After the introduction of intravitreal ocriplasmin (Jetrea; ThromboGenics, Iselin, NJ) for symptomatic vitreomacular traction (VMT), reports began surfacing of diffuse ellipsoid zone (EZ) changes and acute visual loss after treatment. 1–5 Two explanations for these abnormalities have been proposed. 2 Because ocriplasmin is a recombinant protease, the drug may cleave layers in the outer retina beyond the vitreomacular interface. Alternatively, because these changes are found primarily after successful VMT release, the effect could be secondary to a transient increase in mechanical traction on the retina when the vitreous separates.

Purpose To develop a predictive model based on quantitative characteristics of geographic atrophy (GA) to estimate future potential regions of GA growth. Design Progression study and predictive model. Participants One hundred eighteen spectral-domain (SD) optical coherence tomography (OCT) scans of 38 eyes in 29 patients. Methods Imaging features of GA quantifying its extent and location, as well as characteristics at each topographic location related to individual retinal layer thickness and reflectivity, the presence of pathologic features (like reticular pseudodrusen or loss of photoreceptors), and other known risk factors of GA growth, were extracted automatically from 118 SD OCT scans of ...

Purpose To evaluate the specific spectral-domain (SD) optical coherence tomography (OCT) features of retinal astrocytic hamartoma (RAH) and the relationship of these features with tumor size and location. Design Retrospective case series. Participants Forty-seven eyes of 42 patients with RAH. Methods All patients with clinically confirmed RAH were imaged with fundus photography and SD OCT. Main Outcome Measures Precise OCT location of RAH features and the relationship of patient age, visual acuity, tumor size, and tumor location to the presence and size of intralesional optically empty spaces (OESs), appearing as so-called moth-eaten spaces. Results Of 42 patients with RAH, 36 ...

Purpose Ruling out glaucoma in myopic eyes often poses a diagnostic challenge because of atypical optic disc morphology and visual field defects that can mimic glaucoma. We determined whether neuroretinal rim assessment based on Bruch's membrane opening (BMO), rather than conventional optic disc margin (DM)-based assessment or retinal nerve fiber layer (RNFL) thickness, yielded higher diagnostic accuracy in myopic patients with glaucoma. Design Case-control, cross-sectional study. Participants Myopic patients with glaucoma (n = 56) and myopic normal controls (n = 74). Methods Myopic subjects with refraction error greater than −2 diopters (D) (spherical equivalent) and typical myopic optic disc morphology ...

Purpose To map the 3-dimensional (3D) strain of the optic nerve head (ONH) in vivo after intraocular pressure (IOP) lowering by trabeculectomy (TE) and to establish associations between ONH strain and retinal sensitivity. Design Observational case series. Participants Nine patients with primary open-angle glaucoma (POAG) and 3 normal controls. Methods The ONHs of 9 subjects with POAG (pre-TE IOP: 25.3±13.9 mmHg; post-TE IOP: 11.8±8.6 mmHg) were imaged (1 eye per subject) using optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany) before (<21 days) and after (<50 days) TE. The imaging protocol ...

Purpose To describe the spectral-domain optical coherence tomography (SD OCT) features of peripheral retinal findings using an ultra-widefield (UWF) steering technique to image the retinal periphery. Design Observational study. Participants A total of 68 patients (68 eyes) with 19 peripheral retinal features. Main Outcome Measures Spectral-domain OCT–based structural features. Methods Nineteen peripheral retinal features, including vortex vein, congenital hypertrophy of the retinal pigment epithelium, pars plana, ora serrata pearl, typical cystoid degeneration (TCD), cystic retinal tuft, meridional fold, lattice and cobblestone degeneration, retinal hole, retinal tear, rhegmatogenous retinal detachment, typical degenerative senile retinoschisis, peripheral laser coagulation scars, ora tooth ...

Purpose To determine whether angiography with swept-source (SS) optical coherence tomography (OCT) identifies subclinical type 1 neovascularization in asymptomatic eyes with intermediate age-related macular degeneration (iAMD). Design Prospective, observational, consecutive case series. Participants Patients with asymptomatic iAMD in one eye and neovascular age-related macular degeneration (AMD) in their fellow eye. Methods The patients underwent SS OCT angiography (OCTA), fluorescein angiography (FA), and indocyanine green angiography (ICGA), and the images from these 3 angiographic techniques were compared. Main Outcome Measures Identification of subclinical type 1 neovascularization with SS OCTA in asymptomatic eyes with iAMD. Results Eleven consecutive patients with iAMD in ...

Purpose To investigate the prevalence, features, associated factors, and reproducibility of segmentation errors in macular ganglion cell inner plexiform layer (GCIPL) thickness measurement as determined by optical coherence tomography (OCT). Design Cross-sectional study. Participants Five hundred thirty-eight glaucomatous and healthy eyes from 290 subjects with OCT-measured macular GCIPL thickness were enrolled. Eyes with macular disorders, including epiretinal membrane, macular degeneration, macular hole, and myopic maculopathy, were excluded. Methods By inspecting 128 cross-sectional OCT B-scan images per eye, the presence (yes vs. no), layer (anterior vs. posterior border), location (quadrants), and area (diffuse vs. focal) of macular GCIPL segmentation error were ...

Purpose To derive macular thickness measures and their associations by performing rapid, automated segmentation of spectral-domain optical coherence tomography (SD OCT) images collected and stored as part of the UK Biobank (UKBB) study. Design Large, multisite cohort study in the United Kingdom. Analysis of cross-sectional data. Participants Adults from the United Kingdom aged 40 to 69 years. Methods Participants had nonmydriatic SD OCT (Topcon 3D OCT-1000 Mark II; Topcon GB, Newberry, Berkshire, UK) performed as part of the ocular assessment module. Rapid, remote, automated segmentation of the images was performed using custom optical coherence tomography (OCT) image analysis software (Topcon ...

I read with interest the article by McNabb et al 1 regarding the measurement of corneal power in eyes that have undergone refractive surgery. One of the study's limitations was that myopic and hyperopic eyes were analyzed in a single group. It is known that after refractive surgery there is an overestimation of the corneal power in the eyes that had surgery for myopia, 2,3 and there is an underestimation of the power of the cornea in eyes that had surgery for hyperopia. 4 Evaluating the overall differences in corneal power for both refractive defects may introduce bias ...

Purpose To evaluate and compare the diagnostic accuracy of global and sector analyses for detection of early visual field (VF) damage using the retinal nerve fiber layer (RNFL) reference databases of the Spectralis (Heidelberg Engineering, Heidelberg, Germany) and Cirrus (Carl Zeiss Meditec, Dublin, CA) spectral-domain optical coherence tomography (SD OCT) devices. Methods Healthy subjects and glaucoma suspects from the Diagnostic Innovations in Glaucoma Study (DIGS) and African Descent and Glaucoma Evaluation Study (ADAGES) with at least 2 years of follow-up were included. Global and sectoral RNFL measures were classified as within normal limits, borderline (BL), and outside normal limits (ONL ...

Purpose To investigate ultrahigh-speed, swept-source optical coherence tomography (SSOCT) angiography for visualizing vascular changes in eyes with nonexudative age-related macular degeneration (AMD) with geographic atrophy (GA). Design Observational, prospective, cross-sectional study. Participants A total of 63 eyes from 32 normal subjects and 12 eyes from 7 patients with nonexudative AMD with GA. Methods A 1050-nm, 400-kHz A-scan rate SSOCT system was used to perform volumetric optical coherence tomography angiography (OCTA) of the retinal and choriocapillaris (CC) vasculatures in normal subjects and patients with nonexudative AMD with GA. Optical coherence tomography angiography using variable interscan time analysis (VISTA) was performed to ...

Purpose To estimate the diagnostic accuracy and lead time gained by retinal nerve fiber layer (RNFL) thickness measurements from optical coherence tomography (OCT) for detecting glaucoma before the development of visual field defects. Design Observational cohort study. Participants The study group included 75 eyes of 75 patients suspected of having glaucoma. These eyes had normal standard automated perimetry (SAP) at baseline and demonstrated repeatable (3 consecutive) abnormal tests during a median follow-up of 6.3 years. A control group of 75 eyes of 75 healthy subjects matched by age and number of OCT tests during follow-up was included. Methods The ...

Purpose The in vivo microstructural features of familial exudative vitreoretinopathy (FEVR) have not been well described. We present new anatomic features of FEVR with functional and genetic correlations. Design Consecutive, retrospective, observational case series. Participants Patients with FEVR treated from 2009 to 2014. Methods We identified 346 patients with FEVR. Those imaged with spectral-domain optical coherence tomography (SD OCT) with or without enhanced depth imaging (EDI) were included, and images were correlated with best-corrected visual acuity (BCVA), widefield angiography, fundus autofluorescence (AF), and wnt signaling pathway mutations. Main Outcome Measures Exploratory SD OCT findings and BCVA. Results A total of ...

Purpose To evaluate the vascular structure of eyes with macular telangiectasia type 2 (MacTel2) using volume-rendered optical coherence tomography angiography (OCTA). Design Retrospective cross-sectional study. Participants A total of 14 consecutive patients (20 eyes) with MacTel2 who had a signal strength score ≥55 and could maintain fixation during the scan process. Methods The eyes were scanned using optical coherence tomography with split-spectrum amplitude decorrelation techniques to derive flow information. Data were extracted and used to create volume-rendered images of the retinal vasculature that could be rotated about 3 different axes for evaluation. Main Outcome Measures Descriptive appraisal of the vascular ...

A 49-year-old man with history of complicated tractional retinal detachment repair presented with long-standing 20/400 visual acuity in the right eye. Ophthalmoscopy revealed subfoveal perfluorocarbon liquid (PFCL) bubbles (top left). En face optical coherence tomography (OCT; Avanti RTVue XR, Optovue, Fremont, CA) at the level of the middle retina demonstrated large areas of hyporeflectivity corresponding to the PFCL with surrounding stippled hyporeflectivity likely representing inner nuclear layer microcysts.

Purpose To describe the characteristics as well as the sensitivity and specificity of detection of choroidal neovascularization (CNV) on optical coherence tomography angiography (OCTA) using spectral-domain optical coherence tomography. Design Observational, retrospective study. Participants Seventy-two eyes of 61 subjects (48 eyes of 43 subjects with CNV, 24 eyes of 18 subjects without CNV). Methods Patients imaged using the prototype AngioVue OCTA system (Optovue, Inc, Fremont, CA) between August 2014 and October 2014 at New England Eye Center were assessed. Patients in whom CNV was identified on OCTA were evaluated to define characteristics of CNV on OCTA: size using greatest linear ...

Purpose To assess treatment efficacy using spectral-domain (SD) optical coherence tomography (OCT) measurements of papilledema in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT), which evaluated the effects of acetazolamide and weight management and of placebo and weight management in eyes with mild visual loss. Design Randomized double-masked control clinical trial of acetazolamide plus weight management compared with placebo plus weight management in subjects with mild visual field loss and previously untreated idiopathic intracranial hypertension (IIH). Participants Eighty-nine (43 acetazolamide treated, 46 placebo treated) of 165 subjects meeting IIHTT entry criteria. Methods Subjects underwent perimetry, papilledema grading (Frisén method), high- ...

Purpose To estimate the diagnostic accuracy and lead time gained by retinal nerve fiber layer (RNFL) thickness measurements from optical coherence tomography (OCT) for detecting glaucoma before the development of visual field defects. Design Observational cohort study. Participants The study group included 75 eyes of 75 patients suspected of having glaucoma. These eyes had normal standard automated perimetry (SAP) at baseline and demonstrated repeatable (3 consecutive) abnormal tests during a median follow-up of 6.3 years. A control group of 75 eyes of 75 healthy subjects matched by age and number of OCT tests during follow-up was included. Methods The ...

The ophthalmic examination of infants and children is often challenging owing to reduced cooperation; however, it is indispensable to make reliable diagnoses and prevent amblyopia and loss of vision. In this context, examination under general anesthesia is often required.

Purpose To evaluate the application of an optical coherence tomography angiography (OCTA) system adapted for the assessment of anterior segment vasculature. Design Cross-sectional, observational study. Participants Consecutive subjects with normal eyes on slit-lamp clinical examination and patients with abnormal corneal neovascularization. Methods All scans were performed using a commercially available AngioVue OCTA system (Optovue, Inc., Fremont, CA) using an anterior segment lens adapter and the split-spectrum amplitude decorrelation angiography algorithm. Each subject underwent scans from 4 quadrants (superior, inferior, nasal, and temporal) in each eye by 2 trained, independent operators. Main Outcome Measures Analysis of signal strength, image quality, and ...

Humans have main lacrimal glands and accessory lacrimal glands. The main lacrimal glands comprise the orbital and palpebral lobes, which are located in the superotemporal area of the orbit. The palpebral lobe lies below the aponeurosis of the levator palpebrae superioris and is in contact with the superior and lateral conjunctival fornices. 1 Even in healthy subjects, the palpebral lobe is seen through the conjunctiva when the eyelid is elevated. Therefore, optical coherence tomography (OCT) scanning of the exposed palpebral lobe can be used to visualize the parenchyma of the palpebral lobe just beneath the conjunctiva.

Posterior vitreous detachment (PVD) is a physiologic process that occurs with aging, having a reported incidence of 53% in patients >50 years old. 1 With advancing age, the vitreous progressively liquefies and its extracellular matrix undergoes remodeling, facilitating the eventual formation of a PVD. 1 Although usually a benign event, complications such as macular traction, macular hole, vitreous hemorrhage, retinal tears, and retinal detachment may arise.

Ocular changes in some types of the mucopolysaccharidoses (MPS) include corneal clouding, glaucoma, pigmentary retinopathy, optic disc edema, and optic atrophy. 1,2 Pigmentary retinopathy has been reported in MPS I (Hurler disease), MPS I-S (Scheie syndrome), MPS I-H/S (Hurler/Scheie), MPS II (Hunter disease), MPS III (Sanfilippo syndrome), and MPS IV A (Morquio A syndrome). 1,2 Clinical signs of retinopathy include atrophy of the retinal pigment epithelium (RPE), arteriolar narrowing, and later bone spicules.