy with some caffeine in the form of coffee from a pot.

OCT is more appropriate as a higher level scan for customers known to have retinal abnormalities — just like fancy macchiatos are more appropriate for coffee snobs. Even if your optical store has an OCT scanning machine, it is highly recommended that you also have an SLO for quicker screening purposes.

And as with any business decision, you also want to ask: Who’s paying for this and how much? You’ll need to come up with a pricing structure that works for both you and your customers. If you plan on charging separately for a scan, forecast how many customers will want one, and which scan they are more likely to pay for. Someone with great eye health will balk at a high price tag on something they don’t need. Meanwhile, someone with eye disease will see the value of a more advanced scan.



Who will perform and review the scans?

Images collected by both SLO and OCT machines are reviewed by an optometrist in the exam room, during the customer’s appointment. However, OCT scanning machines must be operated by an optometrist in an examination room as well. The reason for this is that the retinal region of interest for this scan can only be determined after the optometrist reviews the preliminary fundus image and its broader field of view.

Because any store staff member can operate an SLO and take images, and because the SLO scanning machine can be placed in the pre-screening area of your business, you keep both your optometrist and your examination room free. This means that two customers can be seen at the same time: For example, one customer can get a scan with an optician in the pre-screening room while another customer consults with the optometrist in the examination room. The result is more efficiency for you and less foot-tapping for the customers — everybody wins.

Although both require optometrist time to review the scans and explain findings to the customer, OCT scans require more time because of the various cross sections provided by the machine. While some customers may appreciate an ophthalmology class at every visit, others prefer to be on their way after getting a basic explanation that assures them they’re getting high quality attention. It’s also important to note that after you review OCT images with a customer, you may need to refer them to an ophthalmologist for further review of the scans, diagnosis, and treatment.



What will my customers like better?

To answer this question, consider two primary factors: workflow and efficiency. Both can contribute to — or detract from — customer satisfaction as well as your store’s profit margin. The nature of SLO technology proves to be superior in keeping wait times to a minimum and improving customer experience. Here’s why.

Because of the larger pupil size required for an OCT scan, this exam often requires dilation. And as optometrist Ken Jeffers rightly states in a Review of Optometry article, “We all know dilating is probably the biggest bottleneck in our office flow.”

The OCT is also more bothersome for the customer, who needs to:

  • Sit and wait while the dilation drops take effect
  • Spend 10 minutes in the exam
  • Take several hours off work while their vision is altered
  • Avoid driving and arrange for alternate transportation
  • Wear protective glasses for several hours to protect their dilated pupils from light


Believe it or not, something as simple as dilation can really affect your sales revenue. Since an OCT needs to be performed by an optometrist and the images also take longer to review, your optometrist will be just as busy with the OCT technology as with supporting your number one profit generator: your eyeglasses and lenses dispensary. And because the scan may result in a longer visit to your office than a customer anticipated — when they couldn’t even see well enough to read a magazine in the waiting room — many customers may lose interest in discussing lenses after the exam. So you could find yourself with really great retinal images and a really empty glasses order queue.

Those are just the adult customers. What if you’re also checking children’s eyes in your store? “Drops traumatize kids because they sting,” optometrist Ryan Parker relates to Optometric Management. “Take eye drops out of the equation, and you’ll make the experience a lot better for them.” Not to mention a better experience for adult customers when you take screaming kids in the waiting room out of the equation, and a better experience for parents because their kids are smiling.

Since SLO is capable of taking high-resolution images through a small pupil, there is no need for dilation and no down time (or tears) for the customer. After the scan, you should still have ample time to talk about purchasing new lenses. And with better efficiency, your optometrist can spend more quality time with each customer and you can even book more appointments in a single day.



How does scanning allow you to educate your customers and sell more lenses?

Reviewing SLO scan results with your customers can prove to be a useful jumping-off point for educating them about eye health. How so? The optometrist has an opportunity to explain what he or she is looking for on the scan and discuss any retinal abnormalities that are detected, even if they are not leading to problems yet. This makes it clear to customers that your team is investing time in their eye health. The bonus is that by learning this information, your customerrs also become aware of important reasons to take preventative measures and return to your optical store each year.

While an OCT scan creates an opportunity for customer education as well, the impact is smaller because this scan usually isn’t offered to all customers. And somewhat ironically, because OCT results are usually geared to diagnosing more advanced eye conditions, the OCT may provide information that takes customers’ attention away from purchasing eyeglasses and lenses. It may turn their attention to clinical care that, while important, is not what you are providing them.



How does all of this translate to standing out among competitors?

Technology in and of itself does not differentiate one optical store from another. What sets an optical store apart from the rest is the overall customer experience, including wait times, convenience, and personal treatment.

As Director of Optical Success Academy Conor Heaney writes in an Optician article , “There are not many people laying awake at night wishing their optician had an OCT — but lots are frustrated with the service, the experience, the hassle… by focusing on these areas we can win.”

If you’re tempted to invest in retinal scanning because you’ve heard that other nearby optical stores have it — but you’re not sure how to you’ll use the data obtained from the images or how you’ll profit from the investment — you might want to take a step back to define these aspects first.

Once you’ve decided to move forward, the right technology chosen and implemented with impact and experience in mind can be a gamechanger for you. For many optical stores, an SLO machine will be an investment that allows you to focus on your main income generator — providing the right lenses for your customers — while taking an active role in their eye health and respecting their time. And as optometrist and CEO of a 16-store optometry business, Gregg Ossip, tells Optometric Management, “The ability to instantly obtain retinal data without inconveniencing the customer… is awesome.”

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Don’t miss our upcoming events: