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    1. Spending Money to Save Money on Patient Care—The Development of Ocular Coherence Tomography

      Spending Money to Save Money on Patient Care—The Development of Ocular Coherence Tomography

      The rising costs of medical care affect individuals' insurance coverage, shape the medical plans offered by companies, and challenge national policymakers. Several factors drive inflation, including the development and application of potent pharmaceuticals, interventional technologies, and advanced imaging. Ophthalmology patients have benefited tremendously from the novel application of new laser technologies, improved phacoemulsification machines, advanced intraocular lenses, and minimally invasive glaucoma surgery.

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    2. Estimating Public and Patient Savings From Basic Research—A Study of Optical Coherence Tomography in Managing Antiangiogenic Therapy

      Estimating Public and Patient Savings From Basic Research—A Study of Optical Coherence Tomography in Managing Antiangiogenic Therapy

      Purpose To compare patient and Medicare savings from the use of optical coherence tomography (OCT) in guiding therapy for neovascular age-related macular degeneration (nvAMD) to the research investments made in developing OCT by the National Institutes of Health (NIH) and the National Science Foundation (NSF). Design Observational cohort study. Methods Main outcome measures were spending by Medicare as tracked by Current Procedural Terminology codes on intravitreal injections (67028), retinal OCT imaging (92134), and anti–vascular endothelial growth factor (anti-VEGF) treatment–specific J-codes (J0178, J2778, J9035, J3490, and J3590). These claims were identified from the Medicare Provider Utilization and Payment Data ...

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    3. Impacts of Implantable Collamer Lens V4c Placement on Angle Measurements Made by Optical Coherence Tomography: Two-Year Follow-up

      Impacts of Implantable Collamer Lens V4c Placement on Angle Measurements Made by Optical Coherence Tomography: Two-Year Follow-up

      We appreciate the comments made by Galvis and associates regarding our recently published article in which we report anterior chamber angle narrowing in response to implantable collamer lens (ICL) placement. The mean angle narrowing observed was approximately 39%–41% for the whole population. In response to the first question, in patients with a vault larger than 750 μm, angle reduction was 55.2%–56.7%, compared with 34.7%–38.3% produced in patients with a vault ≤ 750 μm. It is well known that vault is an important determinant of anterior chamber angle, and, as we describe in our article ...

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    4. Reproducibility of vessel density, fractal dimension and foveal avascular zone using 7 different optical coherence tomography angiography devices

      Reproducibility of vessel density, fractal dimension and foveal avascular zone using 7 different optical coherence tomography angiography devices

      Purpose To evaluate the reproducibility of parafoveal microvascular anatomy of 7 different optical coherence tomography angiography (OCT-A) devices by comparing vessels density (VD), fractal dimension (FD) and foveal avascular zone (FAZ) of superficial and deep capillary plexus in healthy volunteers. Design Reliability analysis. Methods Consecutive healthy volunteers presenting at the Eye Clinic, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan in the same clinic visit were imaged by 7 different OCT-A devices: Optovue RTVue XR Avanti (Optovue, Inc, Fremont, CA), prototype Spectralis OCT-A (Spectralis Heidelberg Engineering, Heidelberg, Germany), AngioPlex (Cirrus 5000 HD-OCT, Carl Zeiss Meditec, Inc ...

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    5. High Resolution Imaging in male germ cell associated kinase (MAK)-related Retinal Degeneration

      High Resolution Imaging in male germ cell associated kinase (MAK)-related Retinal Degeneration

      Purpose To describe the characteristics of MAK -related retinal degeneration using optical coherence tomography angiography (OCTA) and adaptive optics scanning laser ophthalmoscopy (AOSLO). Design Cross-sectional study. Methods Six patients with rod-cone degeneration and disease-causing mutations in MAK were evaluated with visual acuity, spectral domain OCT, confocal AOSLO and OCTA. Foveal avascular zone (FAZ) area, vessel densities and perfusion densities of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the central macula in all 6 patients were compared with 5 normal subjects. Cone spacing was measured in 4 patients from AOSLO images and compared with 37 normal subjects ...

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    6. Assessment of Optical Coherence Tomography Color Probability Codes in Myopic Glaucoma Eyes After Applying a Myopic Normative Database

      Assessment of Optical Coherence Tomography Color Probability Codes in Myopic Glaucoma Eyes After Applying a Myopic Normative Database

      We thank Drs Qiu and Zhang for their interest in our article. 1 Their comments focused on the possible influence of age, axial length, and disc size on the diagnostic performance of peripapillary retinal nerve fiber layer (RNFL) measurements. In this correspondence, we would like to expand our discussion in response to the comments raised by Drs Qiu and Zhang.

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    7. Use of a Neural Net to Model the Impact of Optical Coherence Tomography Abnormalities on Vision in Age-Related Macular Degeneration

      Use of a Neural Net to Model the Impact of Optical Coherence Tomography Abnormalities on Vision in Age-Related Macular Degeneration

      Purpose To develop a neural network for the estimation of visual acuity from optical coherence tomography (OCT) images of patients with neovascular age related macular degeneration and to demonstrate its use to model the impact of specific controlled OCT changes on vision. Design Artificial Intelligence (neural network) study. Methods We assessed 1400 OCT scans of patients with neovascular age related macular degeneration (AMD). 15 physical features for each eligible OCT as well as patient age were used as input data and corresponding recorded visual acuity as the target data to train, validate and test a supervised neural network. We then ...

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    8. Macular fluid reduces reproducibility of choroidal thickness measurements on enhanced depth optical coherence tomography

      Macular fluid reduces reproducibility of choroidal thickness measurements on enhanced depth optical coherence tomography

      Purpose To determine if different types of retinal fluid in the central macula affect the reproducibility of choroidal thickness (CT) measurements on enhanced depth imaging optical coherence tomography (EDI-OCT) Design retrospective, reliability analysis Methods EDI-OCT images were obtained and the choroidal-scleral junction was analyzed through semi-automated segmentation. CT was measured at the fovea and averaged across the central 3 mm horizontal segment. Demographic data, central macular thickness and type of fluid present were recorded. Intragrader and intergrader repeatability were assessed using the intraclass correlation coefficient (ICC) and coefficient of repeatability (CR). Results Of 124 eyes analyzed, 60 (48.4%) had ...

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    9. Diabetic Choroidopathy: Choroidal Vascular Density and Volume in Diabetic Retinopathy with Swept-Source Optical Coherence Tomography

      Diabetic Choroidopathy: Choroidal Vascular Density and Volume in Diabetic Retinopathy with Swept-Source Optical Coherence Tomography

      Purpose To compare choroidal vascular density (CVD) and volume (CVV) in diabetic eyes and controls, using en face swept-source optical coherence tomography (SS-OCT). Design Prospective cross-sectional study. Methods ▪▪▪ Setting Multicenter Patient Population 143 diabetic eyes – 27 with no diabetic retinopathy (DR), 47 with nonproliferative DR (NPDR), 51 with NPDR and diabetic macular edema (DME), and 18 with proliferative DR (PDR), and 64 age-matched non-diabetic control eyes. Observation procedures Complete ophthalmologic examination and SS-OCT imaging. En face SS-OCT images of the choroidal vasculature were binarized. Main outcome measures CVD, calculated as the percent area occupied by choroidal vessels in the central ...

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    10. Optical Coherence Tomography Protocols for Screening of Hydroxychloroquine Retinopathy in Asian Patients

      Optical Coherence Tomography Protocols for Screening of Hydroxychloroquine Retinopathy in Asian Patients

      Purpose To investigate the distribution of outer retinal changes in hydroxychloroquine (HCQ) retinopathy and explore optical coherence tomography (OCT) protocols to maximize the sensitivity of HCQ retinopathy detection in Asian patients. Design Diagnostic validity assessment Methods Setting : Institutional Patient Population : Forty-eight eyes (24 patients) with HCQ retinopathy underwent 6-mm horizontal and vertical line scans and 6 × 6-mm 2 volume scans using spectral-domain OCT (SD-OCT), and 9-mm line scans and 6 × 6-mm 2 and 12 × 9-mm 2 volume scans using swept-source OCT (SS-OCT). Observation Procedures : Distances from the fovea to the defective photoreceptors were measured in the temporal, nasal, superior, and ...

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    11. Differences in OCT Assessment of Bruch Membrane Opening Compared to Stereoscopic Photography for Estimating Cup-to-Disc Ratio

      Differences in OCT Assessment of Bruch Membrane Opening Compared to Stereoscopic Photography for Estimating Cup-to-Disc Ratio

      Purpose To compare the vertical and horizontal cup-to-disc ratio (VCDR, HCDR) by an updated optical coherence tomography (OCT) Bruch’s membrane opening (BMO) algorithm and stereoscopic optic disc photograph readings by glaucoma specialists. Design Reliability analysis. Methods 195 eyes (116 glaucoma and 79 glaucoma suspects) of 99 patients with stereoscopic photos and OCT scans of the optic discs taken during the same visit were compared. Optic disc photos were read by two masked glaucoma specialists for VCDR and HCDR estimation. Intraclass correlation coefficient (ICC) and Bland-Altman plots were used to assess the agreement between photo reading and OCT in estimating ...

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    12. Comparison of Glaucoma Progression Detection by Optical Coherence Tomography and Visual Field

      Comparison of Glaucoma Progression Detection by Optical Coherence Tomography and Visual Field

      Purpose To compare longitudinal glaucoma progression detection using optical coherence tomography (OCT) and visual field (VF). Design Validity assessment Method We analyzed subjects with more than 5 follow-up visits (every 6 months) in the multi-center Advanced Imaging for Glaucoma Study. Fourier-domain optical coherence tomography (OCT) was used to map the thickness of the peripapillary retinal nerve fiber layer (NFL) and ganglion cell complex (GCC). OCT-based progression detection was defined as a significant negative trend for either NFL or GCC. VF progression was reached if either the event or trend analysis reached significance. Result The analysis included 417 glaucoma suspect/pre-perimetric ...

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    13. Assessment of OCT color probability codes in myopic glaucoma eyes after applying a myopic normative database

      Assessment of OCT color probability codes in myopic glaucoma eyes after applying a myopic normative database

      Purpose To evaluate the optical coherence tomography (OCT) color probability codes based on a myopic normative database and to investigate whether the implementation of the myopic normative database can improve the OCT diagnostic ability in myopic glaucoma. Design Comparative validity study. Methods In this study, 305 eyes (154 myopic healthy eyes and 151 myopic glaucoma eyes) were included. A myopic normative database was obtained based on myopic healthy eyes. We evaluated the agreement between OCT color probability codes after applying the built-in and myopic normative databases, respectively. Another 120 eyes (60 myopic healthy eyes and 60 myopic glaucoma eyes) were ...

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    14. OCT-Angiography and Ultra-Widefield Fluorescein Angiography for Early Detection of Adolescent Sickle Retinopathy

      OCT-Angiography and Ultra-Widefield Fluorescein Angiography for Early Detection of Adolescent Sickle Retinopathy

      Purpose Using standard screening techniques, sickle retinopathy reportedly occurs in 10% of adolescents with sickle cell disease (SCD). We performed a prospective, observational clinical study to determine if ultra-widefield fluorescein angiography (UWFA), spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCT-A) detect more frequent retinopathy in adolescents with SCD. Design Cross-sectional study. Methods Setting : Institutional. Subjects : Sixteen adolescents with SCD, ages 10-19 years, (mean age 14.9 years) and 5 age-equivalent controls (mean age 17.4 years). Observation Procedures: Examinations including acuity, standard slit-lamp biomicroscopy, UWFA, SD-OCT and OCT-A were performed. Main Outcome Measures : Sickle retinopathy defined by ...

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    15. Morphological and Functional Retinal Vessel Changes in Branch Retinal Vein Occlusion: An Optical Coherence Tomography Angiography Study

      Morphological and Functional Retinal Vessel Changes in Branch Retinal Vein Occlusion: An Optical Coherence Tomography Angiography Study

      Purpose The present study aimed to investigate the morphology of the retinal vasculature in eyes with branch retinal vein occlusion (BRVO) using optical coherence tomography (OCT) angiography. Design Observational case series. Methods Fluorescein angiography (FA) and OCT angiography were used to examine macular area and the retinal vasculature at the affected arteriovenous (AV) crossing in 46 patients with BRVO. Results FA revealed that the affected AV crossing pattern involved arterial overcrossing in 23 eyes (50.0%) and venous overcrossing in 11 eyes (23.9%). However, FA failed to detect the crossing pattern in 10 eyes (21.7%). OCT angiography was ...

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    16. Diagnostic Capability of Peripapillary 3D Retinal Nerve Fiber Layer Volume for Glaucoma Using Optical Coherence Tomography Volume Scans

      Diagnostic Capability of Peripapillary 3D Retinal Nerve Fiber Layer Volume for Glaucoma Using Optical Coherence Tomography Volume Scans

      Purpose To determine the diagnostic capability of peripapillary 3-dimensional (3D) retinal nerve fiber layer (RNFL) volume measurements from spectral domain optical coherence tomography (OCT) volume scans for open angle glaucoma (OAG). Design Assessment of diagnostic accuracy. Methods Setting: Academic clinical setting. Study population : 180 patients (113 OAG and 67 normal subjects). Observation procedures : One eye per subject was included. Peripapillary 3D RNFL volumes were calculated for global, quadrant, and sector regions, using four different sized annuli. Peripapillary 2D RNFL thickness circle scans were also obtained. Main outcome measures : Area under the receiver operating characteristic curve (AUROC) values, sensitivity, specificity, positive ...

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    17. En Face Optical Coherence Tomography Analysis to Assess the Spectrum of Perivenular Ischemia and Paracentral Acute Middle Maculopathy in Retinal Vein Occlusion

      En Face Optical Coherence Tomography Analysis to Assess the Spectrum of Perivenular Ischemia and Paracentral Acute Middle Maculopathy in Retinal Vein Occlusion

      Using en face optical coherence tomography (OCT), Falavarjani and associates recently illustrated the variability in the area of macular middle-retinal infarction (MMRI) exhibited in eyes with subtotal central retinal venous or arterial occlusion (CRVO or CRAO).1 The severity spectrum from narrow perivenular MMRI to diffuse MMRI with periarteriolar sparing was thought to reflect the extent of circulatory failure during infarct evolution. This chimes with funduscopic observations going back 40 years.

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    18. Optical Coherence Tomography Angiography of the Peripapillary Retina in Primary Angle-Closure Glaucoma

      Optical Coherence Tomography Angiography of the Peripapillary Retina in Primary Angle-Closure Glaucoma

      Purpose To measure the change of peripapillary retinal vessel density (VD) in eyes with a history of acute primary angle closure glaucoma (PACG). Design Case-control study. Methods Twenty-one consecutive Chinese patients with history of unilateral acute PACG were enrolled. Eyes with acute PACG constituted the case group, while the contralateral eyes without attack constituted the control. All patients underwent ophthalmic examinations including best-corrected visual acuity, intraocular pressure, and visual field (VF). Spectral-domain optical coherence tomography (SD-OCT) was used to obtain both structural OCT and OCT angiography (OCTA). Structural OCT scans provided thickness measurements of the peripapillary retinal nerve fiber layer ...

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    19. Combined Hamartoma of the Retina and Retinal Pigment Epithelium: An Optical Coherence Tomography-Based Reappraisal

      Combined Hamartoma of the Retina and Retinal Pigment Epithelium: An Optical Coherence Tomography-Based Reappraisal

      Purpose To analyze the optical coherence tomography (OCT) characteristics of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) involving the macula. Design Retrospective, observational case series. Methods Setting: Single institutional. Study population: Fourteen consecutive patients of CHRRPE were included. Observation procedures: The authors analyzed the clinical features, color fundus photography, and swept source or spectral domain OCT of all the involved eyes. Main outcome measures: OCT characteristics, especially the involvement of the retinal pigment epithelium (RPE). Results Total 16 eyes of 5 female and 9 male patients were analyzed. The mean age (±SD) was 17.9 ± 6.4 ...

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    20. Optical Coherence Tomography-Angiography of Macular Features after Proton Beam Radiotherapy for Small Choroidal Melanoma

      Optical Coherence Tomography-Angiography of Macular Features after Proton Beam Radiotherapy for Small Choroidal Melanoma

      Purpose To describe the macular features of patients treated with proton beam therapy for choroidal melanoma (CM), using the optical coherence tomography-angiography (OCTA). Design Retrospective case-control study. Methods This study included patients treated with proton beam radiotherapy (PBR) for a small CM. Only patients that had received 100% of the dose 60 GyEBR to the macular area were included in the analysis. All the patients have undergone a full ophthalmological examination including: visual acuity, OCT B-scan and OCTA. Qualitative and quantitative vascular features of the retinal plexus and the choriocapillaris were analyzed on OCTA and compared to healthy subjects matched ...

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    21. Choroidal Changes Associated with Subretinal Drusenoid Deposits in Age-related Macular Degeneration using Swept-source OCT

      Choroidal Changes Associated with Subretinal Drusenoid Deposits in Age-related Macular Degeneration using Swept-source OCT

      Purpose To compare choroidal vascular features of eyes with and without subretinal drusenoid deposits (SDD), using swept-source optical coherence tomography (SS-OCT). Design Multicenter, cross-sectional study. Methods We prospectively recruited patients with intermediate age-related macular degeneration (AMD), without other vitreoretinal pathology. All participants underwent complete ophthalmic exam, color fundus photography (used for AMD staging), and spectral-domain OCT (to evaluate the presence of SDD). SS-OCT was used to obtain automatic macular choroidal thickness (CT) maps, according to the Early Treatment Diabetic Retinopathy Study (ETDRS) sectors. For data analysis, we considered mean choroidal thickness as the arithmetic mean value of the 9 ETDRS ...

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    22. Quantitative Analysis of Retinal Structure Using Spectral-Domain Optical Coherence Tomography in RPGR-Associated Retinopathy

      Quantitative Analysis of Retinal Structure Using Spectral-Domain Optical Coherence Tomography in RPGR-Associated Retinopathy

      Purpose To quantify retinal structure and progression using spectral-domain optical coherence tomography (SDOCT) in patients with retinitis pigmentosa (RP) associated with retinitis pigmentosa GTPase regulator gene ( RPGR ) mutations. Design Retrospective observational case series. Methods Setting : Moorfields Eye Hospital, London, United Kingdom. Subjects : Both eyes of 32 patients. SDOCT follow-up period of >1 year (3.1 ± 1.4 years). Main Outcome Measures : Ellipsoid zone (EZ) width (EZW) and outer nuclear layer (ONL) and inner retinal layer (IRL) thickness measurements. Progression rates, interocular symmetry, and association with age and genotype were investigated. Results Significant differences were observed between baseline and final measurements ...

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      Mentions: Joseph Carroll
    23. Pseudophakic Macular Edema in Primary Open-Angle Glaucoma: a Prospective Study Using Spectral-Domain Optical Coherence Tomography

      Pseudophakic Macular Edema in Primary Open-Angle Glaucoma: a Prospective Study Using Spectral-Domain Optical Coherence Tomography

      Purpose To determine the incidence of and risk factors for pseudophakic macular edema (PME) after uncomplicated cataract surgery in primary open-angle glaucoma (POAG) using spectral-domain optical coherence tomography (SD-OCT). Design Cohort study Methods Macular retinal thickness was evaluated using SD-OCT at 1-week before surgery and at 1-, 3-, 6-, and 12-months postoperatively, in 70 POAG and 68 control eyes. Forty-three healthy subjects without impaired vision or cystoid PME were recruited separately as pilot samples to define significant PME. Significant PME was defined as an increase in the average thickness exceeding the mean+three standard deviations of the increase shown in ...

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    24. Relationship between internal reflectivity of diabetic microaneurysms on SD-OCT and detection on OCT Angiography

      Relationship between internal reflectivity of diabetic microaneurysms on SD-OCT and detection on OCT Angiography

      Purpose To correlate the appearance of Microaneurysms (MAs) on structural spectral-domain optical coherence tomography (SD-OCT) with their detection on OCT angiography (OCTA) in patients with non-proliferative diabetic retinopathy (NPDR). Design Inter-instrument reliability study. Methods Sixteen patients with NPDR without macular edema underwent SD-OCT and OCTA. To compare MAs seen on OCTA to those on SD-OCT, we superimposed the OCTA superficial capillary plexus (SCP) vascular landmarks onto those of the near infrared. Two observers blinded to patient groupings evaluated reflectivity of MAs on SD-OCT scans, graded as hypo-, moderate, or hyper-reflective, and their visualization at the level of SCP and deep ...

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