What Is O.C.T. and Why Should I Give A Rip? OCT & Me How Optical Coherence Tomography Changed the Life of a Small Town Optometrist 5/19/2014

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1 OCT & Me How Optical Coherence Tomography Changed the Life of a Small Town Optometrist myoder@wcoil.com Mark A. Yoder, O.D. 107 N. Main Street PO Box 123 Bluffton, OH Histoplasma capsulatum retinitis Malignant neoplasm of choroid Benign neoplasm of choroid Hemangioma of retina Retinal detachment w retinal defect, unspecifie A recent retinal detachment, partial, w single defects Partial, w multiple defects Partial, w giant tear Partial, w retina dialysis Total or subtotal Old retinal detachment, partial Total or subtotal Retinoschisis, unspecified Macular degeneration (senile) of retina, unspecified Nonexudative senile macular degeneration of retina Exudative senile macular degeneration of retina Cystoid macular degeneration of retina Macula cyst, hole or pseudohole of retina Toxic maculopathy of retina Macular puckering of retina Peripheral retinal degeneration, specified Paving stone degeneration of retina Microcystoid degeneration of retina Lattice degeneration of retina Flat retinoschisis Bullous retinoschisis Primary retinal cysts Secondary retinal cysts Other retinoschisis and retinal cysts Serous retinal detachment Traction detachment of retina Background or proliferative diabetic Retinopathy Nonproliferative diabetic retinopathy nos Mild nonproliferative diabetic retinopathy Moderate nonproliferative diabetic retinopathy Severe nonproliferative diabetic retinopathy Diabetic macular edema Background retinopathy, unspecified Hypertensive retinopathy Exudative retinopathy Changes in vascular appearance of retina Senile reticular degeneration of retina Secondary pigmentary degeneration of retina Secondary vitreoretinal degeneration Hereditary retinal dystrophy, unspecified Retinal dystrophy in systemic or cerebr lip In other systemic disorders and syndromes Vitreoretinal dystrophies Pigmentary retinal dystrophy Other dystrophies Dystrophies primarily involving the sensory retina Retinal dystrophies primarily involving bruch smem Retinal hemorrhage Exudates and deposits Edema Retinal nerve fiber bundle defects Focal chorioretinitis, unspecified Focal choroiditisand chorioretinitis, juxtapapillary What Is O.C.T. and Why Should I Give A Rip? Retinal microaneurysms NOS Telangiectasia Neovascularization NOS Other intraretinal microvascular abnormalities Retinal vasculities Central retinal artery or branch occlusion Arterial branch occlusion Vein occlusion Venous tributary (branch) occlusion of retina Venous engorgement of retina Retinal layer separation, unspecified Central serous retinopathy Serous detachment of retinal pigment epitheliu Hemorrhagic detachment of retinal pigment epithelium Of other posterior pole Peripheral; Juxtapapillary Macular or paramacular Of other posterior pole Peripheral Disseminated chorioretinitis, unspecified Disseminated choroiditis & chorioretinitis, post pole Peripheral Generalized Metastatic 1

2 Pigment Chorioretinitis, unspecified Pars planitis Harada s disease Choroidal degeneration, unspecified Senile atrophy of choroid Diffuse secondary atrophy of choroid Angioid streaks of choroid Choroidal rupture Choroidal detachment, unspecified Serous choroidal detachment Hemorrhagic choroidal detachment Glaucomatocyclitic crises Pigmentary iris degeneration Goniosynechiae Visual field defect, unspecified Scotoma involving central area Scotoma of blind spot area Sector or arcuate defects Other localized visual field defect Generalized contraction or constriction Papilledema, unspecified Papilledema associated w/ intracranial pressure Papilledema associated w decreased ocular pressure Papilledema associated w retinal disorder Foster-Kennedy syndrome Unspecified disorder of optic nerve or visual pathways Buphthalmos, unspecified Simple buphthalmos Buphthalmos associated w other ocular anomalies 1850 Hermann Von Helmoltz Pupillary membranes Recession of chamber angle Preglaucoma, unspecified Open angle glaucoma w borderline findings Anatomical narrow angle glaucoma Glaucoma, steroid responders Glaucoma, ocular hypertension Open-angle glaucoma, unspecified Primary open angle glaucoma Low tension glaucoma Pigmentary glaucoma Glaucoma of childhood Residual stage of open angle glaucoma Primary angle-closure glaucoma Intermittent angle-closure glaucoma Glaucomatous stage Chronic angle-closure glaucoma Tools We Use To See The Retina Intermittent angle-closure glaucoma Glaucomatous stage Residual stage Glaucoma associated w anomalies of iris Glaucoma associated w chamber angle anomalies Glaucoma associated w other anterior segment Phacolytic glaucoma Pseudoexfoliation glaucoma Glaucoma associated w tumors or cysts Glaucoma associated w ocular trauma Hypersecretion glaucoma Glaucoma w increased episcleral venous pressure Other specified glaucoma Unspecified glaucoma Ophthalmoscope 2

3 Photography Flourescein Angiography Ultrasound 3

4 CME Vitreous Traction O Optical CME No Vitreous Traction Optical Utilizing light and the principles of optics Disc Edema 4

5 C Coherence Tomography Images by sections or sectioning through the use of a penetrating wave. Coherence The study of how correlated two waves are. How OCT Works T Tomography 5

6 Spectral Domain Vs. Fourier Domain OCT The reference mirror moves back and forth over a distance that corresponds to the axial (depth) range of interest in the sample. The data acquisition is synchronized with the scan cycle of the reference mirror. Each cycle provides one axial scan that contains information on the reflected signal strength versus depth in the sample. A transverse scan mirror steers the probe beam over a transverse dimension. The OCT image is a representation of reflected signal strength over axial and transverse dimensions. 6

7 pie9dvc What Are We Looking At? Micrometer (micrometre) The reference mirror is stationary. The spectral interferogram is the spectrum of the combined reference and sample reflections. Reflections from different depths of the sample produce spectral modulations of different periodicities. The Fourier Transform converts the spectral modulations into depth information (axial scan). What Does An OCT Measure? One Micrometer Equals 1/1000 meter or inches Time Domain OCT Sequential 1 pixel at a time 1024 pixels per A-scan.0025 seconds per A scan 512 A-scans in 1.28 sec Slower than eye movements Fourier Domain OCT Simultaneous Entire A-scan at once 2048 pixels per A scan sec per A scan 1024 A-scans in 0.04 sec Faster than eye movements µ µ 7

8 8 µ Macula 212 µ µ 8

9 RTVue Optivue Problems We Evaluate Heidelberg Spectralis Nidek OCT Topcon Macular Degeneration Optos Zeiss Stratus Zeiss Cirrus 9

10 Macular Edema Macular Holes 10

11 Peripheral Retina Glaucoma Glaucoma is a progressive optic neuropathy characterized by structural changes of the optic nerve and retina that are associated with the development of visual functional defects. Optic Nerve Head 11

12 The CD Ratio gets larger as axons get sicker. Glaucoma is the ONLY disease where the cupping gets worse. Retinal Nerve Fiber Layer The Retinal Ganglion Cell Layer gets thinner as axons get sicker. 12

13 Vitreous 13

14 Other Structures 14

15 15

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