INSTRUMENTS

Posterior Segment

OPTOM. KOUSHIK KR.

SINGH
OCT
 Optical Coherence Tomography (OCT) is a non-
invasive diagnostic technique that renders an in vivo
cross sectional view of the retina. OCT utilizes a
concept known as inferometry to create a cross-sectional
map of the retina that is accurate to within at least 10-15
microns.
 Optical coherence tomography uses a low-powered laser
to create pictures of the layers of your retina and optic
nerve. The cross-sectional images are three-dimensional
and color-coded.
OCT IS USEFUL IN DIAGNOSING MANY EYE CONDITIONS

 macular hole.
 macular pucker.
 macular edema.
 age-related macular degeneration.
 glaucoma.
 central serous retinopathy.
 diabetic retinopathy.
 vitreous traction.
OCT
HRT ( HEIDELBERG RETINAL TOMOGRAPHY)

 Heidelberg Retinal Tomography is a diagnostic procedure

used for precise observation and documentation of the
optic nerve head, essential for the diagnosis and management
of glaucoma. The HRT uses a special laser to take 3-
dimensional photographs of the optic nerve and surrounding
retina.
 Heidelberg Retina Tomograph (HRT) is a non-invasive
confocal scanning laser microscope that is used to obtain a
three-dimensional, computerized scan (like a CAT scan) of
optic nerve head and retina in the posterior segment. This
sophisticated technology is applied effectively to diagnosing
early glaucoma and monitoring the progression of glaucoma,
as well as, evaluating macular holes or edema.
USES OF HRT
 The HRT image can be used to compute things
such as the area of the optic disc, the volume of
the cup, and the area of the rim around the cup.
Over several visits, scans are layered and changes
are measured.
GDX
 The GDx (short for Glaucoma Diagnosis) is a
type of scanning laser polarimeter. The GDx
uses a diode laser in the near infrared region to
measure nerve fiber layer thickness and 65,536
retinal points. The polarized light passes through
the retinal nerve fiber layer.
HOW GDX WORKS
 The GDx uses a type of scanning laser polarimeter
to measure the thickness of the nerve fiber layer.
The procedure is painless and is usually
performed on an undilated pupil. The thickness of
the nerve fiber layer is then compared with the
nerve fiber layer of normal eyes. The GDx maps
the nerve fibers and compares them to a database
of healthy, glaucoma-free patients. A thinning of
the fibers indicates glaucoma..
ONH EVALUATION
 The detection of structural damage to the optic
nerve head (ONH) is central to the diagnosis of
glaucoma and is extremely important for
monitoring patients at risk of glaucoma or with
established disease. Glaucoma, by definition, is
an optic neuropathy and therefore specific
attention must be directed to the examination of
the optic nerve. 
There are several techniques to examine the ONH
clinically, including direct ophthalmoscopy, indirect
ophthalmoscopy and slit-lamp biomicroscopy with a
contact lens (such as a Goldman lens), handheld lens or
aspheric lenses. The use of a slit lamp with a handheld
lens provides a good balance between the quality of
stereopsis and magnification, besides being
comfortable to patients and easy to incorporate in the
routine slit-lamp examination. Slit-lamp biomicroscopy
with a contact lens provides a better view and has the
advantage of providing a non-inverted image. 
FUNDUS PHOTOGRAPHY
 Fundus photography eye test involves capturing
a photograph of the back of the eye, i.e. fundus
or the retina, all the retina blood vessels, and
the optic nerve.
WORKING PRINCIPLE
 Color Fundus Retinal Photography uses a fundus
camera to record color images of the condition of the
interior surface of the eye, in order to document the
presence of disorders and monitor their change over
time.
 A fundus camera or retinal camera is a specialized low
power microscope with an attached camera designed to
photograph the interior surface of the eye, including the
retina, retinal vasculature, optic disc, macula, and
posterior pole (i.e. the fundus).
USES
 The retina is imaged to document conditions
such as diabetic retinopathy, age related
macular degeneration, macular edema and
retinal detachment.
 Fundus photography is also used to help
interpret fluorescein angiography as certain
retinal landmarks visible in fundus
photography are not visible on a fluorescein
angiogram.
FFA (FUNDUS FLUORESCEIN ANGIOGRAPHY)

 A fundus fluorescein angiography is a procedure

for examining the circulation of blood in the back
surface of your eye, known as the retina. The test
is a diagnostic test that allows us to see if there
are problems with the circulation in your
retina.
 Fluorescein Angiography (FA) is a diagnostic
procedure that uses a special camera to record the
blood flow in the RETINA – the light sensitive tissue
at the back of the eye.
 The test does not involve any direct contact with the
eyes. The eyes will be dilated before the procedure.
 Fluorescein dye is injected into a vein in the
arm/hand. As dye passes through the blood vessels of
your eye, photographs are taken to record the blood
flow in your retina. The photographs can reveal
abnormal blood vessels or damage to the lining
underneath the retina.
 The images will be captured in black and white. The dye
will fluoresce in the blood vessels and be recorded as
light grey or white in the image. Interpretation of the
abnormal angiogram relies on the identification of areas
that exhibit hypofluorescence (darkness) or
hyperfluorescence (brightness).
 Fluorescein angiograms are often recommended to
follow the course of a disease and to monitor treatment
results. It is particularly useful in the management of
diabetic retinopathy and macular degeneration.
PHASES OF FFA

 Normal FFA Phases

 Choroidal phase: The dye takes 10 to 15 seconds to
reach the retina after being injected into the arm.
 Arterial phase: The dye enters the arteries usually 1
to 2 seconds after the choroidal phase.
 Arteriovenous: This is seen 1 to 2 seconds after the
arterial phase.