Interpretation of OCT(Glaucoma)
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Strictly restricted to interpretation of OCT print out pertaining to Glucoma
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Interpretation of OCT(Glaucoma)
- 1. Interpretation of OCT Dr Shylesh Dabke Glaucoma Consultant AEH, Tirunelveli 1 Application in Glaucoma
- 2. 3 ONH Cupping VF Abnormalities RNFL Thinning “may or may not be associated with IOP rise”
- 4. Structural damage preceed functional loss About 50% of RNFL has to be lost* Window of about 6years Dr. Harry Quigley. Kerrigan- Baummen, Quigley et al. IOVS 2000
- 6. 7 “Whether it is not Glaucoma?”
- 7. Optical Coherance Tomography 8 Normal scan: Very unlikely there is glaucoma Physiological cupping from early glaucoma Diagnose and follow up pre perimetric glaucoma Monitor progression confirm whether VF defect is real or an artifact
- 8. 9 Various OCT instruments are available Generations - Nadik - Topcon - Zeiss - Optovue - Heidelberg - TD-OCT - SD-OCT
- 10. 11
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- 12. 13 Center
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- 26. 29 Artifacts Involuntary saccade artifact Blink Artifacts Floaters and vitreous opacity Segmentation Error
- 27. 30 Involuntary saccade artifact Blink Artifacts Floaters and vitreous opacity Segmentation Error Artifacts
- 29. 32 Involuntary saccade artifact Blink Artifacts Floaters and vitreous opacity Segmentation Error Artifacts
- 30. 33 Floaters and vitreous opacity
- 31. 34 Involuntary saccade artifact Blink Artifacts Floaters and vitreous opacity Segmentation Error Artifacts
- 33. 36
- 34. 37 Error In reading OCT Scan When we ignore the sensitivity and specificity of OCT Concept of Red DiseaseGreen Disease
- 35. 38 “I bark at everyone.. cant go wrong that way”
- 36. Cirrus OCT 40 284 Volunteers 46.5 years Caucasians 43% Asians 24% A America 18% Hispanic 12% mixed ethnicity 6% Indian 1% Age 18–29 30–39 40–49 50–59 60–69 >70 years Refractive error − 12 to + 8D
- 40. 44 “Thank You”
Editor's Notes
- Chronic progressive optic neuropathy associated with accelerated apoptosis of the RGCs , resultingin………… that may or may not be associated with IOP rise”.
- As we all know structural damage preceeds functional loss and abt 50% of RNFL has to be lost before VF defect becomes apparent and RNFL thinning may precede appearance of VF defect by almost 6years. So there is a large window for pts we can intervene and prevent or delay any visual field loss from occurring in potential glaucoma pts.
- Pertaining to glaucoma OCT very help ful
- Glaucoma as we all know effects three areas in posterior segment of eye
- best quality scans have signal strength greater than 8 (minimum acceptable scan > 6).
- Machine algorithm identifies termination of bruchs membrane as the disc edge
- Retina is mostly NFL. Large enough to avoid the edge of ONH. Large enough to avoid peripapillary atrophy
- Glaucoma as we all know effects three areas in posterior segment of eye
- Segmentation error: Machine cannot differenciate where the different layers of the retina are and it just shows everything as black cos machine is not able to delineate where the nerve fiber layer is. So areas where it cannot delineate it shows RNFL thickness as zero. Which shows as black in thickness map. If these areas happens to involve part of measurement circle we can see graph value goin down to 0 in TSNIT plot
- People are referred to me for glaucoma diagnosis when there is absolutely no glaucoma, simply because an OCT scan was abnormal. And I’m seeing patients who have glaucoma but were told they did not have any disease because their OCT results appeared to be normal. Red disease is when the OCT mistakenly indicates that something is abnormal; green disease is when the OCT data shows no sign of abnormality, but the eye is, in fact, in trouble.
- Normative data has limitations
- The macular and optic disc LSO fundus images are registered and combined. The RNFL and GCA deviation maps are registered and combined.
- Glaucoma diagnosis depends on triad of – raised IOP, ONH changes and VF limitations OCT has added fourth dimension to glaucoma diagnosis
- Kim N.R, H et al, J. Glaucoma 2012; 21: 116. Stein D M et al : Ophthalmology, 2006; 113:985