OCT (OPTICAL COHERENCE TOMOGRAPHY)

IN OPHTHALMOLOGY
Sudha Cugati
MBBS MS PhD FRANZCO
Modbury Hospital, Smart Road, SA
OUTLINE
• Tips for assessing Macular OCT
• Typical OCT features in Retinal Diseases – What to Refer and When to Refer
• Other OCTs (Disc/ Anterior Segment)
PRINCIPLE OF OCT
• Based on the principle of Low Coherence interferometry
ASSESSMENT OF MACULAR OCT
Basic tips includes
• Pay attention to the scan quality
• Use proper language
• Familiarise with the Anatomy
• Assessment of Subfield analysis
ASSESSMENT OF MACULAR OCT
• Pay attention to the scan quality
• Use proper language
• Familiarise with the Anatomy
• Assessment of Subfield analysis
GOOD QUALITY SCAN
CATARACT CAUSING POOR QUALITY OF THE
SCAN
OTHER MEDIA OPACITIES
SHADOWS (WEISS RING)
SCAN QUALITY - VIGNETTING
SCAN QUALITY - OUT OF RANGE ERROR
SCAN QUALITY - SOFTWARE BREAKDOWN
(INABILITY TO ASSESS THE RPE)
SCAN QUALITY - OUT OF RANGE ERROR & ALSO
SOFTWARE BREAKDOWN
SCAN QUALITY - MISALIGNMENT
SCAN QUALITY - MOTION ARTEFACT
SCAN QUALITY - BLINK ARTEFACT
SCAN QUALITY - MIRROR ARTEFACT
ASSESSMENT OF MACULAR OCT
• Pay attention to the scan quality
• Use proper language
• Familiarise with the Anatomy
• Assessment of Subfield analysis
USE OF APPROPRIATE LANGUAGE –
HYPOREFLECTIVE AREA IN CRVO
HYPOREFLECTIVE AREA IN MACTEL

ATLAS OF RETINAL OCT GOLDMAN R ET AL

 CH

Cyst like spaces

? Degen muller’s cells

Choroidal hyperreflectivity
HYPER REFLECTIVE AREAS - DIABETIC
RETINOPATHY

Intra retinal fluid

Hard exudates
ASSESSMENT OF MACULAR OCT
• Pay attention to the scan quality
• Use proper language
• Familiarise with the Anatomy
• Assessment of Subfield analysis
NORMAL OCT - MACULA

NFL

GCL
IPL
INL
OPL
ONL
ELM
IS/OS junction
RPE

Choroid
Discuss OCT features
1. RPE Changes
2. Outer Retinal Changes
3. Inner Retinal Changes
4. IS/OS Junction
5. Vitreous Changes

RPE ABNORMALITY
AMD
DRUSEN
RETICULAR DRUSEN
CUTICULAR DRUSEN
DRUSENOID PED
ISOLATED PIGMENT EPITHELIAL DETACHMENT
NEOVASCULAR AMD TYPE 1 CNVM

Subretinal Fluid PED with heterogenous

internal reflectivity
NEOVASCULAR AMD – TYPE 2 CNVM

CNV COMPLEX
ACQUIRED TYPE 2 (MYOPIC) CNVM

CNV Complex
TYPE 3 CNVM
Subretinal Fluid

Irregular PED Presumed RAP lesion

POLYPOIDAL CHOROIDAL VASCULOPATHY

Large PED
Subretinal Fluid
DRUSEN WITH SRF

Polling Question 1
Same patient over 9 months
SUBRETINAL HAEMORRHAGE

Subretinal Fluid

Subretinal haemorrhage
DISCIFORM SCAR
Intraretinal Cyst

Organised
Subretinal Scar
RETINAL PIGMENT EPITHELIAL TEAR

Edge of tear
OCT Signal blockage Subretinal fluid
RPE bunching
GEOGRAPHIC ATROPHY
CENTRAL SEROUS CHORIORETINOPATHY

Subretinal Fluid
Pigment Epithelial Detachment
Polling Question 2. On routine examination of a 48 year old smoker, you notice that the
patient has drusen at the macula. You perform an OCT. What would be your possible
diagnosis?

A. Drusen
B. Type 2 CNVM
C. Geographic Atrophy
 Polling Question 3. 75 year old patient presents with for routine update of spectacles. BCVA in
the RE is 6/12. Based on the fundus examination, OCT is performed which is as below. What
will you do?

A. Prescribe glasses
B. Send a referral to the Ophthalmologist
C. Advise the patient to return for a follow up examination in 1 month for another trial of spectacles
OUTER RETINAL CHANGES
DIABETIC MACULAR EDEMA

Intraretinal Fluid

Subretinal Fluid
BRANCH RETINAL VEIN OCCLUSION
CENTRAL RETINAL VEIN OCCLUSION
RETINAL DETACHMENT
ELLIPSOIDAL LAYER/ IS-OS JUNCTION

Full thickness Macular Hole

PLAQUENIL TOXICITY

ATLAS OF RETINAL OCT GOLDMAN R ET AL

ATLAS OF RETINAL OCT GOLDMAN R ET AL
RETINITIS PIGMENTOSA
CHOROIDAL MELANOMA
INNER RETINAL ABNORMALITY
ACUTE RETINAL ARTERY
OCCLUSION

Increased Hyper reflectivity

OLD CENTRAL RETINAL ARTERY OCCLUSION
EPIRETINAL MEMBRANE
EPIRETINAL MEMBRANE WITH LAMELLAR
MACULAR HOLE
VITREOUS CHANGES
NORMAL VITREOUS

POSTERIOR HYALOID

RETROHYALOID SPACE
VITREOMACULAR ADHESION AND
VITREOMACULAR TRACTION
VMT
 VMT

VMT POST SURGERY

VITREOUS HAEMORRHAGE
(PROLIFERATIVE DIABETIC
RETINOPATHY )
Polling Question 4. You have performed an OCT for symptoms of metamorphopsia. Would you
refer patient A or B for an urgent referral?

B
ASSESSMENT OF MACULAR OCT
Basic tips includes
• Pay attention to the scan quality
• Use proper language
• Familiarise with the Anatomy
• Assessment of Subfield analysis
HELPS IN ASSESSING THE OUTCOME OF
TREATMENT
Registration : Automatic Registration succeeded

Exam from 21/08/2019 3:03:53 PM Exam from 2/10/2019 3:32:27 PM

Fovea: Not found Fovea: Not found

Overlay: OCT Fundus Transparency: 0 % Overlay: ILM-RPE Difference Transparency: 0 %

Extracted B-Scan
 QUANTITATIVE AND QUALITATIVE ANALYSIS
Scan Angle: 0° Spacing: 0.25 mm Length: 6 mm

ILM-RPE Thickness (µm) Fovea: Not found

Overlay: ILM - RPE Transparency: 50 %

ILM - RPE

ILM

RPE

Central Cube
Cube
Subfield Average
Volume
Thickness Thickness
(mm³)
(µm) (µm)

Qualitative analysis –Location of the abnormality, Description of the structure &

identify the anomalous structure
Quantitative – Retinal thickness and volume and NFL thickness
OTHER OCT SCAN USED IN OPHTHALMOLOGY

OCT NFL
OCT OF NFL - GLAUCOMA
Technician: Operator, Cirrus Signal Strength: 7/10 8/10

ONH and RNFL OU Analysis:Optic Disc Cube 200x200 OD OS

RNFL Thickness Map RNFL Thickness Map

RNFL Deviation Map RNFL Deviation Map

Neuro-retinal Rim Thickness

Disc Center(0.18,0.12)mm Disc Center(0.09,0.03)mm

RNFL Thickness
Extracted Horizontal Tomogram Extracted Horizontal Tomogram

Extracted Vertical Tomogram Extracted Vertical Tomogram

RNFL
Quadrants
RNFL Circular Tomogram RNFL Circular Tomogram

RNFL
Clock
Hours

Doctor's Signature CIRRUSREVIEW1

Comments
OCT NFL AND PAPILLOEDEMA
ONH and RNFL OU Analysis:Optic Disc Cube 200x200 OD OS
RNFL Thickness Map RNFL Thickness Map

RNFL Deviation Map RNFL Deviation Map

Neuro-retinal Rim Thickness

Disc Center(-0.39,0.27)mm Disc Center(0.03,0.06)mm

RNFL Thickness
Extracted Horizontal Tomogram Extracted Horizontal Tomogram

Extracted Vertical Tomogram Extracted Vertical Tomogram

RNFL
Quadrants
RNFL Circular Tomogram RNFL Circular Tomogram

RNFL
Clock
Hours

Doctor's Signature CIRRUSREVIEW1

Comments
ANT SEGMENT OCT

PRE PI

POST PI
TAKE HOME MESSAGE
1. OCT should be performed only to aid
diagnosis and it does not replace
history and thorough clinical
examination
2. Good quality OCT Scan is essential
3. Appropriate referral is based on the
clinical diagnosis and OCT