10/28/14 Accurate measurements are important given that future tx
are on the horizon
Advanced RPE Analysis s/p CNV tx (VOLUMETRIC) ` -33%
Changing the face of GA: Monitoring GA
1 Novel Choroidal OCT imaging: EDI (enhanced depth image) Almost no choroid capillaries
Choroidal defect using En face (<125um) 1st used by Spaide (2009) in the Dx of new entity: Age related choroidal atrophy EDI: ICSC Nevus with drusen or CHRPE with lacunae? ú  Other uses for EDI   ICSC: Increase thickness (as high as 500um) ­  Stays thicken after laser tx but not after PDT Nevus w drusen
1 10/28/14 Another pigmented lesion
OCT can help with DDx
Choroiditis Choroidal metastasis (note
underlying & height)
Decrease vision since birth
Shadowing of under or
CHRPE 20/200??? But the macula doesn’t
seem affected
is it?
ONH staphyloma
Easily viewed via OCT
OCT’s value in ICSC: The OCT’s smokestack
Evaluates TRUE idiopathic nature fovea
Metamorphopsia
But 20/20
Can show pathogenesis detail
Serofibrinous exudative material (gradient force)
2 10/28/14 Courtesy Dr. J Gerson
Superficial cut
OCT monitors progression/resolution even if VA unchanged
Deep cut
En face shows hot
spot
20/40
3 wks
20/40
1M
20/25+
2M
20/20
FA hot spot
early
late
folds
translucent
?Holes
OCT can help in Dx of retinoschisis The BASIC RRD via OCT
Courtesy of Dr. L Alexander
3 10/28/14 Recommended 2011 new protocols What we are looking at on OCT
For our plaquenil pts Normal
Patient
Further damage leads toPlaquenil
absence of PIL
Patient
Saucer appearance
Courtesy Dr. J Sherman
Why TDOCT is not ideal OCT: Saucerazation & Sinkhole appearance TDOCT
perifoveal outer retinal abnormalities displacement of the inner retinal structures toward the RPE SDOCT
Rodriguez-­‐Padilla, J. A. et al. Arch Ophthalmol 2007;125:775-­‐780. Progression s/p D/C is related to stage of dz(Marmor & Hu JAMA 2014) N= 11 pts with varaible stages of macular toxicity that D/C plaquenil Stages: mild (parafoveal damage in SDOCT/VF), moderate (50-­‐100% ring parafoveal damage and severe thinning SDOCT), severe (bull’s eye maculopathy/RPE damage) Chen et al. Clinical Ophthalmology 2010
Tamoxifen toxicity: Estrogen antagonist for commonly
Breast CA X 5yr duration
The risk of ocular toxicity exists in 1-­‐2% of patients on standard tamoxifen dosage f/u 1-­‐3yrs Tests: SDOCT, VF, FAF s/p D/C of meds Results: SDOCT moderate-­‐severe cases confirm progression w foveal thinning Severe cases also showed loss of EZ (100 μm/yr). VF showed no CLEAR progression FAF ONLY showed decreased autoFl in severe cases Bottom line Crystals are likely not associated with VL.
They are transient & may disappear s/p tx
The decision to allow continuation of tamoxifen depends on
presence of CME , which can affect vision HENCE OCT is of great value!
4 10/28/14 ON COLOBOMA : Exaggerated effect of an incomplete closure of the fetal fissure with glial tissue filling the defect ON pit ON pit is more localize defect Located inferior or IT
Glial tissue
Excavation of the ON
Note: enlarge disc
w sharp/enlarge white bowl shape excavation
Fluid can leak through pit leading to central serous macular
detachment or macular schisis. Hence, management of pit is
monitor for maculaopthies & OCT can help
neovascularization via OCT
Project forward
OCT of Collaterals
Optociliary shunts
Small thick bud (no FA leak)
Pre-existing capillaries that
become ectatic
Bridge b/t non perfuse & perfuse retina
Note capillary drop out
Pigtail like appearance
5