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The basics of retinal oct ophso.net

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The document provides an overview of retinal optical coherence tomography (OCT). It discusses how OCT works using light to provide non-invasive, high resolution imaging of ocular structures. Examples of anterior segment, optic nerve, and retinal OCT scans are shown. Interpretation of macular OCT scans and quantitative thickness maps are described. Indications for retinal OCT include examining retinal layers, monitoring progression of diseases like age-related macular degeneration and diabetic macular edema, aiding treatment planning, and monitoring response to therapy. Case studies demonstrate how OCT enhanced diagnosis and treatment decisions for vitreoretinal interface disorders, retinal vascular diseases, and other retinal entities compared to other imaging tests.

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OCT Bootcamp: The Basics of Retinal OCT Optometry Symposium Hilary Wilson, M.D. November 2, 2008
Question • How many ophthalmic imaging tests can claim the following? – Non-invasive – Non-contact – No radiation – Painless – Fast – Reliable and sensitive (to 10 microns)
Optical Coherence Tomography • Diagnostic test that allows for imaging and measurement of various ocular structures
OCT: Anterior Segment
OCT: Optic Nerve
OCT: Retina
Goals • Quick overview of OCT function • Interpretation of macular OCT scan • Define indications for macular OCT • Practical examples
How does OCT work? • Rays of light provide 2 and 3-dimensional imaging of tissues at histological level
Optical Biopsy of Retinal Layers
Limitations of Retinal OCT • Mydriasis may sometimes be necessary • Dioptric media must be somewhat transparent • Exploration typically limited to posterior pole • Good lacrimal film necessary
Obtaining A Macular Scan
Composite Macular Scan
Interpretation of Macular OCT Printout • Assessment of reliability – Scan placement – Signal strength – Algorithm performance
Scan Placement
Signal Strength • Signal strength 6 = adequate • Signal strength 8 = very good
Algorithm Performance • For macular scan, the borders of algorithm should fit to ILM and PR inner and outer segment • If algorithm has failed, then the quantitative data should be disregarded
Interpretation of Macular OCT Printout • Color-coded qualitative thickness map
Interpretation of Macular OCT Printout • Color-coded quantitative thickness map – Macula 150 to 250 µ – Foveola ≤ 200 µ
Interpretation of Macular OCT Printout • Table of thickness and volume parameters
Indications for Retinal OCT • To examine the retina and its sub-layers – Atrophy, Edema, Traction, Subretinal fluid, RPE irregularity – ARMD, CME, CSME, CSR • To monitor progression • To aid in treatment planning • To monitor response to therapy
Indications for Retinal OCT • To examine the retina and its sub-layers – Extent of retinal defects or abnormalities – Detailed measurements
Indications for Retinal OCT • To monitor progression
Indications for Retinal OCT • To aid in treatment planning • To monitor response to therapy
Case Studies: Vitreoretinal Interface Disorders
Case 1 • A 67 year-old man notes progressive decrease in vision OS x 6 mos • VA 20/20 OD, 20/200 OS
Case 1 Fundus Photo
Case 1 OCT of Macula • Diagnosis?
Case 1 OCT Macular Scan • Diagnosis: Vitreomacular traction • Epiretinal membrane • Cystoid macular edema
OCT Macular Scan: 3 Months Post-op • No remaining ERM • Macular edema resolved • VA 20/40
Comparison OCT: Preop & Postop
OCT Advantage • Enhanced visualization of pathological process • Aided in determining optimal treatment • Postoperative OCT showed resolution
Case Studies: Retinal Vascular Diseases
Case 2 • 66-yo woman with severe NPDR OS treated with focal laser photocoagulation complains of subsequent worsening vision OS x several months • Her visual acuity 20/60 OD, 20/200 OS
Case 2 Fundus Photo
Case 2: FA Early and Late
Case 2: Initial OCT - CSME
Case 2: OCT 6 wks post-IVK
Case 2: Pre- and Post-Treatment
Case 2 OCT Advantage • Quantified morphological abnormality • Showed failure to respond to original laser treatment • Showed improvement with adjunctive intravitreal therapy
Case Studies: Other Retinal Entities
Case 3 • A 75-year-old woman complains of slowly deteriorating vision OS over 6 months • VA 20/30 OD, 20/60 OS
Case 3: Fundus Photo
Case 3: FA Early and Late
Case 3: OCT • Diagnosis
Case 3: OCT • Diagnosis: Wet ARMD with occult CNVM
Case 3 OCT Advantage • Effectively demonstrates the layers involved in the pathological process
Case 4 • A 70-year-old male was referred for evaluation of persistently decreased central visual acuity OD after retinal detachment repair 3 months earlier • VA remained 20/200 OD
Case 4 Fundus Photo
Case 4 OCT
Case 9 OCT Advantage • Diagnosis?
Case 9 OCT Advantage • Persistent shallow RD
Case 4 OCT Advantage • Reveals structural defect that is difficult to identify ophthalmoscopically
Unexpected Uses
Retinitis Pigmentosa
Angioid Streaks
Summary • Retinal OCT as useful diagnostic tool for: – Evaluating structural integrity of posterior pole – Decision making – Following sequential change
References • Schuman, J, Puliafito, C. and Fujimoto, James. Everyday OCT. Slack. 2006. • Nussenblat, RB, Kaufman, SC, Palestine, AG, Davis, MD, Ferris, FL. (1987) Macular thickening and visual acuity Ophthalmology 94,1134-1139 • Hee, MR, Puliafito, CA, Duker, JS, et al (1998) Topography of diabetic macular edema with optical coherence tomography Ophthalmology 105,360-370 • Chauhan, DS, Marshall, J. (1999) The interpretation of optical coherence tomography images of the retina Invest Ophthalmol Vis Sci 40,2332-2342 • Koozekanani, D, Roberts, C, Katz, SE, Herderick, ED. (2000) Intersession repeatability of macular thickness measurements with the Humphrey 2000 OCT Invest Ophthalmol Vis Sci 41,1486-1491 • Munuera, JM, García-Layana, A, Maldonado, MJ, Aliseda, D, Moreno-Montañés, J. (1998) Optical coherence tomography in successful surgery of vitreomacular traction syndrome Arch Ophthalmol 116,1388-1389 • Hee, MR, Puliafito, CA, Wong, C, et al (1995) Quantitative assessment of macular edema with optical coherence tomography Arch Ophthalmol 113,1019-1029 • Otani, T, Kishi, S, Maruyama, Y. (1999) Patterns of diabetic macular edema with optical coherence tomography Am J Ophthalmol 127,688-693 • . Early Treatment Diabetic Retinopathy Study Research Group (1991) ETDRS report number 7: Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics Ophthalmology 98,741-756 • Puliafito, CA, Hee, MR, Lin, CP, et al (1995) Imaging of macular diseases with optical coherence tomography Ophthalmology 102,217-229
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The basics of retinal oct ophso.net

  • 1. OCT Bootcamp: The Basics of Retinal OCT Optometry Symposium Hilary Wilson, M.D. November 2, 2008
  • 2. Question • How many ophthalmic imaging tests can claim the following? – Non-invasive – Non-contact – No radiation – Painless – Fast – Reliable and sensitive (to 10 microns)
  • 3. Optical Coherence Tomography • Diagnostic test that allows for imaging and measurement of various ocular structures
  • 7. Goals • Quick overview of OCT function • Interpretation of macular OCT scan • Define indications for macular OCT • Practical examples
  • 8. How does OCT work? • Rays of light provide 2 and 3-dimensional imaging of tissues at histological level
  • 9. Optical Biopsy of Retinal Layers
  • 10. Limitations of Retinal OCT • Mydriasis may sometimes be necessary • Dioptric media must be somewhat transparent • Exploration typically limited to posterior pole • Good lacrimal film necessary
  • 13. Interpretation of Macular OCT Printout • Assessment of reliability – Scan placement – Signal strength – Algorithm performance
  • 15. Signal Strength • Signal strength 6 = adequate • Signal strength 8 = very good
  • 16. Algorithm Performance • For macular scan, the borders of algorithm should fit to ILM and PR inner and outer segment • If algorithm has failed, then the quantitative data should be disregarded
  • 17. Interpretation of Macular OCT Printout • Color-coded qualitative thickness map
  • 18. Interpretation of Macular OCT Printout • Color-coded quantitative thickness map – Macula 150 to 250 µ – Foveola ≤ 200 µ
  • 19. Interpretation of Macular OCT Printout • Table of thickness and volume parameters
  • 20. Indications for Retinal OCT • To examine the retina and its sub-layers – Atrophy, Edema, Traction, Subretinal fluid, RPE irregularity – ARMD, CME, CSME, CSR • To monitor progression • To aid in treatment planning • To monitor response to therapy
  • 21. Indications for Retinal OCT • To examine the retina and its sub-layers – Extent of retinal defects or abnormalities – Detailed measurements
  • 22. Indications for Retinal OCT • To monitor progression
  • 23. Indications for Retinal OCT • To aid in treatment planning • To monitor response to therapy
  • 25. Case 1 • A 67 year-old man notes progressive decrease in vision OS x 6 mos • VA 20/20 OD, 20/200 OS
  • 26. Case 1 Fundus Photo
  • 27. Case 1 OCT of Macula • Diagnosis?
  • 28. Case 1 OCT Macular Scan • Diagnosis: Vitreomacular traction • Epiretinal membrane • Cystoid macular edema
  • 29. OCT Macular Scan: 3 Months Post-op • No remaining ERM • Macular edema resolved • VA 20/40
  • 31. OCT Advantage • Enhanced visualization of pathological process • Aided in determining optimal treatment • Postoperative OCT showed resolution
  • 33. Case 2 • 66-yo woman with severe NPDR OS treated with focal laser photocoagulation complains of subsequent worsening vision OS x several months • Her visual acuity 20/60 OD, 20/200 OS
  • 34. Case 2 Fundus Photo
  • 35. Case 2: FA Early and Late
  • 36. Case 2: Initial OCT - CSME
  • 37. Case 2: OCT 6 wks post-IVK
  • 38. Case 2: Pre- and Post-Treatment
  • 39. Case 2 OCT Advantage • Quantified morphological abnormality • Showed failure to respond to original laser treatment • Showed improvement with adjunctive intravitreal therapy
  • 41. Case 3 • A 75-year-old woman complains of slowly deteriorating vision OS over 6 months • VA 20/30 OD, 20/60 OS
  • 42. Case 3: Fundus Photo
  • 43. Case 3: FA Early and Late
  • 44. Case 3: OCT • Diagnosis
  • 45. Case 3: OCT • Diagnosis: Wet ARMD with occult CNVM
  • 46. Case 3 OCT Advantage • Effectively demonstrates the layers involved in the pathological process
  • 47. Case 4 • A 70-year-old male was referred for evaluation of persistently decreased central visual acuity OD after retinal detachment repair 3 months earlier • VA remained 20/200 OD
  • 48. Case 4 Fundus Photo
  • 50. Case 9 OCT Advantage • Diagnosis?
  • 51. Case 9 OCT Advantage • Persistent shallow RD
  • 52. Case 4 OCT Advantage • Reveals structural defect that is difficult to identify ophthalmoscopically
  • 56. Summary • Retinal OCT as useful diagnostic tool for: – Evaluating structural integrity of posterior pole – Decision making – Following sequential change
  • 57. References • Schuman, J, Puliafito, C. and Fujimoto, James. Everyday OCT. Slack. 2006. • Nussenblat, RB, Kaufman, SC, Palestine, AG, Davis, MD, Ferris, FL. (1987) Macular thickening and visual acuity Ophthalmology 94,1134-1139 • Hee, MR, Puliafito, CA, Duker, JS, et al (1998) Topography of diabetic macular edema with optical coherence tomography Ophthalmology 105,360-370 • Chauhan, DS, Marshall, J. (1999) The interpretation of optical coherence tomography images of the retina Invest Ophthalmol Vis Sci 40,2332-2342 • Koozekanani, D, Roberts, C, Katz, SE, Herderick, ED. (2000) Intersession repeatability of macular thickness measurements with the Humphrey 2000 OCT Invest Ophthalmol Vis Sci 41,1486-1491 • Munuera, JM, García-Layana, A, Maldonado, MJ, Aliseda, D, Moreno-Montañés, J. (1998) Optical coherence tomography in successful surgery of vitreomacular traction syndrome Arch Ophthalmol 116,1388-1389 • Hee, MR, Puliafito, CA, Wong, C, et al (1995) Quantitative assessment of macular edema with optical coherence tomography Arch Ophthalmol 113,1019-1029 • Otani, T, Kishi, S, Maruyama, Y. (1999) Patterns of diabetic macular edema with optical coherence tomography Am J Ophthalmol 127,688-693 • . Early Treatment Diabetic Retinopathy Study Research Group (1991) ETDRS report number 7: Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics Ophthalmology 98,741-756 • Puliafito, CA, Hee, MR, Lin, CP, et al (1995) Imaging of macular diseases with optical coherence tomography Ophthalmology 102,217-229