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Nw2015 rcopt oct_retina22
This document provides guidance on interpreting optical coherence tomography (OCT) scans of the macula in common retinal diseases. It discusses how to acquire high-quality OCT images and systematically evaluate the scans. Key steps in image acquisition include proper scan centration and verification of data quality. When evaluating scans, the document outlines examining scan quality, overall retinal profile, foveal contour, retinal layers, and identifying any abnormalities. Specific pathologies are demonstrated, such as macular edema, holes, detachments, and changes at the retinal pigment epithelium. Overall, the document serves as a guide for clinicians to optimize OCT image quality and systematically read scans to accurately diagnose and monitor macular diseases.
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Nw2015 rcopt oct_retina22
- 1. Interpreting OCTs in CommonMacular Diseases Nawat Watanachai RCOPT : July 2015 1
- 2. » pros ofFDOCT – accurate – reproducible – non invasive – fast » good in – diagnosis – gold std in some diseases – monitor objectively – retinal thickness measurement – fluid collection why OCT 2
- 3. How to getthe best information from macular OCT? » 1. do the RIGHT scan » 2. read the scan properly 3
- 4. How to getthe best information from macular OCT? » 1. do the RIGHT scan » take the best image » minimise all possible error » 2. read the scan properly 4
- 5. Image Acquisition 1. centralization – ptsc good vision : easy – Pts c poor fixation : hard • Identify the fovea location • Place the scan on it correctly 5
- 6. Image Acquisition 2. Dataverification and validation – Do it at the end of scanning session – error in the retinal boundary delineation – re-do the scan 6
- 7. Image Acquisition 7 2. Dataverification and validation – Verify centralizationof the 6 scans – Retinal map(single eye), retinal thickness/volume (OU) analyze protocols »SD should be around 0 mcm »SD > 30 mcm » poor centration » do the scan again
- 8. Image acquisition 3. rasterscanning 8
- 9. • radial OCT BasicKnowledge : Scan Patterns for macula • raster • cruciate • single 9
- 10. OCT Basic Knowledge: radial line protocol – 6X 6mm-long lines, 30’ apart – Center at foveal center 10
- 11. 3. raster scanning –to minimize the chance of missing morphological details – 8 mm length scan – best for vitreomacular adhesion – May hit small lesions that missed on radial protocol 11 OCT Basic Knowledge : raster scan protocol
- 12. Image acquisition A. fovealsplit B. lamellar hole A’ FTMH B’ FTMH 12
- 13. OCT Basic Knowledge: Retinal thickness map 13 color Thickness (microns) White >470 red 350-470 Orange 320-350 Yellow 270-320 Green 210-270 blue 150-210 » from radial scan
- 14. Retinal Thickness » 1.fundamental of OCT automatic retinal thickness measurement – algorithm (math. calculation) – presumes 2 high reflective structures • 1. VR surface • 2. RPE-photoreceptor outer segment interface – compares the shape of 1 a-scan to adjacent a-scans 14
- 15. OCT Basic Knowledge: Retinal thickness map 15 » Depth 2 mm » For thickness map » Interpolation for thickness between sample point
- 16. 16 Retinal Thickness machine canbe error
- 17. » 2. softwaredelineation of outer neuro-sensory retinal boundary » HRL – TDOCT : RPE-choriocapillaries reflective complex – SDOCT : 2 lines • IS/OS junction • RPE-choriocapillaries reflective complex Retinal Thickness 17
- 18. » 2. softwaredelineation of outer neuro- sensory retinal boundary » SDOCT sometimes detect innerHRL as outer boundary of retina • error in thickness measurement • may need manual caliper-assisted technique – auto VS manual differed by 9.9-38% • Costa 2004 Retinal Thickness 18
- 19. Retinal Thickness » (L)automated retinal thickness measurement (VR-IS/OS) » (R) manual retinal thickness measurement » difference 51 mcm 19
- 20. Image acquisition 4. scanreview software tool 20
- 21. How to getthe best information from macular OCT? » 1. do the RIGHT scan » 2. read the scan properly » systematic approach 21
- 22. Basic Principles inOCT reading » Know your retinal histo/histopathology » Know what is normal : contour/ thickness » Remember you’re dealing with » light and its wave properties » Reflections/ interfaces » Attenuation/ shadowing » Always consider image quality/ artefacts 22
- 23. OCT Basic Knowledge: Retinal layers in OCT 23
- 24. »High reflectivity :NFL/ IS-OS Junction/ RPE-choriocapillaris »Intermediate reflectivity : plexiform layers »Low reflectivity : nuclear layers/ photoreceptor outer segment/ vitreous »Fovea »Absence of inner retinal layer »Increased thickness of the photoreceptor layer 24 OCT Basic Knowledge : Retinal layers in OCT
- 25. »High reflectivity :NFL/ RPE/ choriocapillatis »Intermediate reflectivity : plexiform layers »Low reflectivity : nuclear layers/ photoreceptor outer segment/ vitreous »Fovea »Absence of inner retinal layer »Increased thickness of the photoreceptor layer 25 OCT Basic Knowledge : Retinal layers in OCT
- 26. »High reflectivity :NFL/ RPE/ choriocapillatis »Intermediate reflectivity : plexiform layers »Low reflectivity : nuclear layers/ photoreceptor outer segment/ vitreous »Fovea »Absence of inner retinal layer »Increased thickness of the photoreceptor layer 26 OCT Basic Knowledge : Retinal layers in OCT
- 27. • defining innerand outer HRL • HRL - Highly Reflective Layer • TD OCT : single line • FD OCT : 2 lines 27 OCT Basic Knowledge : Retinal layers in OCT
- 28. • defining innerand outer HRL • FD OCT : not 1 line, but 2 • inner line : IS/OS junction • outer line : RPE choriocapillaris complex 28 OCT Basic Knowledge : Retinal layers in OCT
- 29. » IS/OS junction »correlated with VA » irregularities at the level of inner HRL after MH Sx prevent VA improvement » Uemoto 2002, Kitaya 2004, Villate 2005. 29 OCT Basic Knowledge : Retinal layers in OCT
- 30. IS/OS junction :correlated with VA RP localization of missing photoreceptor component Jacobson 1998, 2000 cone-rod dystrophy, Best macular dystrophy prediction of subret./ subRPE deposits Aleman 2002, Pianta203 30 OCT Basic Knowledge : Retinal layers in OCT
- 31. OCT Basic Knowledge: Retinal layers in OCT shadows 31
- 32.
- 33. Morphologic assessment » 1.determine scan quality » 2. rate overall scan profile » 3. evaluate foveal profile » 4. identify foveal cut » 5. structural assessment 33
- 34. Morphologic assessment » 1.determine scan quality » 2. rate overall acan profile » 3. evaluate foveal profile » 4. identify foveal cut » 5. structural assessment 34
- 35. » 1. determinescan quality » identify inner and outer retinal boundaries » good signal to noise ratio » rescan? 35
- 36. Morphologic assessment » 1.determine scan quality » 2. rate overall scan profile » 3. evaluate foveal profile » 4. identify foveal cut » 5. structural assessment 36
- 37. » 2. rateoverall scan profile » normal over-all retinal profile » slightly concave curvature » abnormal » exaggerated concavity and convexity or retinal folds » watch for artefact 37
- 38. » 1. retinaldetachment » RRD/ TRD/ ERD/ HRD » 2. retinal thickening » CSME/ CME/ CNV » 3. RPED » fibrous/ serous/ hemorrhage 38 » 2. rate overall scan profile
- 39. Morphologic assessment » 1.determine scan quality » 2. rate overall scan profile » 3. evaluate foveal profile » 4. identify foveal cut » 5. structural assessment 39
- 40. » 3. evaluatefoveal profile » normal foveal profile » slightly depression in the surface of retina 40
- 41. Morphologic assessment loss offoveal depression some problems 41
- 42. » 3. evaluatefoveal profile » deformations in the foveal profile » VR surface » ERM/ pseudohole » MH/ Lamellar hole/ macular cyst » Retina 42
- 43. Morphologic assessment » 1.determine scan quality » 2. rate overall acan profile » 3. evaluate foveal profile » 4. identify foveal cut » 5. structural assessment 43
- 44. » 4. identifyfoveal cut » do we need rescan? 44
- 45. back to Image Acquisition 1. centralization •Identify the fovea location • Place the scan on it correctly – Centre line tool(OCT3 software) : right click 45
- 46. Morphologic assessment » 1.determine scan quality » 2. rate overall acan profile » 3. evaluate foveal profile » 4. identify foveal cut » 5. structural assessment 46
- 47. Morphologic assessment » 5.structured assesment » alteration of layers » Systematic : antpost 47
- 48. » 5. structuredassesment : Preretinal/ Epiretinal preretinal-vitreous cavity syneresis/ VH Epiretina ERM/ MH vitreo-retinal strands vitreo-retinal traction NVE NVD 48
- 49. 49 »5. structured assesment: Preretinal/ Epiretinal
- 50. 50 »5. structured assesment: Preretinal/ Epiretinal
- 51. » Vitreous assessment »Search for opacities eg » posterior hyaloid » MH operculum 51 »5. structured assesment : Preretinal/ Epiretinal
- 52. 52 »5. structured assesment: Preretinal/ Epiretinal
- 53. 53 » consider lookingfor ERM/ PVD traction in difficult DME cases »5. structured assesment : Preretinal/ Epiretinal
- 54. DME: high prevalenceof perifoveal PVD Gaucher 2005 favorable macular remodeling in DME after spontaneous PVD Watanabe 2000, Yamagachi 2003 54 »5. structured assesment : Preretinal/ Epiretinal
- 55. A,B : PVD C: VM traction D. remodel after completion of PVD 55 »5. structured assesment : Preretinal/ Epiretinal
- 56. » Look forareas of abnormal VMT » Identified areas where thin hyperreflective band from the vit insert into the retina » Look for ERM » Thin hyperreflective structures which show multiple areas of attachment and separation from the inner retinal surface » may demonstrate free posterior hyaloid face 56 »5. structured assesment : Preretinal/ Epiretinal
- 57. 57 »5. structured assesment: Preretinal/ Epiretinal VMT
- 58. 58 »5. structured assesment: Preretinal/ Epiretinal ERM
- 59. 59 »5. structured assesment: Preretinal/ Epiretinal ERM
- 60. » early MH »oblique vitreofoveal tractional forces » intrafoveal split » Hee1995, Gaudric1999, Haouchine2001, Tornambe2003 60 »5. structured assesment : Preretinal/ Epiretinal
- 61. 61 »5. structured assesment: Preretinal/ Epiretinal » early MH
- 62. » late MH 62 »5.structured assesment : Preretinal/ Epiretinal
- 63. » FTMH: typicalconfiguration » round cystic margins » SRF 63 »5. structured assesment : Preretinal/ Epiretinal
- 64.
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- 66. » 5. structuredassesment: Intra-Retinal 1. macula edema diffuse cystoid 2. hard exudates 3. scar tissue 4. atrophic degeneration 66
- 67. » macula edema: Characteristics » diffuse vs cystoid » Central/symmetric vs asymmetric (eg RVO) » Remember thickened retina can attenuate signal 67 » 5. structured assesment: Intra-Retinal
- 68. » Cystic space: Discrete area of hyporeflectivity 68 » 5. structured assesment: Intra-Retinal
- 69. Case courtesy ofDr. Scott Lee, East Bay Retina Consultants, Oakland, CA, USA 69 » 5. structured assesment: Intra-Retinal
- 70. Mid-retina slab enfaceview emphasizes the presence of hard exudates in a subject with mild macular edema 70 » 5. structured assesment: Intra-Retinal
- 71. 71 » 5. structuredassesment: Intra-Retinal
- 72. 72 » 5. structuredassesment: Intra-Retinal
- 73. 73 » 5. structured assesment: »Intra-Retinal
- 74. » Retinal thinning »Increase transmission of light to the deeper layer 74 » 5. structured assesment: Intra-Retinal
- 75. 75 » 5. structuredassesment: Intra-Retinal » Retinal thinning » mostly found in late stage of many diseases
- 76. IS/OS-Ellipsoid Enface Slab:Hydroxychloroquine toxicity example with classic bull’s eye maculopathy Case courtesy of Dr. Scott Lee, East Bay Retina Consultants, Oakland, CA, USA 76 » 5. structured assesment: Intra-Retinal
- 77. 77 » 5. structuredassesment: Intra-Retinal thick/ thin/ edema
- 78. » 1. CNV »2. RPED » 3. drusen » 4. subretinal fibrosis » 5. scar » 6. RPE atrophy » 7. SRF 78 » 5. structured assesment: sub-retina
- 79. » Separation betweenneural retina and RPE » Generally hyporeflective » Look for associated RPE level change eg small PED in CSR » Partial preservation of foveal depression 79 » 5. structured assesment: sub-retina clear SRF
- 80.
- 81. 81 » 5. structuredassesment: sub-retina
- 82. » Not hyporeflectivespace » Presence of tissue eg typeII CNV, subretinal fibrosis » Hemorrhage or lipid » Viscous SRF eg fibrinous CSR » Correlate with color fundus photo/ FA/ ICG*** 82 » 5. structured assesment: sub-retina NOT so clear SRF?
- 83. 83 » 5. structuredassesment: sub-retina
- 84. 84 » 5. structuredassesment: sub-retina A. 1st visit B. 6 wks after
- 85. 85 » 5. structuredassesment: sub-retina
- 86.
- 87. - drusen - RPED 87 »5. structured assesment: RPE/ sub-RPE
- 88. 88 » 5. structuredassesment: RPE/ sub-RPE drusen Small/ discrete low-lying areas of RPE elevation c highly reflectivity
- 89. » RPED :area of hypo-reflectivity underneath RPE elevation 89 » 5. structured assesment: RPE/ sub-RPE
- 90. » RPED » Assessits size, contour and reflectivity » Look for adjacent areas » eg atrophy from RPE tear 90 » 5. structured assesment: RPE/ sub-RPE
- 91. Morphologic assessment :RPE elevation » RPED : content » serous/ hemorrhagic/ fibrovascular 91
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- 103. 103 2. 1 yrlater after rx
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Editor's Notes
- #10 New Smart HD Scans deliver targeted visualizations of critical anatomy HD 21 Line – more scans covering a larger area to better assess the retina HD Radial – 12 radial lines with the fovea as the comm