OCT & OCT-A Insightful Analysis : Diagnose and Monitor Changes

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OCT & OCT-A

Insightful Analysis:

Diagnose and Monitor Changes

Erwin Iskandar

Divisi Vitreoretina:

Iwan Sovani

Arief S. Kartasasmita Erwin Iskandar Rova Virgana Grimaldi Ihsan

Made Indra Widyanatha

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Agenda

1.Basic OCT: How to read OCT for Retina Application 2.Case Studies:

• Age-related Macular Degeneration

• Diabetic Retinopathy

• Other common pathologies

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What is Optical Coherence Tomography (OCT)?

• OCT is a non-contact, high

resolution, axial cross-sectional imaging device.

• It is indicated for measurement posterior and anterior ocular structures.

• Scan can be performed on small

pupils (min. 2 mm)

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OCT: A Dynamic Tool

Optical Biopsy of the Retina

(in vivo)

Make an initial diagnosis

Plan treatment approaches

Evaluating and

monitoring treatment result

Predict visual

prognosis

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Limitations of Retinal OCT

• Mydriasis may sometimes be necessary

• Dioptric media must be somewhat

transparent

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OCT Scan Location

Tomography/cross sectional imaging

F o ve a

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• High Reflectivity : RNFL , RPE.

• Medium Reflectivity : Plexiform layers, Nuclear layers.

• Low Reflectivity : Photoreceptors.

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Color B-Scan Grayscale B-Scan

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How to read OCT?

OCT Analysis

Qualitative Analysis

Morphology Morphology &

Anomalous Structure

Reflectivity

Hyper- reflectivity

Hypo- reflectivity Shadowing

Quantitative Analysis

Thickness

Volume

Area

MHI

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Qualitative Analysis

Q ua lit at iv e A na ly si s

^Morphology

Morphology

Overall retinal structure deformities.

Retinal Outline changes.

Intra-retinal structural changes.

Posterior layers morphologic changes

Anomalous Structure

Epi-retinal.

Intra-retinal.

Sub-retinal

Reflectivity

Hyper-reflectivity (Increased Reflectivity)

Hypo-reflectivity (Reduced Reflectivity) Shadowing (Shadow -

screen) effect)

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04 RSUP Dr. Kariadi, VR Consultants, Ophthalmology

Qualitative Analysis

Morphology & Anomalous Structure

Deformation of the entire retina:

 Concavity : high Myopia

 Convexity : RD, Cysts, sub-retinal tumors.

Intra-Retinal Structural Changes:

High Myopia

RD

High Reflective lesion Eminent Rupture

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Stages of Idiopathic

Macular Hole Stages of

Idiopathic

Macular Hole

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Pre retinal

 Epi retinal membrane

 Vitreo retinal strands or Traction

 NVE/NVD

Intra retinal

 Choroidal neovascularization

 Diffuse intra retinal edema

 CME

 Hard Exudates

 Scar

 Choroidal neovascularization

 RPE detachment

 Drusens

 Sub retinal fibrosis

 Scar

 RPE atrophy

Sub retinal

Vitreoretinal Disease by Regions

Epiretinal

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Hyper -

Superficial : ERM , Hge

Intraretinal :

Hge , hard exudate , deg (+ dec thickness).

Deep :

RPE hyperplasia , Drusen , CNVM, laser.

Hypo-

( cyst , Serous fluid , Tissue atrophy)

Intraretinal :

Subretinal:

Sub RPE:

Shadow effect

Deep:

Hard exudates, IOFB,RPE hyperplasia

Reflectivity

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Quantitative Analysis

Thickness Volume

Area MHI

ETDRS Grid with Normative Data

Central Retinal Thickness

MHI

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OCT Angiography

Basic Principles

 Ultra-clear visualization of microvascular blood flow using

• non-invasive OCT Angiography.

 OCTA allows visualization of both perfused vasculature and vascular abnormalities of the

retina by detection of movement in tissue  Red Blood Cells

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Cirrus AngioPlex

OCT-Angiography layers Wet AMD with CNV

VRI Superficial Deep Avascular

ORCC

Outer Retina Choriocapillaries

RPE-RPEfit Sub-RPE Choriocapillaries Choroid

Retina Depth

Encoded

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OCT Angiography

Potential clinical applications

OCT Angiography can potentially be used to detect vascular structures, such as:

• Areas of CNV in AMD

• Neovascularization in Mactel

• Micro-aneurysms and ischemia in DR

• Occlusions and abnormalities in CRVO and BRVO cases

• Abnormalities of optic nerve

vasculature

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CASE STUDIES

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CASE 1 – Female, 73 y.o

Wet AMD with CNV (OS)

Courtesy of PMN RSM Cicendo

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CASE 1 – Female, 73 y.o

Wet AMD with CNV (OS)

OCT + FAF

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CASE 1 – GROWING CNV - CHOROID

1

^st

Visit 2

^nd

Visit 3

^rd

Visit

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CASE 1 – GROWING CNV - Choriocapillaries

1

^st

Visit 2

^nd

Visit 3

^rd

Visit

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CASE 1 – GROWING CNV – Sub-RPE

1

^st

Visit 2

^nd

Visit 3

^rd

Visit

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CASE 1 – GROWING CNV – RPE-RPEFit

1

^st

Visit 2

^nd

Visit 3

^rd

Visit

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CASE 1 – GROWING CNV - ORCC

1

^st

Visit 2

^nd

Visit 3

^rd

Visit

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CASE 1 – GROWING CNV - Avascular

1

^st

Visit 2

^nd

Visit 3

^rd

Visit

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CASE 1 – GROWING CNV - Deep

1

^st

Visit 2

^nd

Visit 3

^rd

Visit

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CASE 1 – GROWING CNV - Superficial

1

^st

Visit 2

^nd

Visit 3

^rd

Visit

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CASE 2 – Female, 64 y.o

PDR with FAZ enlargement & irregularity

OCT Angiography 6x6 mm Superficial Slab

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Angiography 12x12 Superficial Slab

Angiography 12x12 VRI Slab

CASE 2 – Female, 64 y.o PDR with FAZ enlargement

Angiography 6x6 Superficial Slab

NVE

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CASE 3 – Male, 64 y.o

PDR with VH

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CASE 4 – Male, 55 y.o • No history of diabetic

• History of hypertension

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CASE 4 – Male, 55 y.o OCT-A

Treatment Plan?

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CASE 5 – MALE, 54 y.o

BRVO

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CASE 5 – OCT-A 6x6 Superficial Slab

BRVO

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CASE 5 – OCT-A 12x12 Superficial Slab BRVO – Treatment Plan?

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CASE 6 – Male, 60 y.o

Subretinal Hemorrhage ec PCV (OD)

OCT + FF (OD)

OCT + FF (OS)

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CASE 6 – Male, 60 y.o

Subretinal Hemorrhage ec PCV (OD)

After Avastin 1

^st

Injection

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Case 7 – Post Vitrectomy (OD)

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CASE STUDY - Male, 51 y.o.

What is your treatment plan?

• PDR ODS, PV OD, ART

• OD buram 1 bulan perlahan, Floaters+

• OS fotopsia

• DM 10 tahun, HT-

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CASE STUDY – Female, 68 y.o FF

• History of diabetic

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What is your treatment plan?

CASE STUDY – Female, 68 y.o OCT

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CASE STUDY – Male, 56 y.o (Wet AMD) Fundus Imaging

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CASE STUDY – Male, 56 y.o (Wet AMD) OCT + OCT-A

What is your treatment plan?

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