Imaging Artifacts Sarah Moyer, CRA, OCT-C Director, Ophthalmic Imaging Kittner Eye Center University of North Carolina Chapel Hill, NC Disclose financial interest now Overview Sarah s Thoughts on Artifacts OCT Slit Lamp AF FA ICG Fundus Quiz Sarah s Thoughts on Artifacts 1. Be able to identify artifacts. -This talk will not cover all artifacts. 2. Understand / Learn how they got there 3. Prevent them from occurring -Know your equipment!! 4. Inform your doctors -Especially if clinically significant!! Macular OCT Artifacts Check Scan Quality! signal strength scan placement movement / fixation scan saturation segmentation lines standard deviation Macular OCT Artifact Study ~100 eyes from Cirrus ~85% had at least 1 artifact ~33% had 1 artifact in the center 1mm area ~5% were clinically significant More than 50um ~90 eyes from Spectralis ~91% had at least 1 artifacts ~38% had 1 artifact in the center 1mm area ~8% were clinically significant Macular OCT Artifacts Misidentification of the Inner Retina Misidentification of the Outer Retina Fixation Off-center (not on foveal depression) Fixation Movement Out of register, Inverted, Ghost image Cut Edge Motion Waves (Cirrus only) Ian Han, Glen Jaffe. Evaluation of Artifacts Associated with Macular SD OCT Assessment of Artifacts and Reproducibility Ian Han, Glen Jaffe. Evaluation of Artifacts Associated with Macular SD OCT Assessment of Artifacts and Reproducibility Misidentification of the Inner Retina Misidentification of the Inner Retina Misidentification of the Inner Retina Scan Quality signal strength signal to noise ratio scan saturation standard deviation Segmentation lines Artifact affected central thickness Ian Han, Glen Jaffe. Evaluation of Artifacts Associated with Macular SD OCT Assessment of Artifacts and Reproducibility 1
Misidentification of the Outer Retina Misidentification of the Outer Retina Misidentification of the Outer Retina Joseph Ho, Alan Sull, Laurel Vuong, Yueli Chen, Jonathan Liu, James Fujimoto, Joel Schuman, Jay Duker. Assessment of Artifacts and Reproducibility across Spectral and Time-Domain OCT Ophthalmology. October 2009: Vol 116: 1960-1970. Myopic Degeneration Neovascular AMD with drusen. Spectralis included drusen in measurement. Manual redraw followed RPE to show actual thickness of retina. Ian Han, Glen Jaffe. Evaluation of Artifacts Associated with Macular SD OCT Assessment of Artifacts and Reproducibility Fixation off-center Fixation Movement Fixation Movement: Double Fovea Ian Han, Glen Jaffe. Evaluation of Artifacts Associated with Macular SD OCT Assessment of Artifacts and Reproducibility Joseph Ho, Alan Sull, Laurel Vuong, Yueli Chen, Jonathan Liu, James Fujimoto, Joel Schuman, Jay Duker. Assessment of Artifacts and Reproducibility across Spectral and Time-Domain OCT Ophthalmology. October 2009: Vol 116: 1960-1970. Out of register, Inverted, Ghost image Out of register, Inverted, Ghost Image Cut Edge and Segmentation Ghost image is from inverted retina Ian Han, Glen Jaffe. Evaluation of Artifacts Associated with Macular SD OCT Assessment of Artifacts and Reproducibility Ian Han, Glen Jaffe. Evaluation of Artifacts Associated with Macular SD OCT Assessment of Artifacts and Reproducibility 2
Motion Waves What s this artifact? Asteroid Hyalosis Ian Han, Glen Jaffe. Evaluation of Artifacts Associated with Macular SD OCT Assessment of Artifacts and Reproducibility Macular OCT Artifacts Image taken before scanner engaged Shadowing from Vitreous Hemorrhage Gas Bubble Iris Clipping Image taken before scanner engaged Shadowing from Vitreous Hemorrhage Images provided by Dennis Orlock Images provided by Dennis Orlock Gas Bubble Iris Clipping RNFL OCT Artifacts Check Scan Quality! signal strength scan placement movement / fixation scan saturation segmentation lines standard deviation Images provided by Dennis Orlock Images provided by Dennis Orlock 3
Optic Nerve Optic Nerve Optic Nerve Scan Quality signal strength circle placement movement / fixation scan saturation segmentation lines Scan Quality signal strength circle placement movement / fixation scan saturation segmentation lines Optic Nerve OCT when the patient isn t dilated? Scan Quality signal strength circle placement movement / fixation scan saturation segmentation lines RNFL Artifact: Pathology RNFL Artifact: Pathology Pupil Dilation for RNFL Are you requiring patients be dilated before doing RNFL OCTs? Slit Lamp Lids, Lashes and Tears Corneal defect patient Lids, Lashes, Tears Pseudoexfoliation Light Reflexes Oooops! Thin Slit 4
Light Reflexes Light Reflexes Tyler, ME. Creating an Artifact-Free Retroillumination Photo-Illustration of the Crystalline Lens. Fall/2005 Vol 27:2 p.82 Tyler, ME. Creating an Artifact-Free Retroillumination Photo-Illustration of the Crystalline Lens. Fall/2005 Vol 27:2 p.82 Ooops! Thin Slit AF I love auto fluoresence! Averaging/Patient Motion Artifact Composite Feature Cunningham Sign IR Bleaching? Plaquenil AMD Averaging/Patient Motion Artifact 5
AMD Composite Feature: CSR Composite Feature: CSR Cunningham Sign Cunningham Sign Cunningham Sign Retinal Bleaching Cunningham D. Retinal Bleaching During Fundus Autofluorescence Using a Confocal Scanning Laser Ophthalmoscope. JOP. Summer/2007 Vol 29:Supplement p.93 Cunningham D. Retinal Bleaching During Fundus Autofluorescence Using a Confocal Scanning Laser Ophthalmoscope. JOP. Summer/2007 Vol 29:Supplement p.93 Cunningham D. Retinal Bleaching During Fundus Autofluorescence Using a Confocal Scanning Laser Ophthalmoscope. JOP. Summer/2007 Vol 29:Supplement p.93 IR Bleaching? FA Floaters? What s this? Barrier Filter Smudge Barrier Filter- UNC problem Tears Newborn Vessels Myopic Degeneration Floaters?? 6
Blood in the Vitreous What s this? Shooting around the IOL Dislocated Misplaced Large dilation Barrier Filter Smudge Barrier Filter Barrier Filter Kelly M, Kline K. Letter to the Journal: An Unfamiliar Photographic Artifact,. 12/1992 Vol 14:2 p.48 I hope those tears aren t on my lens now. Newborn Vessels Newborn Vessels OD 2:52 3:00 3:05 OD OS 7
Newborn Vessels OS Retcam Artifact FA of Myopic Degneration -19.75 Myopic Degeneration ICG ICG of Myopic Degneration -19.75 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Fundus Artifact Quiz Artifact 1 Artifact 2 Artifact 3 8
Artifact 4 Artifact 5 Artifact 6 Artifact 7 Artifact 8 Artifact 9 Artifact 10 Thank you! Resources Debra Cantrell, COA Rona Lyn Esquejo-Leon, CRA Cunningham D. Retinal Bleaching During Fundus Autofluorescence Using a Confocal Scanning Laser Ophthalmoscope. JOP. Summer/2007 Vol 29:Supplement p.93 Ian Han, Glen Jaffe. Evaluation of Artifacts Associated with Macular SD OCTssessment of Artifacts and Reproducibility Joseph Ho, Alan Sull, Laurel Vuong, Yueli Chen, Jonathan Liu, James Fujimoto, Joel Schuman, Jay Duker. Assessment of Artifacts and Reproducibility across Spectral and Time-Domain OCT Ophthalmology. October 2009: Vol 116: 1960-1970. Kelly M, Kline K. Letter to the Journal: An Unfamiliar Photographic Artifact. JOP 12/1992 Vol 14:2 p.48 Marcel Menke, Gilbert Feke, and Clement Trempe. OCT Measurements in Patients with Optic Disc Edema. IOVS. 2005; 46 (10):3807-3811. Tyler, ME. Creating an Artifact-Free Retroillumination Photo-Illustration of the Crystalline Lens. JOP Fall/2005 Vol 27:2 p.82 9
Imaging the Pupil Sarah Moyer, CRA, OCT-C University of North Carolina Chapel Hill smoyer@unch.unc.edu 10