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    1. Detecting Structural Progression in Glaucoma with Optical Coherence Tomography

      Detecting Structural Progression in Glaucoma with Optical Coherence Tomography

      Optical coherence tomography (OCT) is increasingly used to obtain objective measurements of the retinal nerve fiber layer (RNFL), optic nerve head, and macula for assessing glaucoma progression. Although OCT has been adopted widely in clinical practice, uncertainty remains concerning its optimal role. Questions include: What is the best structure to measure? What quantity of change is significant? Are structural changes relevant to the patient? How are longitudinal measurements affected by aging? How can changes resulting from aging be differentiated from true progression? How best should OCT be used alongside visual fields, and how often should OCT be performed? Recent studies ...

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    2. The Promise of Optical Coherence Tomography Angiography in Glaucoma

      The Promise of Optical Coherence Tomography Angiography in Glaucoma

      Optical coherence tomography angiography (OCTA) studies in primary open-angle glaucoma have consistently demonstrated reduced microcirculation in the superficial optic nerve, 1 peripapillary retina, 2 , 3 and the macula 4 , 5 of glaucoma patients. These studies clearly demonstrate the superior resolution of OCTA compared with prior methods that were used to measure ocular blood flow (OBF) or its surrogates. How will OCTA help the glaucoma clinician now and in the future? What else must we learn before achieving more practical usefulness from OCTA for glaucoma? First, OCTA will supplement current glaucoma diagnostic tools to aid in the early detection of glaucoma ...

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    3. Infrared Pupillometry Using an Optical Coherence Tomography Scanner

      Infrared Pupillometry Using an Optical Coherence Tomography Scanner

      Assessing pupil size can be challenging in dim light, especially in dark brown eyes. This evaluation is facilitated by the infrared camera of the Heidelberg Spectralis Optical Coherence Tomography (OCT) system (Heidelberg Engineering, Heidelberg, Germany), which gives a bright pupillary reflex. Figure 1 shows a 67-year-old woman with metastatic breast cancer. Her pupils were difficult to see clinically (Fig 1 A ), and flash photography before (Fig 1 B ) and after (Fig 1 C ) 0.5% apraclonidine drops did not show reversal of her anisocoria very clearly. Using the Spectralis system it was much easier to see that her anisocoria was ...

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    4. Cellular Characterization of Optical Coherence Tomography and Outer Retinal Bands Using Specific Immunohistochemistry Markers and Clinical Implications

      Cellular Characterization of Optical Coherence Tomography and Outer Retinal Bands Using Specific Immunohistochemistry Markers and Clinical Implications

      Purpose Optical coherence tomography has been a technological breakthrough in the diagnosis, treatment, and follow-up of many ocular diseases, especially retinal and neuro-ophthalmologic pathologic conditions. Until now, several controversies have arisen over the specific cell types that the bands observed in the OCT represent, especially over the 4 outer retinal bands. Design To correlate the 4 outer hyperreflective bands observed in the OCT with the histologic structures using human retinal sections and immunocytochemistry at the fovea level. Participants Eyes from human donors. Methods Vertical cryosections of human retinas were immunostained with antibodies specific for cones photoreceptors, bipolar cells, mitochondria, M ...

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    5. Re: Kwon et al.: Subclassification of primary angle closure using anterior segment optical coherence tomography and ultrasound biomicroscopic parameters (Ophthalmology. 2017;124:1039-1047)

      Re: Kwon et al.: Subclassification of primary angle closure using anterior segment optical coherence tomography and ultrasound biomicroscopic parameters (Ophthalmology. 2017;124:1039-1047)

      To the Editor: We read with interest the article by Sung et al. 1 In this observational study, the authors concluded that the most distinct difference between the 2 subgroups in the cluster analysis was trabecular–ciliary process angle (TCA) and that the position of the ciliary body is important in subclassifying primary angle closure. However, there are several limitations that may affect the results. First, in the study, the authors reported that gonioscopy and image analysis using ImageJ was all conducted by a single researcher. These 2 measurements, however, both can be influenced by observers' subjectivity. To reduce influence ...

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    6. Intraoperative Optical Coherence Tomography of Internal Limiting Membrane Flap

      Intraoperative Optical Coherence Tomography of Internal Limiting Membrane Flap

      A 66-year-old woman with a 450-μm diameter macular hole (MH) in her right eye underwent vitrectomy, internal limiting membrane (ILM) peel with inverted ILM flap, and perfluoropropane (C3F8) gas tamponade. Inverted ILM flaps may improve outcomes for holes larger than 400 μm; however, confirming proper ILM placement is difficult after air-fluid exchange.

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    7. Cilioretinal Artery Imaged with Optical Coherence Tomography Angiography

      Cilioretinal Artery Imaged with Optical Coherence Tomography Angiography

      A 48-year-old woman presented with peripapillary chorioretinal atrophy and cilioretinal artery in the left eye without other findings (Fig 1A). Optical coherence tomography angiography (OCTA) through full-thickness retinal segmentation (Fig 1B) showed intact retinal perfusion. The cilioretinal artery arose from the temporal margin of the optic nerve and coursed into the retina, resembling a hook.

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    8. Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

      Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

      Purpose Appearance of geographic atrophy (GA) on color photography (CP) is preceded by specific features on spectral-domain optical coherence tomography (SD OCT). We aimed to build SD OCT–based risk assessment models for 5-year new onset of GA and central GA on CP. Design Prospective, longitudinal study. Participants Age-Related Eye Disease Study 2 Ancillary SD OCT study participants with age-related macular degeneration (AMD) with bilateral large drusen or noncentral GA and at least 1 eye without advanced disease (n = 317). Methods For 1 eye per participant, qualitative and quantitative SD OCT variables were derived from standardized grading and semiautomated segmentation ...

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    9. Retinal Loop Vessel Captured with Optical Coherence Tomography-Angiography

      Retinal Loop Vessel Captured with Optical Coherence Tomography-Angiography

      A 50-year-old woman with a history of rheumatoid arthritis and macular hydroxychloroquine toxicity presented for a routine eye examination. An incidental loop vessel of the inferior prepapillary arteriole was readily apparent on examination (Fig 1 A ). Three-dimensional optical coherence tomography (OCT; Avanti, Optovue, Fremont, CA) demonstrated the elevation of this vessel into the vitreous (Fig 1 B ). The vessel was also captured on OCT-angiography (Fig 1 C ) with segmentation of the superficial retina and vitreous interface demonstrated by the B-scan image (inset). Retinal loop vessels are a common incidental finding on ophthalmic examination, but they can also be associated with ...

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    10. Optical Coherence Tomography Imaging of a Large Spherical Seed in Retinoblastoma

      Optical Coherence Tomography Imaging of a Large Spherical Seed in Retinoblastoma

      The clinical applications of handheld optical coherence tomography (OCT) imaging (Bioptigen, Morrisville, NC) for retinoblastoma continue to evolve and include characterization of small tumors, tumor recurrences, evaluation of seeding, and retinal anatomy. OCT was performed at staging examination of the left eye in a 13-month-old child diagnosed with bilateral retinoblastoma (Group C right eye, Group D left eye) demonstrated normal foveal architecture, preretinal dusting of small hyper-reflective seeds, and a hollow reflective cystic structure floating above the retina, with shadowing posteriorly, which correlated clinically with a large translucent spherical seed in the vitreous cavity (Fig 1, asterisk).

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      Mentions: Bioptigen
    11. Retinal Loop Vessel Captured with Optical Coherence Tomography-Angiography

      Retinal Loop Vessel Captured with Optical Coherence Tomography-Angiography

      A 50-year-old woman with a history of rheumatoid arthritis and macular hydroxychloroquine toxicity presented for a routine eye examination. An incidental loop vessel of the inferior prepapillary arteriole was readily apparent on examination (Fig 1 A ). Three-dimensional optical coherence tomography (OCT; Avanti, Optovue, Fremont, CA) demonstrated the elevation of this vessel into the vitreous (Fig 1 B ). The vessel was also captured on OCT-angiography (Fig 1 C ) with segmentation of the superficial retina and vitreous interface demonstrated by the B-scan image (inset). Retinal loop vessels are a common incidental finding on ophthalmic examination, but they can also be associated with ...

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    12. Projection-Resolved Optical Coherence Tomography Angiography of Macular Retinal Circulation in Glaucoma

      Projection-Resolved Optical Coherence Tomography Angiography of Macular Retinal Circulation in Glaucoma

      Purpose To detect macular perfusion defects in glaucoma using projection-resolved optical coherence tomography (OCT) angiography. Design Prospective observation study. Participants A total of 30 perimetric glaucoma and 30 age-matched normal participants were included. Methods One eye of each participant was imaged using 6 × 6–mm macular OCT angiography (OCTA) scan pattern by 70-kHz 840-nm spectral-domain OCT. Flow signal was calculated by the split-spectrum amplitude-decorrelation angiography algorithm. A projection-resolved OCTA (PR-OCTA) algorithm was used to remove flow projection artifacts. Four en face OCTA slabs were analyzed: the superficial vascular complex (SVC), intermediate capillary plexus (ICP), deep capillary plexus (DCP), and all-plexus ...

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    13. Objective Quantification of Anterior Chamber Inflammation

      Objective Quantification of Anterior Chamber Inflammation

      Purpose To assess the ability of swept-source (SS) optical coherence tomography (OCT) of the anterior segment (AS) to measure anterior chamber (AC) inflammation (both flare and cells) objectively. To compare OCT-derived inflammatory indices with standard techniques. Design Prospective evaluation of a diagnostic test. Participants Patients diagnosed with anterior uveitis (active or inactive) and controls. Methods Participants underwent an AC inflammation evaluation including: clinical cell and flare grading and laser flare photometry (LFP). Uveitis patients were divided into active or inactive uveitis status according to clinical grading. Anterior segment SS-OCT scans were obtained for each participant. Tomographic images were analyzed to ...

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    14. Dynamic Change in Optic Nerve After Intracranial Pressure Reduction in Children

      Dynamic Change in Optic Nerve After Intracranial Pressure Reduction in Children

      Advances in optical coherence tomography (OCT) have enabled researchers to obtain in vivo information regarding the lamina cribrosa (LC) in a noninvasive manner. We used swept-source OCT (SS-OCT) to investigate the dynamic changes in deep anterior optic nerve head (ONH) structures after surgical decompression for increased intracranial pressure (IICP) in pediatric patients.

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    15. Ganglion Cell–Inner Plexiform Layer Change Detected by Optical Coherence Tomography Indicates Progression in Advanced Glaucoma

      Ganglion Cell–Inner Plexiform Layer Change Detected by Optical Coherence Tomography Indicates Progression in Advanced Glaucoma

      Purpose To examine the performance of Guided Progression Analysis (GPA; Carl Zeiss Meditec, Dublin, CA) in spectral-domain optical coherence tomography (OCT) in detecting progressive thinning of ganglion cell–inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) in glaucoma. Design Longitudinal, observational study. Participants A total of 196 eyes of 123 primary open-angle glaucoma patients (mean follow-up, 5.0 years). Methods Macular GCIPL and peripapillary RNFL thicknesses were measured by Cirrus HD-OCT (Zeiss, Dublin, CA), and progressive GCIPL and RNFL thinning were assessed by GPA. The reference standard of glaucoma progression was determined by visual field (VF) progression. Glaucomatous ...

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    16. RE: Traber et al.: Enhanced depth imaging optical coherence tomography of optic nerve head drusen: a comparison of cases with and without visual field loss (Ophthalmology. 2017;124:66-73)

      RE: Traber et al.: Enhanced depth imaging optical coherence tomography of optic nerve head drusen: a comparison of cases with and without visual field loss (Ophthalmology. 2017;124:66-73)

      To the Editor: We read with interest the study by Traber et al, where the presence or absence of visual field defects was correlated with optic nerve head drusen (ONHD) morphology. 1 The ONHD were classified using enhanced depth imaging optical coherence tomography (OCT) morphologic characteristics as either peripapillary, granular, or confluent. The hyperreflective structures classified as peripapillary ONHD in the present study have previously been labeled as ONHD 2 ; however, we do not find substantial evidence for this suggestion. First, we regularly see similar hyperreflective mass-like peripapillary changes in OCT volume scans of patients with papilledema from idiopathic intracranial ...

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    17. Re: Goto et al.: Prediction of postoperative intraocular lens position with angle-to-angle depth using anterior segment optical coherence tomography (Ophthalmology. 2016;123:2474-2480)

      Re: Goto et al.: Prediction of postoperative intraocular lens position with angle-to-angle depth using anterior segment optical coherence tomography (Ophthalmology. 2016;123:2474-2480)

      To the Editor: We read with interest the study by Goto et al, 1 who described a new formula to predict the postoperative position of the intraocular lens (IOL). Although their results are interesting and might be useful for IOL power calculation, we feel that some comments are necessary. First, comparing what they define as the “postoperative external anterior chamber depth,” either measured or predicted by anterior segment optical coherence tomography, to the IOL position, as predicted by thin lens formulas, is not the proper method. The measurements performed by the authors, in fact, refer to a thick lens system ...

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      Mentions: Giacomo Savini
    18. Profound Macular Ischemia on Optical Coherence Tomography Angiography in Severe Diabetic Retinopathy

      Profound Macular Ischemia on Optical Coherence Tomography Angiography in Severe Diabetic Retinopathy

      A 24-year-old woman with type I diabetes mellitus with significant macular ischemia in her left eye with a large net of neovascularization of the disc (Fig 1A). There is profound retinal capillary nonperfusion contrasting with perfusion of the neovascularization of the disc demonstrated on a full thickness 6×6-mm optical coherence tomography−angiography scan (Fig 1B), using Angiovue software (Optovue, Inc. Fremont, CA).

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      Mentions: Optovue
    19. Evaluation of Femtosecond Laser Intrastromal Incision Location Using Optical Coherence Tomography

      Evaluation of Femtosecond Laser Intrastromal Incision Location Using Optical Coherence Tomography

      Purpose To use optical coherence tomography (OCT) to evaluate the femtosecond laser intrastromal incisions made during cataract surgery to reduce corneal astigmatism. Design Retrospective case series. Participants Seventy-seven eyes of 77 patients. Methods Paired intrastromal incisions were created using the Catalys femtosecond laser (Abbott Medical Optics, Inc., Santa Ana, CA). The planned intrastromal incision parameters were 20% uncut anterior, 20% uncut posterior, midpoint depth of 50%, and 90° side cut angle. Optical coherence tomography scans were obtained 3 weeks or more after surgery to assess these 4 parameters, and actual values were compared with intended values. Main Outcome Measures Percentages ...

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    20. Diagnostic Accuracy of Spectralis SD OCT Automated Macular Layers Segmentation to Discriminate Normal from Early Glaucomatous Eyes

      Diagnostic Accuracy of Spectralis SD OCT Automated Macular Layers Segmentation to Discriminate Normal from Early Glaucomatous Eyes

      Purpose To evaluate the accuracy of the macular retinal layer segmentation software of the Spectralis spectral-domain (SD) optical coherence tomography (OCT) device (Heidelberg Engineering, Inc., Heidelberg, Germany) to discriminate between healthy and early glaucoma (EG) eyes. Design Prospective, cross-sectional study. Participants Forty EG eyes and 40 healthy controls were included. Methods All participants were examined using the standard posterior pole and the peripapillary retinal nerve fiber layer (pRNFL) protocols of the Spectralis OCT device. Using an Early Treatment Diagnostic Retinopathy Study circle at the macular level, the automated retinal segmentation software was applied to determine thicknesses of the following parameters ...

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    21. Choroidal Imaging with Swept-Source Optical Coherence Tomography in Patients with Birdshot Chorioretinopathy

      Choroidal Imaging with Swept-Source Optical Coherence Tomography in Patients with Birdshot Chorioretinopathy

      Purpose To characterize choroidal thickness and choroidal reflectivity in the eyes of patients with birdshot chorioretinopathy (BSCR). Design Cross-sectional observational study. Participants Two hundred twenty BSCR patients and 59 healthy controls. Methods Patients with BSCR and healthy controls underwent imaging of the macula in both eyes with a swept-source optical coherence tomography device (DRI-OCT1 Atlantis; Topcon). Images were exported from the device, and analysis was performed by 2 graders in the Doheny Image Reading Center using Image J software. The choroidal thickness at the foveal center was measured. In addition, the inner and outer boundaries of the choroid and retinal ...

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    22. Parapapillary Choroidal Microvasculature Dropout in Glaucoma A Comparison between Optical Coherence Tomography Angiography and Indocyanine Green Angiography

      Parapapillary Choroidal Microvasculature Dropout in Glaucoma  A Comparison between Optical Coherence Tomography Angiography and Indocyanine Green Angiography

      Purpose To investigate whether the parapapillary choroidal microvasculature dropout (MvD) determined by optical coherence tomography angiography (OCTA) in glaucomatous eyes indicates a true perfusion defect and whether the MvD accurately represents the area of nonperfusion. Design Observational case series. Participants Thirty primary open-angle glaucoma (POAG) patients with choroidal MvD as determined by OCTA and 13 POAG patients without this dropout. Methods Peripapillary circulation was evaluated using both OCTA and indocyanine green angiography (ICGA). For OCTA, the choroidal microvasculature was evaluated using 4.5×4.5-mm choroid–disc vessel density maps of OCTA images of the optic nerve head. An MvD ...

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