OCT: Topcon vs. Zeiss for Glaucoma

[salami bahama]

Does anyone have any strong opinions on using either Topcon (Maestro 2 being the newest model) vs. Zeiss Cirrus (6000 being the latest model) as a tool for OCT RNFL/GC analysis and monitoring for progression? The Maestro has the convenient feature of a fundus camera built in. I'm curious if anyone has been happy with their Topcon as a tool in their management of glaucoma and specifically if there are any advantages or disadvantages compared to Cirrus.

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[hello lady!]

I have experience with both machines.

The Maestro 2 is identical (in software and hardware) to the Maestro 1 except for the addition of a port that can accept a separate OCT-angiography machine. Their OCT-angiography is not FDA approved and they don't even have a timeline of when it will happen (if it even does). It's not worth the added cost at this point.

I believe the Maestro is about $45,000 (again, without angiography). It is serviceable for retina evaluations but NOT in a busy practice with multiple docs. The image acquisition is slow and clunky. If you're a small guy on your own or if you have a small satellite office it may work as a combo photography/OCT station.

The glaucoma portion of the Maestro is weak. Retina it works pretty well (and it's nice to have the OCT linked to the photo - but remember you can't bill for both; you'll lose photo revenue because of this). The RNFL segmentation really isn't trustworthy and the guided progression analysis is dismal. They give you some dots/lines/projections but there is no way to see the actual numbers being analyzed like the Zeiss machine. The other thing that bugs me is the software - viewing reports on the machine and is awkward and there are so many ways to generate a report that your technicians will send images to your EMR in different formats. I almost never see a macula OCT displayed the same way twice in a row with this machine.

The Cirrus 6000 is a thing of beauty. If you get angiography you're looking at an $85,000 price tag. Truth be told, I don't think this machine will give you a clinical advantage compared to the 5000. OCT-Angiography is nice to play with but I haven't seen a clinical study yet that shows superior management of AMD or CNV compared to traditional OCT (my knowledge may be obsolete and our retina-experts here can chime in). I think you could save some cash and stick with the 5000 machine.

One downside to the Zeiss is that they created and are pushing this extra software that is pricey for glaucoma trending. It's called "Glaucoma Workplace" (ZEISS Ophthalmology Data Management Systems). It's an expensive subscription-based model. As they push more and more for this software I could see the local-machine processing getting weaker in the future.

Just my thoughts.

 

[MstaKing10]

No experience with topcon. Have a few cirrus machines and love them. Lots of useful data and easy to use and aquire scans. Most of our offices are stocked with Heidelberg machines however and these to me are superior to the other two at least for retina. The images are exquisite and the software is powerful. We have optos or old topcon cameras for photos.

As for OCTA I haven’t found it clinically useful yet. Takes forever to aquire the images and it’s difficult to know what to do with the data. It doesn’t add much to management compared to a straight OCT or angiogram at least in my clinic. Though we have it and it’s fun to play with I wouldn’t prioritize it. That said their May be a role for it going forward (especially to supplant angiography) so as a forward thinker might be a good idea to consider it. Also as I understand it the reimbursement for OCTA is no different than regular OCT, thus, hard to justify financially.

 

[Fascia Lata]

I have experience with both. The Topcon glaucoma software is very disappointing. It’s a no brainer. Get a Cirrus for sure. Make sure you have upgraded software for GCIPL and progression analyses

 

[salami bahama]

Thank you all for your input! Very helpful.

 

[gahnu]

Anyone with opinions on the Optovue OCT machines?

 

[Fascia Lata]

Anyone with opinions on the Optovue OCT machines?

We had that one as well. TBH was also poor when it came to glaucoma, although ok for retina.

If you are a glaucoma specialist, get a Cirrus. A close second would be the Spectralis with the glaucoma upgrade bundle. The other ones mentioned here are just not very useful if you want to really be able to diagnose questionable cases and follow your patients reliably, and not merely do an OCT just to bill for it. If I only had topcon or Optovue, I would still be ok but I would know I am missing on a lot of information I could otherwise obtain.