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 ...

A 7-year-old boy presented with decreased vision in the right eye to 20/300. He had longstanding 20/400 vision in the left eye due to a congenital scar. His examinations revealed right anterior chamber and vitreous inflammation, as well as optic disc and macular edema with diffuse irregular retinal pigmentation.

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.

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.

Identification and characterization of patients with diabetic macular edema (DME) are important for individualizing treatment and optimizing outcome. We investigated optical coherence tomography (OCT) biomarkers for DME treated by intravitreal dexamethasone (DEX) implant.

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 ...

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 ...

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).

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 ...

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 ...

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 ...

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.

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 ...