OCT: Optical

Coherence Tomography
Stephanie R.
Internship
August 19, 2010
 How It Works
 Optical biopsy, using light
 How It Works
 Interferometer measures time it takes for
light to be reflected back from retina.

 Compare that time to time it takes for

light to reflect back from reference mirror.
 Which Scan?
 Line

 Macular Cross

 Fast Macular Thickness

 Fast RNFL Thickness

Comparing Cross & FMT Scans
 Fast Macular Thickness Scan
will scan the thickness and
volume over a greater area,
but has lower resolution.

 Macular Cross Scan will scan

with higher resolution, but
may miss areas that a Fast
Macular Thickness Scan
covers.
 FAs and OCTs
 FAs show retinal blood flow in X and Y
directions (north-south and east-west).

 OCTs show depth (Z direction) of retina and

which layers are affected.

 The information from each will usually

overlap.
 Scanning
 Check doctor’s drawing of retina and the
patient’s FA, if there is one.
 Determine where to scan from these; it may
need to be somewhere other than the center.
 Refer to past OCT scans and repeat
whichever one was used (vertical/horizontal).
 Adjust scan or use a different type of scan to
find problem area, even if not detected
initially.
 Scanning
 Minimize fatigue in patient by keeping scan
time as short as possible.
 Never scan an eye for longer than ten
minutes (regulation).
 If patient’s eye is dry, it will be hard to see
into it.
 Have patient blink or use artificial tears.
 Use joystick to get around any opacities.
 Scanning
 A clear tear layer will allow the best image to
be acquired.
 Artificial tears can be more efficient in
keeping the eyes wet than blinking repeatedly
because he/she should not blink during the
session itself.
 Do not base scan quality on video window.
 Sometimes the best images are
accompanied by a poor video image.
Layers of the Retina
 Normal pre-retina should be black because it
shows the vitreous, which is translucent.
 Other layers are reflective to some degree
and show up as different colors.
Retinal Thickness Analysis
 The software will identify and trace the NFL
and the RPE layer, the two key layers of the
retina.
 The better the scan is, the easier it is to
differentiate the NFL and the RPE layer.
 It is possible to differentiate these layers
because they are highly reflective.
Retinal Thickness Analysis
 Distance between NFL and RPE layer is
retinal thickness.
 When reviewing each scan, it is important to
note the position of the trace lines.
 With a weak signal and poor scan, the
software may have made a mistake in tracing
the layers.
Error in RNFL Thickness Scans
 Circle must be centered on optic nerve, which
can be challenging with patient movement.

 These scans are of the same eye, which is

normal. The first was centered on the optic
nerve, the second wasn’t.
Find the Fovea
 When scanning the macula, it is always
important to start with locating the foveal
depression.
 Many deformations are observed here.
Edema and Shadows
 Low reflective (black) areas can be either
fluid or shadows.
 Edema (fluid) may be intraretinal cavities,
cysts, diffuse intraretinal edema, or exudative
detachments.
 Shadows are caused by blood vessels, a
hemorrhage, etc. in front of the retina.
Edema and Shadows
exudative detachment
 Overlooked Problem
 Sometimes a macular cyst or hole, for
example, cannot be automatically confirmed
with an OCT.
 This patient was suspected of having a cyst.
 Outside the Fovea
 Clearly, it was not in view in previous scan.
 The cyst was found by readjusting the scan
and searching outside the fovea.
 A Good Scan
 Should be in focus and have good reflectivity.
 Should be horizontally level.
 The retina should be a little lower than the
center of the screen, so vitreous can be seen
as well.
 Align with pupil, so there is no shadow from
iris.
 Scans
Layers are reflected
well and placement of
scan is good.

Lack of reflectivity on right

side because the edge of
the scan is catching the iris.
 Alignment
 Z-offset Optimize button is used when an
image seems to be aligned, but is not visible
in the scan window.
 Use this when you can’t focus on the image
manually.
 Even though the scan may not be good yet,
optimizing it will probably help…
 Optimization
 Clicking the Optimize Polarize button should
automatically refine the focus on the retina
and improve the colors of the scan.

Before Optimizing After Optimizing

 Optimization
 Adjusting the focus knob on the side of the
OCT unit may also enhance the image’s
reflectivity.
 This is especially helpful if the patient is
significantly farsighted or nearsighted.
 After changing this knob, the polarization
must be optimized again.
Serial FMT Scans
 It is important to scan the same area on repeat
scans over time.
 If patient has good fixation, he/she needs to look
at the central fixation target during each scan.
(Target can be moved by dragging image in
video window.)
 There is also a “repeat” option for scans outside
the fovea, which will place the target and scan in
the same location as the patient’s last scan.
Retinal Volume Analysis
 Retinal volume data is interpolated.

 The closer together the lines

are in this chart (shown by
the green circle), the more
accurate the interpolation of
the data will be.
Retinal Volume Analysis
 Error in data interpolation can be seen by
dark wedge area in diagram.
 New Technology
 Topcon 3D OCT-2000 System is the latest
imaging system.
 Allows scans to be viewed in 3D, 2D, and
fundus images simultaneously.

Macular Hole Epiretinal Membrane