The basics of retinal oct ophso.net

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The basics of retinal oct ophso.net

  1. 1. OCT Bootcamp:The Basics of Retinal OCT Optometry Symposium Hilary Wilson, M.D. November 2, 2008
  2. 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. 3. Optical Coherence Tomography• Diagnostic test that allows for imaging and measurement of various ocular structures
  4. 4. OCT: Anterior Segment
  5. 5. OCT: Optic Nerve
  6. 6. OCT: Retina
  7. 7. Goals• Quick overview of OCT function• Interpretation of macular OCT scan• Define indications for macular OCT• Practical examples
  8. 8. How does OCT work?• Rays of light provide 2 and 3-dimensional imaging of tissues at histological level
  9. 9. Optical Biopsy of Retinal Layers
  10. 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
  11. 11. Obtaining A Macular Scan
  12. 12. Composite Macular Scan
  13. 13. Interpretation of Macular OCT Printout• Assessment of reliability – Scan placement – Signal strength – Algorithm performance
  14. 14. Scan Placement
  15. 15. Signal Strength• Signal strength 6 = adequate• Signal strength 8 = very good
  16. 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. 17. Interpretation of Macular OCT Printout• Color-coded qualitative thickness map
  18. 18. Interpretation of Macular OCT Printout• Color-coded quantitative thickness map – Macula 150 to 250 µ – Foveola ≤ 200 µ
  19. 19. Interpretation of Macular OCT Printout• Table of thickness and volume parameters
  20. 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. 21. Indications for Retinal OCT• To examine the retina and its sub-layers – Extent of retinal defects or abnormalities – Detailed measurements
  22. 22. Indications for Retinal OCT• To monitor progression
  23. 23. Indications for Retinal OCT• To aid in treatment planning• To monitor response to therapy
  24. 24. Case Studies:Vitreoretinal Interface Disorders
  25. 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. 26. Case 1 Fundus Photo
  27. 27. Case 1 OCT of Macula• Diagnosis?
  28. 28. Case 1 OCT Macular Scan• Diagnosis: Vitreomacular traction • Epiretinal membrane • Cystoid macular edema
  29. 29. OCT Macular Scan: 3 Months Post-op• No remaining ERM• Macular edema resolved• VA 20/40
  30. 30. Comparison OCT: Preop & Postop
  31. 31. OCT Advantage• Enhanced visualization of pathological process• Aided in determining optimal treatment• Postoperative OCT showed resolution
  32. 32. Case Studies:Retinal Vascular Diseases
  33. 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. 34. Case 2 Fundus Photo
  35. 35. Case 2: FA Early and Late
  36. 36. Case 2: Initial OCT - CSME
  37. 37. Case 2: OCT 6 wks post-IVK
  38. 38. Case 2: Pre- and Post-Treatment
  39. 39. Case 2 OCT Advantage• Quantified morphological abnormality• Showed failure to respond to original laser treatment• Showed improvement with adjunctive intravitreal therapy
  40. 40. Case Studies:Other Retinal Entities
  41. 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. 42. Case 3: Fundus Photo
  43. 43. Case 3: FA Early and Late
  44. 44. Case 3: OCT• Diagnosis
  45. 45. Case 3: OCT• Diagnosis: Wet ARMD with occult CNVM
  46. 46. Case 3 OCT Advantage• Effectively demonstrates the layers involved in the pathological process
  47. 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. 48. Case 4 Fundus Photo
  49. 49. Case 4 OCT
  50. 50. Case 9 OCT Advantage• Diagnosis?
  51. 51. Case 9 OCT Advantage• Persistent shallow RD
  52. 52. Case 4 OCT Advantage• Reveals structural defect that is difficult to identify ophthalmoscopically
  53. 53. Unexpected Uses
  54. 54. Retinitis Pigmentosa
  55. 55. Angioid Streaks
  56. 56. Summary• Retinal OCT as useful diagnostic tool for: – Evaluating structural integrity of posterior pole – Decision making – Following sequential change
  57. 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
  58. 58. Thank YouAny Questions?

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