Slide 1

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 2

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 3

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 4

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 5

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 6

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 7

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 8

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 9

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 10

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 11

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 12

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 13

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 14

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 15

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 16

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 17

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 18

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 19

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 20

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 21

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 22

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 23

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 24

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 25

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 26

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 27

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 28

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 29

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 30

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 31

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 32

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 33

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 34

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 35

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 36

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 37

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 38

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 39

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 40

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 41

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 42

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 43

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 44

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 45

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 46

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 47

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 48

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 49

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 50

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 51

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 52

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 53

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 54

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 55

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 56

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 57

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 58

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 59

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 60

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 61

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 62

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 63

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 64

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 65

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 66

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 67

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 68

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 69

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 70

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 71

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 72

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 73

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 74

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 75

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 76

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 77

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 78

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.


Slide 79

Oct
interpretation
Ghanbari MD

This is what we wanted

 Qualitative analysis of the OCT scan includes
observation of the reflective qualities of the
retinal structures .

NORMAL MACULA
 The OCT image closely approximates the
histological appearance of the macula and for
this reason it bas been referred to as an in
vivo optical biopsy.

 Differences in signal intensity are represented
by a false color coding system which is
represented by the colors of the visible color
spectrum.

 Highly reflective structures are represented
by red.
 Medium reflections appear yellow or green
 structures with low reflectivity are blue
 Black signal designates the absence of a
reflective signal.

 When evaluating an individual radial line
scan, the clinician reads the left side of the
scan as the beginning of the scan and the right
side of the scan as the end.

 The top of the scan image corresponds to the vitreous cavity. ln a
normal patient (Fig. 87-1), this will be optically silent (black), without
any significant reflections being noted except for perhaps identification
of the posterior hyaloid face (in a patient with complete posterior
vitreous detachment) or normal insertion of the posterior hyaloid near
the macula in young patients.

 The posterior vitreous face appears as a thin
horizontal or oblique line above or inserting
in the retina .

 The Anterior surface of the retina
demonstrates high reflectivity (red) and its
horizontal expanse demonstrates the normal
contour of the macula with the central foveal
depression

 The internal structure of the retina consists of
heterogeneous reflections, corresponding to
varying ultrastructural anatomy.

 The horizontally aligned NFL demonstrates a
high tissue signal (red) that facilitates its
identification.

 High-flow intraretinal structures such as retinal
blood vessels seen in this layer can result in a focal
hyper reflective spot with optical shadowing of the
retinal microstructures posterior to the vessele.

 The (RPE), Bruch's membrane, and
choriocapillaris complex collectively
comprises the highly reflective external band

 This thick band in the outer retina/anterior
choroid appears as a red, linear stripe in OCT
images

 Just anterior to this band is another highly
reflective line representing the junction
between the photoreceptors' inner and outer
segments

 The outer retinal structures are better
discriminated via ultra-high-resolution OCT,
which is not yet commercially available.

 The axially aligned cellular layers of the retina (inner
nuclear, outer nuclear, and ganglion cell layers)
demonstrate less back-scattering and back-reflection
of incident OCT light

 This manifests as relatively low tissue signaIs
(blue, green, yellow) compared to the
horizontally aligned structures( internal
limiting membrane, Henle's layer, and NFL).

 Reflectivity helps to identify anomalous
structures. The sub-retinal fibrosis pictured below
is identified by it's location, shape, and highly
reflective structure.

 Low reflective anomalous structures are areas of
edema (fluid). These may be in the form of
intraretinal cavities, cysts, diffuse intraretinal
edema, or exudative detachments (image below).

 Black areas in the OCT scan may also be caused by
shadowing. Shadowing occurs when a dense
structure prevents light from penetrating below the
structure, just like you or I cast a shadow on the
ground in bright sunlight.

RETINAL THICKNESS ASSESSMENT

 The OCT unit determines the anterior and
posterior surface of the retina in order to
calculate retinal thickness

flat spreading PED (arrowhead) with irregularities of the retinal pigment
epithelium (RPE) band, CME, subretinal fluid

The PED is prominent, bulging, regular, and smooth. (Bottom left)
Fluorescein angiogram (FA) showing smooth and regular PED with
accentuated hyperfluorescence (dotted arrow) associated with an illdelimited hyperfluorescent area of occult choroidal neovascularization

(PED) with chorioretinal anastomosis

Two types of epiretinal macular membrane seen on OCT—one
adherent to the retinal surface and one separated with a focal point of
adhesion and traction

Vitreomacular traction syndrome on OCT. The vitreous, strongly adherent to the
macular surface only, is highly reflective (white color).

Rop foveal hypoplasia

 Optical coherence tomography: coloboma and
glaucoma Shown is a comparison of optical
coherence tomography image of disc with (a)
coloboma and one with (b) glaucoma. Arrow shows
the glial tissue in colobomatous disc. Reprinted with
permission from Ophthalmology (A clinical and
optical coherence tomography study of the margins
of choroidal colobomas, 2007;114: page 579, Fig. 8).

limitations of OCT





Corneal opacity
Cataract
Vitreous hemorrhage
Uncooperative patients

Artifacts
 Artifacts in the OCT scan are anomalies in
the scan that are not accurate images of
actual physical structures, but are rather the
result of an external agent or action.

 large gap in the middle of the scan below. This is an
artifact caused by a blink during scan
acquisition. The was a high resolution scan, which
takes about a second for the scan pass, which is
plenty of time to record a blink.

 The scan below has waves in the retinal
contour. These are not retinal folds, but
rather movement of the eye during the scan
pass.

 This scan has reduced brightness and detail on the right
side. This is not intra-retinal edema. This is caused by a
blockage of the light as it passes into the eye. The OCT was
not centered well in the pupil, with some of the light striking
the edge of the pupil.