OCT in Glaucoma
what should we have to know
M AU L A R I FA D A, A N D I K A P RA H A S TA , E L S A G U S T I A N T Y , S O N I E U M B A RA
G L AU C O M A U N I T
D E PA RT M E N T O F O P H T H A L M O LO GY U N I V E R S I TA S PA D J A D J A RA N N AT I O N A L E Y E C E N T E R C I C E N D O E Y E H O S P I TA L
Spectral Domain OCT (Cirrus HD OCT)
High speed scanning (up to 68,000 A-scan/sec)
Simple operation
High resolution image
Clear Segmentation of retina
Multiple analysis
Clinical Indication
Macula
•ARMD, dry and wet
•Diabetic Retinopathy
•Cystoid Macular Edema
•Macular Holes
•Other Defects…
Glaucoma
•Retinal Nerve Fiber Layer
•C/D Ratio, RIM
•Ganglion Cell Analysis Anterior Segment
•Anterior Segment Imaging and Measurements
Picture source: Carl Zeiss Meditec Media Database
OCT uses in Glaucoma
Structure before Function
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• A 66-year-old patient with POAG
• Progressive RNFL thinning at the
inferotemporal and
superotemporal sectors on Aug. 18, 2009, and Sept.
13, 2010
• “Likely” visual field
progression was observed on Dec. 12, 2011
• The rate of change of RNFL thickness map the
inferotemporal RNFL
declined at a faster rate than
the superotemporal RNFL
Automated identification of the optic disc and cup boundaries
Precise analysis using the dense data in the Optic Disc 200x200 data cube and a proprietary ZEISS
algorithm.
Precisely measure the neuro-retinal rim while accounting for tilted discs, disruptions to the RPE and other challenging pathology.
Optic Nerve Head Analysis
Fundus Photograph
OCT
Cube scan
Measurement of:
• RNFL Thickness
• RIM Area
• C/D Ratio
• Comparison with age-related
Normative database
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Comparison right and left eye on the screen
ONH and RNFL
Analysis
OCT en face fundus image shows boundaries of the cup and disc, and RNFL calculation circle integrated with the RNFL thickness deviation map
RNFL thickness map with cup and disc mask in gray
Optic Nerve Head calculations are presented in a combined report with RNFL thickness data. Key parameters are displayed in table format
ONH & RNFL Analysis Elements
RNFL Peripapillary Thickness
profile, OU Matched to normative data
Neuro-retinal Rim Thickness profile, OU
RNFL Quadrant and Clock Hour average thickness
- Matched to normative data
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ONH & RNFL Analysis Elements
This patient has severe glaucoma in the right eye due to trauma, and a healthy left eye
The CIRRUS™ HD-OCT scans the macular cube either as 512x128 data cube or 200x200 data cube and allows sophisticated analysis of the different layers including:
• GCL+IPL Ganglion Cell and Inner Plexiform Layer analysis for
Glaucoma detection
• Advanced RPE Elevation analysis with quantification of areas and volumes
• Sub RPE Illumination to quantify areas where the RPE has lost integrity or is absent
Macular Cube Scan
Fundus Photograph
OCT
Cube scan
Propriety algorithms are adapted for
specific anatomy, use GCL and IPL thickness
Excludes RNFL
• Measures
thickness of GCL and IPL layers
• using data from the Macular cube scans.
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Ganglion Cell Analysis
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• Horizontal and Vertical B-scans.
• Thickness Map
• Deviation Map
• Sector Map
• Comparison with normative
Database in colors and numbers per sector
Comparison right and left eye on the screen
Ganglion Cell Analysis
Integration of RNFL, ONH, GCA, and Macular
Thickness analyses
• Displays correlation of RNFL and GCA
deviation together in one wide-field
presentation
• Uses high density cube scans you are already acquiring
• Minimizes need for separate wide-field OCT scan
PanoMap Analysis
OCT & VF Findings in young patient
Artefactual Result – errors due to
positioning
Artefactual Result – errors due to VT
CIRRUS OCT Glaucoma Essentials GPA Analysis
•Guided Progression Analysis™ -
Comprehensive history of patient’s progression in a single view, Powered by
CIRRUS Cube
Two baseline exams are required
SS = 10
Baseline Baseline
Registration SS = 10 Baseline
Registration SS = 8
Third exam is compared to the two baseline exams
Sub pixel map demonstrates change from baseline Yellow pixels denote change from both baseline exams
Registration SS = 9
Third and fourth exams are compared to both baselines. Change identified in three of the four comparisons is indicated by red pixels; yellow pixels
denote change from both baselines
Image Progression Map
Change refers to statistically significant change, defined as change that exceeds the known variability of a given pixel based on population studies
CIRRUS
™OCT Glaucoma Essentials
Guided Progression Analysis
™(GPA
™)
Summary Parameter Trend Analysis
Rate and significance of change shown in text
RNFL thickness values for overall Average Superior Average, and Inferior Average are plotted for each exam
Yellow marker denotes change from both baseline exams
Red marker denotes change from 3 of 4 comparisons
Confidence intervals are shown as a gray band
Legend summarizes GPA analyses and
indicates with a check mark if there is possible or likely loss of RNFL
TSNIT Progression Graph
TSNIT values from each exam are shown
Significant difference is colorized yellow or red
Yellow denotes change from both baseline exams
Red denotes change from 3 of 4 comparisons
CIRRUS OCT Glaucoma Essentials
GPA Analysis - Continued
Ganglion Cell Guided Progression Analysis
For Glaucoma Patients
•Potentially detect structural change sooner than ONH/RNFL changes*
•Determine if statistically significant change in Ganglion Cell + Inner PlexiformLayer has occurred
•Complements ONH/RNFL Guided Progression Analysis to provide aComprehensive Glaucoma Analysis
*Na JH1, Sung KR, Baek S et al. , Detection of glaucoma progression by assessment of segmented macular thickness data obtained using spectral domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2012 Jun 20;53(7):3817-26.
Ganglion Cell Guided Progression Analysis compares GCC thickness measurements and over time determines if statistically significant
change has occurred. It allows the user to analyze information from 3 to 8 exams.
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Please note: The earliest two exams are treated as Baseline exams. GPA can be used starting with the third measurement.
Ganglion Cell Guided
Progression Analysis
Two Baseline exams are required
Third exam is compared to the two Baseline exams
Sub pixel map demonstrates change from Baseline Yellow pixels denote change from both Baseline exams
Third and fourth exams are compared to both Baselines.
- yellow pixels denote change from both Baselines
- change identified in three or more comparisons is indicated by red pixels;
GCL+IPL Thickness map
Change refers to statistically significant change, defined as change that exceeds the known variability of a given pixel based on population studies
CIRRUS
™OCT Glaucoma Essentials
GCA Guided Progression Analysis
™(GPA
™)
August 3, 2016 / EN_31_150_0055l
CARL ZEISS MEDITEC, INC. MELY MEDEL / MATTHIAS
MONHART, GLAUCOMA 24
Summary Parameter Trend Analysis
Rate and significance of change shown in text
GCA+IPL thickness values for overall Average Superior Average, and Inferior Average are plotted for each exam
GCL+IPL Summary
Guided Progression Analysis (GPA) analyses and indicates with a check mark if there is possible or likely loss of GCL+IPL layer thickness.
CIRRUS OCT Glaucoma Essentials
GCA GPA Analysis - Continued
Healthy Optic Nerve
Optic Nerve with Glaucoma
From the Merck Manual of Diagnosis and Therapy, edited by Robert Porter. Copyright (2010-2013) by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co, Inc, Whitehouse Station, NJ. Available at http://www.merckmanuals.com/professional/.
February 12,2014.
Ophthalmic Diagnosis
OCT of Anterior chamber and optic disc scan
• Non-contact assessment of irido corneal angle
• Visualization of complete anterior chamber
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