Download HD OCT Cornea and Anterior Segment

10/14/2013
HD OCT
Cornea and Anterior Segment
Please complete your session evaluation
using EyeMAP online at
http://eyemap.cistems.net
Michael Cymbor, OD, FAAO
•Disclosure Statement:
•Member of the Speakers Bureau for Alcon, Optovue,
and Bausch and Lomb
•Principal site investigator for Ciba, Vistakon, and
Bausch & Lomb
•Received educational grants from Heidelberg
Engineering, Zeiss and EyeIC.
•Eye IC Professional Advisory Committee
Tweet about this session using the official
meeting hashtag #aaoptom13
Please silence all mobile devices.
Unauthorized recording of this
session is prohibited.



O = Optical
C = Coherence


Coherence comes from a Latin word meaning “to
stick together
T = Tomography



What instrument has changed eye care the
most???????
OCT - Optical Coherence Tomography
OCT utilizes near-infrared light waves to
measure distances of anatomical structures. A
beam of light is directed onto the structure and
the echo time delay of light is then recorded.
a technique used to obtain an image of a selected
plane section of the human body or some other solid
object
1
10/14/2013
Single line scan






Resolution down to 1 micron!!!!

Scans/
second
Resolution
(microns)
OCT
1995
100 A-scans x
500 points
100
20
OCT2
2000
100 A-scans x
500 points
100
20
OCT3
Stratus OCT 512 A-scans
2002
x1024 points
500
10
Optovue
HD-OCT
2007
26,000
5
4096 A-scans x
1024 points
Higher resolution
Fewer moving parts – faster scan acquisition
Acquisition of a cube of data
Better visualization of tissue/pathology
Slightly better penetration of light
Better registration
3D analysis
In vivo sub-cellular resolution
OCT (A) in a developmental
biology animal model (African
tadpole).
Retina
Glaucoma/Optic Nerve
Cornea/Anterior
Segment
2
10/14/2013
1)
2)
3)
4)





Simple to use
High resolution (higher than UBM)
Expands usefulness of OCT technology
Patient education
45 Y/O White Female
OcHx: Repeated HSK OD with stromal
involvement
SHx: Stage 4 GI cancer with liver involvement
2000, 6 months of chemo, clear until 2005 with
lymph node involvement, 6 months chemo,
clear since.
On acyclovir 400mg bid upon flare –ups
BCVA OD 20/70 OS 20/25
3
10/14/2013





45 Y/O WM
Hx of worsening keratoconus OU with
occasional hydrops OD
Attempted to send for corneal crosslinking, pt
declines
OD contact lens uncomfortable with
inconsistent vision
19 y/o white male
 Entered
 Pt
office as a problem visit
was at work using a nail gun without safety glasses
 Reports
that he got too close to gun, shot himself in the
eye
 Trouble
 Upon
opening OS due to pain
instillation of Proparacaine…
4
10/14/2013






Dx: open globe injury due to penetrating
intraocular foreign body
A driver was found and the patient was sent to
tertiary care for immediate surgical repair
Pieramici DJ. Open-Globe Injuries Are Rarely
Hopeless. Review of Ophthalmology, 15 June 2005.
Rahman I, Maino A, Devadason D, Leatherbarrow B.
Open Globe Injuries: factors predictive of poor
outcome. Eye (2006) 20, 1336-1341.
Havens S, Millicent P, Omofolasade K. Penetrating
Eye Injury: A Case Study. American Journal of Clin
Med, Winter 2009; Volume 6, Number 1.
Friedman, N., Kaiser, P. Massachusetts Eye and Ear
Infirmary. 3rd edition, 2009.
5
10/14/2013





60 Y/O WM
Bilateral Keratoconus
Cc: Sudden vision loss OD
BCVA 20/80 OD, 20/40 OS
Wearing large diameter SoClear Scleral lens
6
10/14/2013

Corneal Power





78 Y/O WF
Ocular History: Bilateral Phaco’s with IOL several
years ago
Initial post-op BCVA 20/25 OD and OS
Cc: decreased VA
Current BCVA 20/40 OD and OS
7
10/14/2013
8
10/14/2013
Central Vault in Dry Eye Patients
Successfully Wearing Scleral Lens
Sonsino, Jeffrey; Mathe, Dora
Sztipanovits
Optometry & Vision Science.
90(9):e248-e251, September 2013.
doi: 10.1097/OPX.0000000000000013
FIGURE 1 This is a cross-sectional OCT
image of a scleral lens. Notice that the
vault can be directly measured using a
caliper tool, in this case, 0.37 mm (or
370 μm).
Copyright © 2013 Optometry & Vision Science. Published by Lippincott Williams & Wilkins.
Descemet Membrane Endothelial Keratoplasty in Eyes with Glaucoma Implants
Heindl, Ludwig M.; Koch, Konrad R.; Bucher, Franziska; Hos, Deniz; Steven,
Philipp; Koch, Hans-Reinhard; Cursiefen, Claus
Descemet Membrane Endothelial Keratoplasty in Eyes with Glaucoma Implants
Heindl, Ludwig M.; Koch, Konrad R.; Bucher, Franziska; Hos, Deniz; Steven, Philipp;
Koch, Hans-Reinhard; Cursiefen, Claus
Optometry & Vision Science. 90(9):e241-e244, September 2013.
doi: 10.1097/OPX.0b013e31829d8e64
Optometry & Vision Science. 90(9):e241-e244, September 2013.
doi: 10.1097/OPX.0b013e31829d8e64
Copyright © 2013 Optometry & Vision Science. Published by Lippincott Williams & Wilkins.
50
51
Copyright © 2013 Optometry & Vision Science. Published by Lippincott Williams & Wilkins.
52
Ocular Surgery News U.S. Edition, July 10, 2013
9
10/14/2013
August 15th, 2013 Issue of Review of Optometry
Aaron Bronner, OD






Anterior Chamber Cell Grading by Optical Coherence
Tomography
Yan Li1,
Careen Lowder2,
Xinbo Zhang1 and
David Huang1
Invest. Ophthalmol. Vis. Sci.January 9, 2013 vol. 54no.
1 258-265

Role of anterior segment optical coherence tomogram in Descemet's membrane detachment
Sonia Kothari, Kulin Kothari, Rajul S Parikh
Bombay City Eye Institute and Research Centre, Mumbai, India
10
10/14/2013
Anterior Segment

Calculates degree of angle
Taken from 2007 Review of Ophthalmology







61 year old white female
CC: Decreased vision and red eyes
BCVA: 20/40 OD and 20/20 OS at distance
IOP’s: 14 OU
Refractive Status:+1.00-0.50x27
-0.50-1.00x140
Anterior Segment:
-Cataracts OD>OS
-Blepharitis OU
-Narrow Angles OU (Grade 2 VH, ATM 360 deg. OU
by gonio)
Posterior Segment: Mild RPE mottling OD
11
10/14/2013



Narrow anatomical angles OU
Cataracts OD>OS
Blepharitis OU
2009
2010

3:45 PM 55 y/o white female presents with
intense pain in the left eye (“This is the worst
pain I've ever felt 11+ out of 10”)
Began with minor discomfort last night that has
continually gotten worse.
Left eye has a history of coloboma of the optic
nerve. VA has always been LP
Patient is on 20+ meds with multiple allergies

Goldmann Tonometry

Slit lamp findings


2009

2010

VA with correction



BP



132/79 p85

NCT



20/30 OD
LP OS

21 OD
ERROR OS


Pupil testing

OS poorly reactive patient not cooperative for swing
test

OS 56 mmhg @4:00PM
Corneal edema
Cells in A/C
0 Vanherrick
Large dense cataract
Ran OCT of angle to confirm diagnosis of acute
angle closure
12
10/14/2013


OCT along with SLE findings provided
confirmation of acute angle closure secondary to
lens growth (phacomorphic)
Pt given one drop Iopidine @4:18







TA @ 5:19 by GAT: 50mmHG



TA @ 5:40pm 50mmhg
TA @ 5:55pm 49mmhg
TA @ 6:05pm 50mmhg
TA @ 6:20pm 47mmhg
At this point a lengthy discussion about
depression gonioscopy was held. The decision
was difficult for the patient due to the amount
of distress she was in.
Depression gonioscopy performed at 7:11 PM


BP 118/80 p80
Pt given 2, 250mg Diamox tabs at 5:08PM
Patient pressure was monitered for 2 hours after
Diamox was given

TA @ 4:38 by GAT: 52mmHG
One drop Cosopt @ 4:55PM with punctal
occlusion



We saw movement in the apposition on the iris and
proceeded to indent for roughly 1 ½ minutes.
TA immediately after depression 34mmHG
At this point the pressure was low enough to
instill pilocarpine 2% @ 7:14pm????????
Pt was taken to OCT shortly after instillation.
13
10/14/2013

Pt was given second dose of 2- 250mg Diamox
tabs at 7:30pm.








TA @ 7:52pm 21mmHg
Pt prescribed Pilocarpine 2% QID until morning
and Diamox 500mg Q4H
Pt was scheduled with Oph first thing in the
morning for LPI which was performed without
complication
She is now scheduled for cataract extraction of
the left eye.
Clinical Ophthalmology: A systematic
approach, by Jack Kanski
The Wills Eye Manual: 5th edition
The Massachusetts Eye and Ear Infirmary:
Illustrated manual of ophthalmology, 2nd
edition
RTVue Fourier-Domain Optical Coherence
Tomography Primer Series: Vol. 111 Glaucoma,
by Robert Weinreb and Rohit Varma
14
10/14/2013





77 YO/WF
Advanced glaucoma
Bilateral Trabeculectomies 2005, IOP 8-11 range
Cataract Surgery OS 2 yrs ago, IOP 10-11 range
Cataract Surgery OD 6 months ago, IOP 16-19 range
15
10/14/2013
16
10/14/2013



The annual incidence is approximately 1/million.
The great majority of iris melanomas occur on the
inferior half of the iris. Sun exposure?
The overall rate of spread at 10 years is 3-5%.*





Treatment options for iris melanomas
include:
Observation
Excision
Enucleation
Plaque radiotherapy

17
10/14/2013
Anterior Segment Optical CoherenceTomography of Conjunctival Nevus
Carol L. Shields, MD, Irina Belinsky, MD, Massi Romanelli-Gobbi, BM, Juan Mica
Guzman, MS,Douglas Mazzuca, Jr., BS, W. Ross Green, BS, Carlos Bianciotto, MD,
Jerry A. Shields, MD Ophthalmology 2011;118:915–919

This preliminary report shows evidence that AS-OCT may
provide important data regarding the configuration
of conjunctival lesions, tumor boundaries, and internalstructures.
This information may contribute to establishing the clinical
diagnosis of a benign conjunctival nevus and assist in defining the
extent of the tumor. Further research
into imaging of conjunctival lesions with ASOCT mayallow characterization of classic features to better aid in
establishing a clinical diagnosis and detecting early malignant
transformation
18
10/14/2013
[email protected]
www.nittanyeye.com
19