Joel Pearlman, MD, PhD
Retina 2015: What You Need to Know to
Impress Your Friends, Colleagues and Patients
SVOS Tahoe 2015
After a brief discussion about the past 100 years of retinal imaging, from the
development of the indirect ophthalmoscope to the invention of fundus
photography and fluorescein angiography, we will take a deep dive into the everevolving world of optical coherence tomography – where we have gotten
diagnostically in the past 10 years and where we might expect this technology to
take us in the next ten. Particular attention will be given to the types of OCT
artifacts that commonly arise and how to avoid them as well as common clinical
and some research applications.
OCT Technology
Basics of OCT
Science underlying the technology
Clinical interpretation
Normal retinal architecture
Inner retinal disorders
Cystoid macular edema
Diabetic Macular Edema
ERM
Macular Hole
Lamellar Macular Hole
Paracentral maculopathy
Outer Retinal Disorders
Dry AMD
Wet AMD
Pigment epithelial detachments
CSR
AZOOR
Photoreceptor Disruptions
Enhanced depth imaging
Choroidal disorders
Vitreous Imaging
Posterior vitreous detachments
Vitreomacular interface disorders
Vitreous cell
Optic Nerve Imaging
Drance Hemorrhages
Predictive models
Anterior Segment Imaging
Old OCT Technologies
Time Domain OCT
Spectral Domain OCT
New OCT Technologies
Swept source OCT
OCT “Angiography”
Doppler OCT
Optophysiology
Polarization sensitive OCT
Adaptive optics OCT
Role of light source in depth and resolution of imaging
OCT Artifacts – How not to get fooled
Misalignment
Software breakdown/Segmentation errors
Shadowing
Blink
Motion
Out of Range
Mirror Artifact
Reflection Artifact
Applying OCT to clinical practice - Case Studies
OCT Unknown 1
Inner retinal cysts following cataract surgery
Diagnosis - CME
Treatment - NSAIDS
OCT Unknown 2
Subretinal fluid and PED with Drusen
Diagnosis – wet AMD
Treatment – Anti-VEGF
OCT Unknown 3
Inner retinal cysts and hyperreflective material (lipid)
Diagnosis - DME
Treatment – Anti-VEGF, vs Intravitreal steroids vs Laser
OCT Unknown 4
Subretinal fluid and thickened choroid
Diagnosis – CSR (r/o uveitis)
Treatment – Observation vs PDT vs Micropulse
OCT Unknown 5
Loss of parafoveal ellipsoid
Diagnosis – plaquenil toxicity
Treatment – stop drug (if possible)
Applications of OCT to Clinical Trials in Retina
Fovista Trials
Identification and characterization of Subretinal Hyperreflective
material
Does Fovista offer better visual and anatomical outcomes?
Does the order of injection matter?
Correlation of SHRM with CNV
Effects on PEDs
Dual Molecule Treatments
AntiVEGF and AntiPEDF Combination therapy