Transcript OCT – What We Can See

Desinee Drakulich O.D.
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I have no affiliation, nor do I received financial
compensation from any of the companies or
brands used in this presentation.
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Historical Overview
Review of Retinal Anatomy
Review Normal Retinal OCT
Review of Optic Nerve Anatomy
Review of Normal ONH OCT
Review of Corneal Anatomy
Review of Normal Corneal OCT
Review of Angle Anatomy
Review of Normal Angle OCT
Case Studies of Abnormal OCTs
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OCT – Optical Coherence Tomography
In Ophthalmology for the past 15 years
Gives us the ability to image high resolution
ocular structures
Based on the technology of low-coherence
interferometry (used to measure Axial length)
Early models allowed scans with 10 um
resolution
Current models allow scans with 2 um
resolution
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The human retina is 10 layers
Each layer performs a specific function in
the eye
Nine of the ten layers are not visible to the
human eye
The OCT can image all ten layer with
almost histological precision
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44 y.o. white male
Presents with sudden onset reduced vision
OD.
Entering visual acuity 20/40 OD, 20/20 OS.
Patient is concerned cause he is a airline pilot
and has always had perfect vision.
No other significant information revealed in
the history.
External slitlamp exam is normal. IOP 16
mmHg OU.
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Central Serous Retinopathy
Fluid trapped under the retina, that causes an
RPE detachment
Common in males, over 40 y.o. Type A
personality with a stressful job.
Treatment – monitor most likely will resolve
on its own.
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65 y.o. white female
Chief complaint, just time for a yearly exam
Dva 20/20 OU sc
Visual Fields normal OU
Dilated Fundus Exam appears normal OU
IOPs 12 mmHg OU
External slitlamp exam appears normal OU
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Epiretinal membrane secondary to a
tractional PVD causing macular sceissis.
Due to the fact that the RPE is unaffected no
vision disturbance was noticed.
Treatment - monitor
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77 y.o. white male
Presents for annual exam, chief complaint is
reduced vision OD>OS
IOPs 12 mmHg OU
Visual Field show central loss OD>OS
External slit lamp exam shows pseudoaphakic
OU
Dilated fundus exam show retinal exudates
OD>OS
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14 y.o. white female
Presents with chief complaint of blurry vision
and headaches
Saw PCP, no diagnosis except overweight
BMI 32
IOPs were 14 OD and 15 OS
DVa was 20/40 OU cc
External slitlamp exam appears normal
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Pseudotumor cerbrei
Swollen ONH secondary to increased
intraocular pressure
Common in young overweight females
Treatment - Diamox
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13 y.o. white male
Presents for contact lens exam
No visual or systemic complaints
Highly myopic OU
Entering DVa cc 20/20 OU
IOPs 16 mmHg OD and 19 mmHg OS
External Slitlamp exam was normal
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Crowded Optic Nerves
Can easily be mistaken for Pseudotumor
History and images reveal this benign
diagnosis
Treatment - none
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20 y.o white female
Presents for annual eye exam
No visual complaints
Entering DVa 20/20 OU sc
IOPs 14 mmHg OD and 15 mmHg OS
Visual Field showed scattered defects OU
External slitlamp exam was normal
Benign Astrocytoma OS
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Optic Nerve Head Drusen
Calcium deposits that are embedded in the
optic nerve
Can cause decrease in nerve sensitivity;
including reduced color vision and contrast
sensitivity
Can also affect visual field
Treatment – monitor, possible nerve
protecting agents like Alphagan P
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32 y.o. white male
Presents as new patient, told at his last eye
exam that he had a “lazy eye”
Visual Acuity cCL 20/20 OD and 20/200 OS
IOP 16 mmHg OD and 12 mmHg OS
Initial slitlamp exam appear normal,
questionable thinning OS?
Dilated Fundus Exam normal OU
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Keratoconus OS >OD
Keratoconus is the thinning of the cornea
secondary to loss of stability of corneal
collagen fibers
NOT a “lazy eye”
Treatment – Rigid Gas Perm CL, UV corneal
crosslinking, Intacs and PKP
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44 y.o. white male
Presents for CL exam
Chief complaint is decreasing near vision
History high hyperopia OU
DVa cc 20/20 OU
Slitlamp exam reveal narrow angles OU
No DFE today
Gross retinal structures appear normal
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Anatomically narrow angles
Patient at risk for angle closure glaucoma
More prevalent in high hyperopes
Treatment – peripheral irodotomy