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Oct in glaucoma

  1. 1. Dr. Jagdish Dukre Senior Resident, Regional Institute Of Ophthalmology, Allahabad
  2. 2. Peri papilary Nerve fiber layer Macular thickness Optic nerve head
  3. 3. OCT Software analyses- Macula Thickness Retinal Nerve Fibre Layer (RNFL) Optic Nerve Head (ONH)
  4. 4. Macula Thickness Analysis Ganglion cells- 30-35% of total retinal thickness at macula upto 50%of ganglion cells in macula glaucoma preferentially involves the ganglion cell complex (GCC). Normal Glaucoma with thinner GCC
  5. 5. RNFL analysis  Circular scanning around ONH at a radius of 1. 73mm  Three scans are acquired and data is averaged and compared with normative data base of age matched subjects  Scan begins temporally
  6. 6. RNFL thickness average analysis printout -7 zones  Zone -1-Pt. I.D  Zone -2-TSNIT with age matched normative data base  Zone-3-TSNIT overlap of two eyes  Zone -4-circular scan-quadrant/clockwise  Zone-5-DATA TABLE-ratio/average  Zone-6-RED FREE PHOTOGRAPH-position  Zone-7-PERCENTILE COLOR CODING
  7. 7. 7 6 5 4 3 2 1
  8. 8. Optic nerve head analysis Optic nerve head scans are composed of six linear scans in a spoke pattern separated by 30-degree intervals centered on the ONH
  9. 9. Cup/disk ratios and cup Volumes Disc size:  by measuring the distance between the terminal ends of the choriod at the level of the pigment epithelium (green line) Cup:  determined by drawing a line b/w both sides of the cup at a point 140um above the green line.  Area below the line is cup and above is neuroretinal rim
  10. 10. Case 1-(Structure Function Correlation)  56 year old female with open angle glaucoma  NFL lesion at inferior pole of ONH  Superior defect in perimetry  Thinning of RNFL in OCT
  11. 11. Case 2 (early glaucoma)  59 year old male with suspicious optic nerve  Normal perimetry  Normal IOP  No positive family history  Thinning of NRR clinically  Nasal step in SWAP  RNFL thinning in OCT
  12. 12. Case 3-(Unilateral Open Angle Glaucoma)  54 year old female  Unilateral exfoliative glaucoma  IOP- 33 mmHg  Thinning of NRR in sup, inf and temporal  Inferior arcuate defect in perimetry  RNFL thinning in sup and inf pole in OCT
  13. 13. Case 4-Glaucoma suspect  62 year old female  Large C:D ratio  B/L with positive family history  Normal IOP  Normal achromatic and FDP  Normal RNFL and large disc area and increased C:D ratio on OCT
  14. 14. Case 5 (Ocular Hypertension)  Suspicious optic nerve head  Perimetry normal  Borderline FDP  Borderline thickness values with more thinning at superior and inferior pole on OCT
  15. 15. DOPPLER OCT(F-Domain) Retinal blood flow measurement with Doppler OCT may help us understand the role of perfusion in the causation and treatment of glaucoma, other optic neuropathies and retinal diseases