In these cases, the oct rnfl was thinner than normal and, in general 67 eyes, were included in the rnfl thickness by the oct algorithm. Analysis of current literature regarding oct in diagnosis and management of vitreomacular interface disease. Guide to interpreting spectral domain oct by patty seiden. The deviation map, which extends the area of evaluation across the 6mm x 6mm area, indicates variance from normal. Optical coherence tomography oct is a new medical diagnostic imaging technology which can perform micron resolution crosssectional or tomographic imaging in biological tissues. Reproducibility of rnfl and onh measurements in oag with.
Jun 10, 2010 part one introduction optical coherence tomography oct is an essential tool for diagnosing and managing retinal diseases and glaucoma. Oct, multiple scanning laser fundus imaging modalities, widefield and ultrawidefield, scanning laser angiography and oct angiography. The spectralis is an ophthalmic imaging platform with an upgradable, modular design. A normative database provides a benchmark against which a given eye can be compared in. The same system will be used consistently for the duration of the study.
Optic nerve and retinal nerve fiber imaging eyewiki. The rnfl defects are consistent with the larger cup os. Rnfl analysis in the diagnosis of glaucoma glaucoma today. Rnfl is a thickness measurement of the tissue and not an absolute measure of the optic nerve. Ideal at any stage of your career, this easytouse, clinically oriented handbook provides a quick, templated, and portable guide for the interpretation of optical coherence tomography scans. Guide to interpreting oct scans student doctor network. In some patients without glaucoma, rnfl layer can be borderline thin. The purpose of this study is to collect preliminary data on retinal nerve fiber layer and ganglion cell layer damage in multiple sclerosis ms patients, using optical coherence tomography oct. Sdoct imaging confirms corresponding inferior rnfl thinning seen both on. Retinal nerve fiber layer imaging with spectraldomain. Since 1991, 1 oct has undergone rapid evolution for use in detection and monitoring of glaucoma and macular diseases.
However, the recently developed imaging device such as the cirrus hd oct includes only the caucasian data. Optical coherence tomography oct has emerged as a noninvasive and readily available approach to observe changes in retinal structure, providing highresolution crosssectional images of the macula, and retinal nerve fiber layer rnfl cheung et al. New perspectives in neuroophthalmology sciencedirect. The normal range of retinal nerve fiber layer thickness might be different between asians and caucasians. A pdf printer is a virtual printer which you can use like any other printer. Optical coherence tomography oct noncontact, noninvasive imaging device produces highresolution images of the posterior segment optical biopsy quickly emerged as the standard of care for imaging in retina and glaucoma revolutionized ocular disease management in all of eye care the origins of the oct 1995 oct1 debuted at 100 axial scans per. There are normals for ocular structures deviation from the norm abnormality pathology being able to discern differences in reflectivity, morphology and qualitative measures either from normals or from previous scans is the essence of oct interpretation. Optical coherence tomography oct oct uses nearinfrared light to provide direct crosssectional measurement of the rnfl. Finally, the rnfl thickness quadrants should be checked for overall thickness and leftright symmetry. Obtaining good quality oct images is pivotal for interpretation of rnfl. And when it comes to teaching you to read oct images, this course can begin your transformation into an oct expert. Some of the most important advances in our glaucoma workup have occurred in diagnostic imaging. This will certainly help in better interpretation of data.
Before knowing how the diseased retina or macula looks like, its very important to learn the normal macula on an oct at first. Since the mid19th century, it has been recognized that changes in the optic nerve appearance correlate with vision and visual field loss in glaucoma. Although there have been variations in the definition of glaucoma over time, increased attention to the structure and appearance of the optic nerve has been a hallmark in understanding glaucoma. Retinal nerve fiber layer thickness profiles associated with ocular laterality and dominance. An en face oct fundus image shows the boundaries of the cup and disc and the rnfl calculation circle integrated with the rnfl thickness deviation map.
Example of retinal nerve fiber layer rnfl analysis with spectraldomain optical coherence tomography sdoct. However, there are some difficult cases including parapapillary atrophy to perform this measurement. Retinal nerve fiber layer imaging with spectraldomain optical. Glaucoma is obviously an important part of this book, but one part is. Litwak, od, faao va medical center baltimore, maryland glaucoma 101 glaucoma is a disease of the ganglion cell axons damage occurs at the level of the lamina cribrosa selective damage to the superior and inferior poles of the optic nerve. With handbook of retinal oct, you can master the latest imaging methods used to evaluate retinal disease, uveitis, and optic nerve disorders. Interpretation of optical coherence tomography george r, patel ts. Imaging and perimetry society 2014 meeting abstracts. Spectralis oct rnfl measurements demonstrate higher sensitivity than hrt.
Age and retinal nerve fiber layer thickness measured by spectral domain optical coherence tomography jong yeon lee 1, young hoon hwang 2,3, sun min lee 4, yong yeon kim 5. T he advent of optical coherence tomography has revolutionized imaging in ophthalmology since its introduction two decades ago. The interpretation of the rnfl thickness map in myopic eyes requires careful consideration of the distribution. Emphasis is placed on proper selection and correct interpretation of the various scan patterns for glaucoma and retinal disease. Frontiers reduced retinal thickness predicts agerelated. A practical guide to reading oct american academy of. Ophthalmology, volume 112, issue 10, pages 1661 1669. Carl zeiss meditec advanced ocular care arctic dx macula risk genentech lampa advisory oct cross section of retinal. The tajimi study report 2 prevalence of primary angle closure and secondary glaucoma in a japanese population.
This article aims to provide a stepbystep approach for interpretation of stratus oct rnfl analysis printout in the evaluation of glaucoma and its progression. Based on the 6 mm x 6 mm data cube captured by the optic disc cube 200x200 scan, this report shows assessment of rnfl and onh for both eyes. Viewers will be able to interpret oct images for the diagnosis andor management of patients with posterior pole disorders. The retinal nerve fiber layer rnfl or nerve fiber layer, stratum opticum, is formed by the expansion of the fibers of the optic nerve. This represents summary data referring to the measurement of the rnfl from the circular tomogram. Rnfl progression analysis with the rtvue software version 4. Haynie, od, faao financial disclosure i have received honoraria or am on the advisory board for the following companies. Nerve fiber layer rnfl thickness map is a topographical display of rnfl. Interpretation of oct american academy of ophthalmology. To compare and evaluate optic nerve head onh and retinal nerve fiber layer rnfl measurements. In just 10 years, the capabilities of optical coherence tomography oct have expanded from 100 to 27,000 ascans per second, with improved resolution and tremendous enhancements in image quality and contrast. Anomalous posterior vitreous detachment emerges when the vitreous cortex fails to cleanly detach from the macula, optic nerve, or other adherent sites. Yet, technologies such as automated perimetry, tonometry and optical coherence tomography oct come with a few drawbacks, the most important of which is the risk of misinterpreting the data due to false positives and false negatives. However, this writing is primarily focused about the basic interpretation of the oct report aiming to ease the clinician but, at the same time, the instrumentation and operational parts are of equal importance too.
Optical coherence tomography oct is a noncontact optical technique that allows imaging and measurement of the retinal nerve fiber layer rnfl. The light source can be directed into the eye through a conventional slitlamp. This website was created for my students and residents so they have examples of oct scans on different retinal and optic nerve pathologies. Normative reference ranges for the retinal nerve fiber layer. You need to be good at oct interpretation to be good at your job. Oct thickness map most useful in detection of early glaucoma rnfl defects classification based on a normative database comparison leads to false readings because topographic distribution of rnfl. Oct in glaucoma diagnosis, detection and screening intechopen. Optical coherence tomography oct has revolutionized the diagnostic field of retina in many different ways.
This may seem obvious, but just as we learned in medical. Oct, multiple scanning laser fundus imaging modalities, widefield and ultrawidefield, scanning. Next, the rnfl deviation map is examined for signs of thinning emanating from the superior and inferior poles of the optic nerve, which could indicate glaucomatous thinning. For timedomain oct, manual placement of the scan circle is required during imaging. Five common glaucoma tests glaucoma research foundation. However, as with any new technology, analysis of the results of oct requires. Oct floor effect mean rnfl values do not generally decrease 30 mm regardless of the extent of optic nerve njury optical coherence tomography can be used to confirm an optic neuropathy based on the presence of peripapillary rnfl thinning. Optic nerve head onh topographic analysis by stratus oct. The rnfl thickness map is calculated based on all the data of the scanned cube. A practical guide for interpretation of optical coherence tomography retinal nerve fiber layer measurement 11 fig. Normative database of the retinal nerve fiber layer thickness.
Normative databases for sdoct are based on studies. Use of oct imaging readonly nova southeastern university. A complete eye exam includes five common tests to detect glaucoma. The images were obtained from 56 healthy and 179 glaucoma eyes over a period of 2 years. What oct tells us about progression oct has made strides as an objective measure of progression, but it still has limitations. It maps the anatomical relationship between visual. So i will be presenting on the retinal nerve fiber layer thickness and optic nerve head parameters by spectral oct and implications for pediatric ophthalmology.
The operation of oct is analogous to ultrasound bmode imaging or radar except that light is used rather than acoustic or radio waves. What you need to convert a oct file to a pdf file or how you can create a pdf version from your oct file. This example involves the stratus timedomain model by carl zeiss meditec, inc. Download scientific diagram manual segmentation of a compensated oct image.
Glaucoma is generally described as a loss of retinal ganglion cell. Sinai, phd glaucoma is a progressive optic neuropathy characterized by a loss of retinal ganglion cells, thinning of the retinal nerve fiber layer rnfl, thinning of the neuroretinal rim, and enlarged cupping. It not only provides a wealth of information, but it is also non invasive and easy to perform. Oct in glaucoma and pathologies of the optic nerve. The rnfl and the prelaminar tissue are shown in red, the rpe in pink, all other. The study of 150 consecutive patients with known or suspected glaucomatous optic nerve damage who underwent oct imaging for rnfl thickness measurement aimed to identify factors associated with variability in measurements. Avoiding clinical misinterpretation and artifacts of. After showing you how to find pathology in oct images, we challenge you to spot them in hundreds of samples. Guide to interpreting spectral domain oct a stepbystep guide for interpreting images and data using cirrus hdoct. The principles employed are similar to those used in bmode ultrasound except light, not sound, is used to produce the 2dimensional images. The website will be updated as new literature is published and will also have. Optic disc cube and is the glaucoma workhorse of the zeiss cirrus oct. You could say the same thing about brvo or artery occlusion.
Box 208052 new haven, connecticut 065208052 nonprofit org. The complete idiots guide to macular oct interpretation. There are different modalities to image rnfl including oct, hrt and slp. Retinal nerve fiber layer thickness measurement on. To evaluate and compare the ability of two fourierdomain optical coherence tomography oct devices to detect retinal and retinal nerve fibre layer rnfl atrophy in patients with alzheimers disease ad compared with healthy subjects.
Stratus oct provides a higher level of diagnostic insight a significant contribution to therapeutic confidence across a broad spectrum of ophthalmic diseases. You can also find the information in this article in our free booklet understanding and living with glaucoma. Optical coherence tomography oct uses coherent interferometry to construct a crosssectional view of ocular structures that is accurate to less than 10 microns. Spectralis oct the modular imaging platform heidelberg. For now, oct is most useful when a patient is either a glaucoma suspect or has earlytomoderate disease, as a tool for helping to detect damage and progression or conversion from glaucoma suspect or ocular hypertensive to glaucoma. For this study the zeiss cirrus oct imaging system will be used. Optical coherence tomography oct imaging has been widely accepted by ophthalmologists as an attractive imaging modality. Comparison study of oct, hrt and vf findings among normal. Early detection, through regular and complete eye exams, is the key to protecting your vision from damage caused by glaucoma.
Recently, the normal reference values for retinal nerve fiber layer rnfl thickness analysis using the stratus oct analyzer have been established in a cohort of healthy subjects and have been incorporated into the stratus oct rnfl analysis software packet. Comparison study of oct, hrt and vf findings among normal controls and patients with pseudoexfoliation, with or without increased iop fryni riga, ilias georgalas, panagiotis tsikripis, dimitrios papaconstantinou department of ophthalmology, university of athens, athens, greece purpose. Oct interpretation in retinal disease executive clinical director retina and macula specialists jay m. Reliability and validity of cirrus and spectralis optical.
Optical coherence tomography oct for the neurologist. Optical coherence tomography interpretation of optic disc area, rim, and cup. The determination of the disc area by its borders is defined by oct using the termination of bruch membrane and is subject to inaccuracies when the signal strength at this location is reduced. The average of all of the individual points measured is displayed along with a statistical analysis comparing the symmetry of the right and left eye. Pdf a practical guide for interpretation of optical. Rnfl analysis in the diagnosis of glaucoma measuring peripapillary retinal nerve fiber layer thickness with spectraldomain optical coherence tomography provides an objective and reliable estimate of glaucomatous optic nerve damage. Retinal physician appropriate interpretation of oct imaging.
Jeroen klevering university medical centre nijmegenthe netherlands interpretation of the oct image and some new developments. Retinal nerve fiber layer and optic disc measurements by. Rnfl features identified by unsupervised machine learning. Guide to interpreting spectral domain oct by patty seiden issuu. Viewers are given an overview of scanning protocols on various sdoct systems as lecturers present an organized method for analysis of images and identification of pathology. Utilizing oct for glaucoma diagnosis and management. Posterior vitreous detachment is typically a nonpathologic agerelated event.
Because there have been no oct longitudinal studies of rnfl thickness in healthy individuals, we make the assumption that a crosssectional analysis is a good surrogate for change over time in an individual. Rnfl across the entire scan rnfl circular tomogram rnfl data calculated across the entire scan are displayed in the rnfl thickness map and rnfl deviation map. Results are colorcoded to make interpretation visual, simple and fast. This platform allows clinicians to configure each spectralis to the specific diagnostic workflow in the practice or clinic. While not pathognomonic, asymmetry of the rnfl is a. Rnfl analysis with spectraldomain optical coherence tomography.
This is part of the spectral domain oct interpretation for the general ophthalmologist series, which focuses on use of sdoct in patients with glaucoma and retinal disease. Interferometry is the general technique of superimposing, or interfering two or more light waves which creates an output wave that is different from the input waves. Physicians should begin by assessing the retinal nerve fiber layer rnfl thickness map, which should ideally show butterfly wings with red spots to indicate adequate thickness. If the patient has dme or exudative agerelated macular degeneration, you cant look in the macular area with oct, but the rnfl should be ok.
The stratus oct peripapillary retinal nerve fiber layer rnfl printout provides a number of representations of rnfl thickness measurements to apply the principle of rnfl thickness asymmetry as a sign of disease, it is necessary to determine the degree of interocular symmetry that might normally be expected in normal individuals to develop parameters for statistically significant differences between eyes. Files of the type oct or files with the file extension. Structural damage in glaucoma often occurs before detectable loss in visual function. Symmetry between the right and left eyes of the normal. The content of this book presents the viewpoint of the author and do not necessarily. Fundus photography reveals rnfl wedge defects superiortemporally and inferiortemporally of the left eye. In 1996, zeiss introduced the first oct system in eye care and since then oct has become the standard of care in eye clinics. Article in neuroscience letters 558 november 20 with 16 reads how we measure reads. And i will have some poll questions for you, and you can answer them instantly, and i will be very glad to answer any queries and questions at the end of my presentation. Optical coherence tomography this is what we got 5. Topcon 3d oct series summary normative database resnikoff et al, bulletin of the world health organization, november 2004, p. Determinants of normal retinal nerve fiber layer thickness. Difficult rnfl assessment the presence of a myopic tilted disc can make it difficult to determine the optic disc margin, thus hindering rnfl analysis by oct nonspecific tilting of the optic discs is a rather frequent anomaly found in 1.
Every day we are continuously working with clinicians like you to further advance oct technology and provide solutions that are designed for the way your work, for every. Retinal nerve fiber layer thickness profiles associated with. Mar 15, 2017 technological changes are continually improving our diagnostics and clinical care, especially for patients with glaucoma. The rnfl deviation map is overlaid on the oct fundus image to illustrate precisely where rnfl thickness deviates from a normal range glaucoma rnfl thickness analysis a tsnit temporalsuperiornasalinferiortemporal circle, with a radius of 1. The current study demonstrates that oct measures the rnfl as thinner in older persons, with a decline of approximately 2.
Cirrus hdoct for glaucoma assessment bryn mawr communications. For many clinicians, the most valuable function of the cirrus hdoct is the evaluation of the rnfl figure 3. A quantitative analysis of the proposed method is presented. A significant thickening is showing in rnfl analysis by octcirrus. Aug 27, 2008 recently, the retinal nerve fiber layer rnfl thickness measurement using the optical coherence tomography oct becomes very useful to detect such a glaucomatous damage. This study applied computational techniques to images from wideangle sweptsource optical coherence tomography ssoct to evaluate whether glaucoma detection could be improved by identification of novel structural features. In a populationbased setting, 1521 young adults were examined as. The 242 302 and rnfl combined report presents a clinical summary of patient status, as derived from the hfa and the cirrus oct analyses. Oct 19, 2012 to determine normative values and associations of retinal nerve fiber layer rnfl and optic disc parameters in normal eyes measured by spectral domain optical coherence tomography oct. The rtvue oct can be helpful to detect glaucomatous damage by quantifying the rnfl thickness, the layers associated with the ganglion cells i.
Oct images demonstrating retinal nerve fiber layer rnfl segmentation and measurement by the stratus oct in the same eye with signal strength from 5 to 10. Optical coherence tomography measurement of macular and nerve fiber layer thickness in normal and glaucomatous human eyes. Age and retinal nerve fiber layer thickness measured by. Cirrus hd oct rnfl and onh analysis report key parameters, compared to normative data, are displayed in table format. Advanced interpretation of the cirrus oct anthony b. Nov 26, 2011 optical coherence tomography this is what we wanted 4. The purpose of this study is to assess and compare the repeatability of sdoct spectralis oct, version 6. The report is displayed in a simple, easytounderstand format. Oct thickness map most useful in detection of early. The rnfl is formed by retinal ganglion cells axons and.
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