OPTICAL COHERENCE
TOMOGRAPHY
INTRODUCTION OF OCT
• Optical coherence tomography (OCT) is a diagnostic, non-invasive, non-contact,
transpupillary imaging system which provides high resolution cross-sectional
images of anterior eye, the retina, vitreous and optic nerve.
• In vivo “optical biopsy” of the retina.
• Fast scanning rates and quick signal processing allows for image visualization in
real time and at a video rate.
Spectral Domain OCT
• light source of 840 nm
• Limited by patient’s ability to avoid eye movements
WHICH EYE IS THIS ?
Picture of Right eye as we can see the thick RNFL hyperreflective band exiting the retinal
through optic nerve head
MACULAR OCT CAN BE ANALYZED
IN 5 DIFFERENT LAYERS AS:
1)PRE-RETINA
2)VITREORETINAL/VITREOMACULAR INTERFACE.
3)EPI-RETINA
4)RETINA
5)CHOROID
2) REFLECTIVITY STUDIES
• Hyperreflectivity :Appear as White and is reflecting light.
• Hyporeflectivity : Appears as dark and caused due to absorption of light.
• Shadowing: Due to increased light absorption.
• Reverse shadowing: Due to loss of pigmented tisuue causing excessive light to be
transmitted to outer layers.
NORMAL REFLECTIVITY OF STRUCTURES.
HIGH MEDIUM LOW
REFLECTIVITY REFLECTIVITY REFLECTIVITY
• Retinal nerve fiber layer • Outer plexiform layer. • Ganglion cell layer.
• Is/os junction • Inner plexiform layer. • Outer and inner nuclear
layers.
• Inter-digitation zone.
• Choriocapillaries.
• Outer limiting membrane.
• Photoreceptors layer.
• RPE/BM complex.
• Myoid zone.
• Ellipsoid zone .
• Choroid.
• Henle’s nerve fiber
layer.
ABNORMAL PATHOLOGICAL REFLECTIVITY.
1) HIGH REFLECTIVITY
SUPERFICIAL INNER REGION OUTER RETINA RPE-CHOROID
• Pre retinal • Hemorrhages. • Hard exudates. • CNVM.
membranes .
• Intraretinal • Hyperplasia.
• Epi-retinal hemorrhages.
membranes. • RPE atrophy.
• Calcification.
• Cotton wool spots . • Nevus.
• Fibrosis. • Scarring.
• Hemorrhages. • Fibrosis.
ABNORMAL PATHOLOGICAL REFLECTIVITY
CONTD.
2) MEDIUM REFLECTIVITY. 3) LOW REFLECTIVITY
• Lipofuschin • Cavities, Cysts.
• Deposits. • Detachments.
• Fluid(retinal edema , SRF, sub-RPE) • Projected shadows.
ABNORMAL PATHOLOGICAL
REFLECTIVITY CONTD.
3)SHADOWING
SUPERFICIAL INTRARETINAL DEEP
a)Dense : a)Dense : • RPE atrophy.
• Micro and Macroaneurysms • Hemorrhages • Nevus.
• Sub-retinal deposits
b)Imperfect • Neovascularization • Sub- epithelial parasitic cysts.
• Scars
• Hemorrhages
b)Imperfect
• Cotton wool spots.
• Laser spots
• Hemorrhages
TEN STEPS TOWARD INTERPRETATION OF AN OPTICAL COHERENCE
TOMOGRAPHY IMAGE
1)Determine the indication for the oct from the patient’s record, fundus pictures,
angiograms,
Does the OCT image shown the area of interest?
2)Is the scan protocol used appropriate for the information required?
3)Is the scan quality good enough for analysis? Identity artifacts, other findings that
could affect image quality
4)Look at the macular thickness map and ETDRS grid and get an idea as to the
location of the pathology. Ensure that the overlay of the thickness map is centered
on the fovea
TEN STEPS TOWARD INTERPRETATION OF AN OPTICAL COHERENCE
TOMOGRAPHY IMAGE
5)Evaluate each layer from the posterior vitreous to the chorio-scleral junction if visible,
for deviation from the normal.
6)Classically the abnormality into one or more of the following: change in contour,
change in thickness ,change in reflectivity, loss of tissue, look for the location of the
abnormality
TERMINOLOGIES FOR ALTERATION OF STRUCTURES
1)Irregularity
2)Fragmentation
3)Rupture
4)Interruption
5)Depression
6)Elevation
7)Thinning
8)Thickening
3)VITREOUS CELLS
1)VITREOUS HAEMORRHAGE
3)HARD EXUDATES
4)COTTON WOOL SPOTS
5)INTRA-RETINAL HAEMORRHAGES
Vitreomacular Adhesion Macular Hole
Pseudohole
Diabetic macular edema
3)EPI-RETINA
Epiretinal membrane
Age related macular degeneration
Polypoidal Choroidal Vasculopathy
Central Serous Chorioretinopathy
6)RETINAL DETACHMENT
ADVANTAGES OF OCT
• Non-invasive, Non-contact
• Improved lesion detection.delineation,differentiation from normal tissues.
• Improved lesion characterization.
• No ionization radiation: Can be performed in pregnancy(2nd trimester onwards) &
young children.
• More repeatability.
• Tissue sections comparable to histopathology sections.
LIMTATIONS OF OCT
• Media opacities can interfere with optimal imaging.
• Unable to show the details of ciliary body & posterior surface of the Iris.
• Landmarks such as scleral spur and Schwalbe’s line are not as clearly visible as UBM.
• Automatic demarcation of the optic disc borders by the machine may be inaccurate.
• As with most diagnostic tests, patient cooperation is a necessity.
• Artifacts.
• The quality of the image is also dependent on the operator of the machine.
• Always in co-relation.
ARTIFACTS ON OCT
1) MIRROR ARTIFACTS:
• It occurs when the area of interest to be imaged crosses the zero delay line and
results in an inverted image.
2) VIGNETTING :
• This occurs when a part of the OCT beam is blocked by the iris and is
characterized by a loss of signal over one side of the image.
3) MISALIGNMENT:
• This occurs when the fovea is not properly aligned during a volumetric scan.
4)OUT OF RANGE ERROR:
• Outer retina/choroidal image is cut off because of improper positioning of the
machine during image acquisition.
5)BLINK ARTIFACT:
• Blink artifacts result in partial loss of data due to the momentary blockage of OCT
image acquisition. Blink artifacts are easily recognized as black horizontal bars
across the OCT image and macular map.
6)MOTION ARTIFACT:
• This occurs when there is movement of the eye during OCT scanning leading to
distortion or double scanning of the same area.
MULTIPLE OTHER ON OCT-A, TO BE DISCUSSED LATER
