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 ...

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 ...

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 ...

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).

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 ...

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 ...

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 ...

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 ...

A 52-year-old man was referred to our ocular oncology department for evaluating a uveal mass in his right eye. Fundus examination revealed an amelanotic, mushroom-shaped choroidal melanoma in the nasal periphery (Fig 1 A ) measuring 8 mm in diameter and 5.9 mm in thickness at B-scan ultrasonography (Fig 1B). Swept-source optical coherence tomography angiography (Fig 1 C ) (Zeiss PLEX Elite 9000) allowed a comprehensive study of the mass despite its unfavorable position and thickness with excellent visualization of its intrinsic vasculature and details comparable to indocyanine green angiography (Fig 1 D ). Seven months after stereotactic radiosurgery the patient is ...

To the Editor: We read with interest the article by Yarmohammadi et al. 1 The authors evaluated the association between vessel density measurements using optical coherence tomography angiography and the severity of visual field loss in primary open-angle glaucoma. They found a significant relationship between vessel density and severity of visual field damage. We have 2 questions. First, participants with spherical refraction within ±10 diopters were included. However, results from a recent study 2 showed that high myopia has a major influence on peripapillary vessel density and retinal nerve fiber layer thickness. Thus, to achieve more accurate conclusions, participants with ...

A 74-year-old man presented 6 hours after sudden painless vision loss in the left eye. He had finger counting vision, normal intraocular pressure, and an afferent pupillary defect. Diagnosis of central retinal artery occlusion was made. Optical coherence tomography angiography performed before (Fig 1 A , C ) and immediately after (Fig 1 B , D ) anterior chamber paracentesis showed dramatic improvement in macular perfusion. Vision was 20/70 at the 1-month visit. Optical coherence tomography at presentation showed acute inner retinal opacification (Fig 1 E ), whereas 10 months later (Fig 1 F ) it illustrated partial preservation of inner retinal laminations, which we ...

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 ...

T Purpose To evaluate the rate of thinning in ganglion cell–inner plexiform layer (GCIPL) thickness by optical coherence tomography (OCT) in glaucomatous eyes and to use a trend-based approach to determine its diagnostic ability for detecting glaucoma progression. Design Prospective, observational study. Participants Sixty-five patients with primary open-angle glaucoma with a minimum 3-year follow-up involving serial spectral-domain OCT measurement of GCIPL thickness. Methods Patients were divided into a nonprogressor group (n = 38) and a progressor group (n = 27) on the basis of serial red-free photography or visual field tests. The rates of GCIPL thinning in the global region, affected ...

Purpose Assess the role of handheld optical coherence tomography (OCT) in guiding management decisions during diagnosis, treatment, and follow-up of eyes affected by retinoblastoma. Design Retrospective, noncomparative, single-institution case series. Participants All children newly diagnosed with retinoblastoma from January 2011 to December 2015 who had an OCT session during their active treatment at The Hospital for Sick Children (SickKids) in Toronto, Canada. The OCT sessions for fellow eyes of unilateral retinoblastoma without any suspicious lesion and those performed more than 6 months after the last treatment were excluded. Methods Data collected included age at presentation, sex, family history, RB1 mutation ...

Purpose To classify eyes with primary angle closure (PAC) in terms of the features visualized using anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). Design Retrospective, observational study. Participants A total of 73 eyes of 73 patients with PAC. Methods Participants' eyes that had undergone laser peripheral iridotomy (LPI) were imaged using AS-OCT and UBM under the same lighting conditions. Anterior chamber depth, anterior chamber width, iris cross-sectional area, peripheral iris thickness, iris curvature, lens vault (LV), and angle opening distance 500 μm from the scleral spur (SS) were determined using the AS-OCT image; trabecular-ciliary process angle (TCA ...

Purpose To evaluate the features of acute retinal pigment epitheliitis (ARPE) at onset and in the course of recovery by serial spectral-domain optical coherence tomography (SD OCT) and the correlation to visual acuity (VA). Design Retrospective cohort study. Participants Consecutive patients with ARPE. Methods A review of medical records was performed. Main Outcome Measures Integrity of SD OCT retinal bands at onset and in the course of disease, time required to achieve each retinal band restoration, corresponding VA change, and final VA. Results Four patients were included. Initial SD OCT showed a dome-shaped hyper-reflective lesion at the photoreceptor outer segment ...

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 ...