Ophthalmology

Optical coherence tomographic findings of glaucomatous eyes with papillomacular retinoschisis

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Objectives To investigate the topographic relationship between the shape of the optic nerve head (ONH) margin detected by optical coherence tomography (OCT) and the clinical characteristics of papillomacular retinoschisis (PMRS) in glaucomatous eyes. Methods The medical record of patients with a PMRS in a glaucomatous eye were reviewed. The eyes were placed into two groups determined by the shape of the ONH margin in the OCT images; eyes with an externally oblique ONH margin (Group 1) and the eyes with an internally oblique ONH margin (Group 2). We compared the clinical characteristics of the PMRS between these two groups. Results We studied 31 eyes of 29 patients with PMRS and glaucoma with 24 eyes in Group 1 and 7 eyes in Group 2. The optic nerve fiber layer schisis on the lamina cribosa (LC), beta zone, and gamma zone, and the LC defects were detected significantly more frequently in Group 1 than in Group 2 eyes (P < 0.05). A retinal nerve fiber schisis was observed a...

Optical Coherence Tomography Angiography (OCTA) Applications in Early Diagnosis of Cerebral Small Vascular Disease (CSVD)

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Optical coherence tomography angiography (OCTA) is a non-invasive, fast and new fundus examination without contrast agent, which can conduct three-dimensional reconstruction of fundus vascular structure by identifying the blood flow movement of retina and choroid, and present the images of fundus vessels layer by layer in the coronary plane. The central retinal artery is a branch of the internal carotid artery, and the internal carotid artery is the main blood supply artery of the intracranial blood vessels. OCTA examination can observe the retinal artery, and can be early detection method of cerebral small vessel diseases (CSVD) when patients are asymptomatic. At present, the diagnosis of CSVD mainly relies on the imaging results of brain MRI, but at this time there are already pathological changes of blood vessels. Therefore, OCTA can be used for the early diagnosis of CSVD, which is helpful for the early intervention and treatment of CSVD.

Effect of Bergmeister papilla on disc parameters in spectral domain optical coherence tomography

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Background: To demonstrate the morphological characteristics of Bergmeister papilla (BMP), a persistent hyaloid remnant tissue, and its effects on the measurements and repeatability of spectral domain optical coherence tomography (OCT). Methods: A prospective cross-sectional study was used to collect 83 patients with BMP and 76 age-matched unaffected individuals from a tertiary care institution. Imaging including 5-line raster and 3 consecutive optic disc cube scans centered on the optic disc were acquired using the Cirrus HD-OCT. Structural characteristics of BMP were classified according to the images of raster scans, and the repeatability of optic nerve head and retinal nerve fiber layer parameters was analyzed by calculating the test-retest standard deviation, coefficient of variance, and intraclass correlation coefficient. Results: BMP was categorized into lifting edge (LE) type where does not cover the entire optic nerve head, but partially covers the corners, and coveri...

Ultrahigh resolution optical coherence tomography markers of normal aging and early age-related macular degeneration

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Purpose Ultrahigh resolution spectral domain optical coherence tomography (UHR SD-OCT) enables in vivo visualization of micrometric structural markers which differentially associate with normal aging versus age-related macular degeneration (AMD). This study explores the hypothesis that UHR SD-OCT can detect and quantify sub-retinal pigment epithelium (RPE) deposits in early AMD, separating AMD pathology from normal aging. Design Prospective cross-sectional study. Participants 53 non-exudative (dry) AMD eyes from 39 patients, and 63 normal eyes from 39 subjects. Methods Clinical UHR SD-OCT scans were performed using a high-density protocol. Exemplary high-resolution histology and transmission electron microscopy (TEM) images were obtained from archive donor eyes. Three trained readers evaluated and labeled outer retina morphological features, including the appearance of a hypo-reflective split within the RPE – RPE basal lamina (RPE-BL) – Bruch’s membrane (BrM) complex on UHR B...

Ultrahigh-speed multimodal adaptive optics system for microscopic structural and functional imaging of the human retina

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We describe the design and performance of a multimodal and multifunctional adaptive optics (AO) system that combines scanning laser ophthalmoscopy (SLO) and optical coherence tomography (OCT) for simultaneous retinal imaging at 13.4 Hz. The high-speed AO-OCT channel uses a 3.4 MHz Fourier-domain mode-locked (FDML) swept source. The system achieves exquisite resolution and sensitivity for pan-macular and transretinal visualization of retinal cells and structures while providing a functional assessment of the cone photoreceptors. The ultra-high speed also enables wide-field scans for clinical usability and angiography for vascular visualization. The FDA FDML-AO system is a powerful platform for studying various retinal and neurological diseases for vision science research, retina physiology investigation, and biomarker development

Sources of errors in measurement of retinal nerve fiber layer thickness using optical coherence tomography

Background:  Optical coherence tomography (OCT)–obtained retinal nerve fiber layer (RNFL) thickness measurements allow for qualitative and quantitative assessment of RNFL thinning in glaucoma. Errors in data acquisition or in software analysis may result in artifacts and erroneous RNFL thickness measurements that may lead to an inaccurate clinical interpretation. Purpose:  This video describes tips to recognize artifacts in RNFL thickness measurement in various OCT printouts. Synopsis:  The video presents a series of OCT of optic nerve head printouts with artifacts and useful teaching points to identify the same and its source of error. Highlights:  The technician must confirm the quality and accuracy of the acquired data before the patient returns to the physician with the final printout. Recognition of artifacts and identifying its source of error is critical to interpret the data accurately, avoiding erroneous clinical interpretation.

Proliferative diabetic retinopathy and diabetic macular edema are two factors that increase macrophage-like cell density characterized by en face optical coherence tomography

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Background Macrophage-like cells (MLCs) located at the ILM were observed in live human retinas using adaptive optics optical coherence tomography (OCT) as well as clinically-used OCT. The study aimed to quantitatively analyzing MLCs at the vitreoretinal interface (VRI) in diabetic retinopathy (DR) using en face OCT and swept-source optical coherence tomography angiography (SS-OCTA). Methods 190 DR eyes were included in the study, with 70 proliferative diabetic retinopathy (PDR) eyes and 120 non- proliferative diabetic retinopathy (NPDR) eyes. Sixty-three eyes from normal subjects were included as controls. MLCs were visualized in a 5 μm en face OCT slab above the VRI centered on the fovea. Mann-Whitney U test and Kruskal-Wallis H test were used to compare the OCTA parameters and the MLC parameters among groups. We evaluated the MLC density among groups on binarized images after image processing. We also investigated the relationship between MLC density and other OCT parameters ...

Impact of pterygium on central corneal thickness measured by optical coherence tomography in older adults

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Purpose To measure the central corneal thickness (CCT) using anterior segment optical coherence tomography (AS-OCT) in older adults with and without pterygium from the Brazilian Amazon Region Eye Survey (BARES). Methods BARES is a population-based epidemiological cross-sectional study conducted in Parintins city. Participants were residents ≥45 years of age identified through a door-to-door interview. Eligible participants were invited for a comprehensive eye exam. Pterygium occurrence and severity were assessed by ophthalmologists through slit-lamp examination considering its location (nasal or/and temporal) and severity (lesion with extension <3 mm, ≥3 mm not reaching the pupillary margin or ≥3 mm reaching the pupillary margin). CCTs were obtained and measurements from the more severely affected eye were included. Images were analyzed offline by masked observers. Results A total of 671 subjects, 533 (79.4%) with pterygium in at least one eye and 138 (20.6%) without pterygi...

Early Detection of Primary Open-Angle, Angle-closure, and Normal-tension Glaucoma in an Asian Population Using Optical Coherence Tomography

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Précis:  SD-OCT facilitates early glaucoma detection in the Chinese population in Taiwan. The best parameters for POAG, PACG, NTG, and GS detection are temporal inferior BMO-MRW, inner temporal mGCL, temporal superior cpRNFL, and mean global BMO-MRW, respectively. Purpose:  We investigated the diagnostic capability of spectral-domain optical coherence tomography (SD-OCT) for different types of early glaucoma among the Chinese population in Taiwan. Methods:  One eye each was assessed from 113 individuals with healthy eyes, 125 individuals with suspected glaucoma (GS), and 156 patients with early glaucoma (primary open-angle glaucoma [POAG], 87; primary angle-closure glaucoma [PACG], 50; and normal-tension glaucoma [NTG], 19). Circumpapillary (cp) retinal nerve fiber layer (RNFL) thickness (global and sectoral); Bruch’s membrane opening-minimum rim width (BMO-MRW); and macular parameters, including the macular RNFL (mRNFL), macular ganglion cell layer (mGCL), and ma...

Novel Application of Conjunctival Anterior Segment Optical Coherence Tomography Angiography to Assess Ocular Redness

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Purpose:  The aim of this study was to determine anterior segment optical coherence tomography angiography (AS-OCTA) parameters to assess ocular redness severity. Methods:  AS-OCTA analyses of 60 eyes of 40 patients were grouped according to ocular redness stages using the 5-category validated bulbar redness scale in a cross-sectional retrospective study (groups 1–5). A subset of patients with slit-lamp photographs, total 35 eyes of 23 patients, were assessed with 10-category validated bulbar redness scale for comparison. AS-OCTA images of nasal and temporal bulbar conjunctiva were analyzed. Vessel density (VD) represented the blood flow pixels by the total pixels of image (%); vessel diameter index represented the VD by the skeletonized density; fractal dimension, measured with the box-count method, represented the vessel branching complexity. Averaged nasal and temporal parameters for each eye were correlated to validated bulbar redness scales. Results:  There w...

Anterior Segment Swept Source Optical Coherence Tomography and In Vivo Confocal Microscopy Findings in a Case With Bleb-Like Epithelial Basal Membrane Dystrophy

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Purpose:  The aim of this study was to evaluate the anterior segment swept source optical coherence tomography (SS-OCT) and in vivo confocal microscopy (IVCM) features in a patient with bleb-like epithelial basement membrane dystrophy (EBMD). Methods:  A 67-year-old man was referred to the hospital for recurrent attacks of severe ocular pain, tearing, and photophobia, typically upon awakening in the right eye. Biomicroscopic examination revealed pebbled glass-like appearance in the corneal epithelium which was remarkable with retroillumination and the patient was suspected to have bleb-like EBMD. The cornea was further evaluated using SS-OCT DRI Triton (Topcon, Tokyo, Japan) and IVCM (Heidelberg Retina Tomograph 3, Rostock Cornea Module). Results:  Using anterior segment SS-OCT, multiple, hyporeflective, round-oval structures within the size range of 30 to 90 μm were observed at the basal epithelial level. IVCM showed circular or oval hyporeflective areas with a d...

Quantification of Hypotony Maculopathy Using Spectral-domain Optical Coherence Tomography

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Abstract Prcis: We provide a free-to-use, open-source algorithm to quantify macular hypotony based on OCT images. This numerical approach calculates a metric that measures the deviations of the Bruch's membrane from a smooth ideal retinal layer. Purpose: Hypotony maculopathy is a recurrent complication of glaucoma surgical interventions, in which [...]

Sudden monocular vision loss after sneezing as captured on widefield swept source optical coherence tomography-angiography

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Purpose:  We report an unusual case of likely combined retinal artery occlusion and retinal vein occlusion following a sneeze. Widefield swept source optical coherence tomography-angiography (WF-SS-OCTA) was used to analyze retinal changes at one-month follow-up. Methods:  The patient reported visual symptoms in his left eye immediately after sneezing five times in a row. Fundus examination showed an embolus along the superior arcade. Stroke workup revealed moderate carotid artery stenosis and a subtherapeutic INR. At one-month follow-up, fundus photography and SS-OCTA were obtained. Results:  Fundus photography showed superior retinal whitening and arteriole attenuation, an inferior perifoveal cotton wool spot, and inferotemporal intraretinal hemorrhages. SS-OCTA showed loss of the deep capillary plexus superiorly and inferotemporally, most consistent with combined retinal artery and retinal vein occlusion. Conclusion:  We report the first case of sneeze-in...

Associations of Midlife and Late-Life Blood Pressure Status With Late-Life Retinal OCT Measures

Purpose: To explore the relationship of long-term blood pressure (BP) patterns with late-life optical coherence tomography (OCT) structural measures reflecting optic nerve health. Methods: Participants in this community-based cohort study of black and white individuals were part of the Atherosclerosis Risk in Communities study and the nested Eye Determinants of Cognition (EyeDOC) study. Participants had BP measured six times from 1987 to 2017 and were categorized into five BP patterns: sustained normotension; midlife normotension, late-life hypertension (systolic BP [SBP] >140 mmHg or diastolic BP [DBP] >90 mmHg or antihypertensive medication use); sustained hypertension; midlife normotension, late-life hypotension (SBP <90 mmHg or DBP <60 mmHg); and midlife hypertension, late-life hypotension. Multivariable linear regression modeling was used to evaluate associations between BP patterns and late-life OCT ganglion cell complex (GCC) and peripapillary retinal nerve fib...

Evidence-Based Guidelines for the Number of Peripapillary OCT Scans Needed to Detect Glaucoma Worsening

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Purpose To estimate the number of OCT scans necessary to detect moderate and rapid rates of retinal nerve fiber layer (RNFL) thickness worsening at different levels of accuracy using a large sample of glaucoma and glaucoma-suspect eyes. Design Descriptive and simulation study. Participants Twelve thousand one hundred fifty eyes from 7392 adult patients with glaucoma or glaucoma-suspect status followed up at the Wilmer Eye Institute from 2013 through 2021. All eyes had at least 5 measurements of RNFL thickness on the Cirrus OCT (Carl Zeiss Meditec) with signal strength of 6 or more. Methods Rates of RNFL worsening for average RNFL thickness and for the 4 quadrants were measured using linear regression. Simulations were used to estimate the accuracy of detecting worsening—defined as the percentage of patients in whom the true rate of RNFL worsening was at or less than different criterion rates of worsening when the OCT-measured rate was also at or less than these criterion rate...

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