Purpose. To study posterior choroidal thickness and its profile based on location in healthy Japanese subjects and the correlation with axial length, refractive error (RE), and age. Methods. Eighty-six eyes of 43 healthy volunteers with no ophthalmic or systemic symptoms were examined with prototype high-penetration optical coherence tomography using a 1060-nm light source. Eyes with high myopia (exceeding -6 D) or with retinal/choroidal disease were excluded. The spherical equivalent RE was measured by autorefractometry, and the axial length was measured by partial coherence inferometry. Results. Mean choroidal thicknesses were 354 +/- 111 mum at the fovea, 364 +/- 86 mum superiorly, 345 +/- 108 mum inferiorly, 227 +/- 532 mum nasally, and 337 +/- 102 mum temporally. Subfoveal choroidal thickness was significantly greater than nasal (P < 0.01) and temporal (P < 0.05) choroidal thickness; however, there was no significant difference compared with superior (P = 0.20) and inferior (P = 0.17) choroidal thickness. The temporal choroid was significantly (P < 0.01) thicker than the nasal choroid, and the inferior choroid was significantly (P < 0.01) thinner than the superior choroid. There was a significant negative correlation between foveal choroidal thickness and axial length (P < 0.05) but a borderline correlation with the RE (P = 0.086) and age (P = 0.07). Age was the factor that was most associated with the choroidal thickness (F = 20.86; P < 0.001), followed by RE (F = 5.37; P < 0.05); axial length was not a significant factor (F = 1.47; P = 0.22) by stepwise analysis. Conclusions. The profile of choroidal thickness depends on its location. RE, axial length, and especially age are critical for evaluation of choroidal thickness.

Choroidal thickness in healthy Japanese subjects.

PURPOSE The measurement reproducibility of the third generation of commercial optical coherence tomography, OCT-3 (StratusOCT, software ver. A2, Carl Zeiss Meditec Inc., Dublin, CA) was investigated. The nerve fiber layer (NFL) thickness, macula thickness map, and optic nerve head (ONH) parameters in normal eyes were studied. METHODS Ten normal subjects were imaged six times (three before and three after dilation) per day, and the series was repeated on three different days. The order of the scans before pupil dilation was randomized in each of the 3 days of scanning. After pupil dilation, the scans were also randomized in each of the 3 days of scanning. Each series was performed separately for standard-density (128 A-scans per macular and ONH image and 256 A-scans per NFL image) and high-density (512 A-scans per image for all three scan types) scanning. RESULTS The mean macular thickness was 235 +/- 9.8 micro m. A-scan density (or image acquisition speed) had a statistically significant effect (P < 0.05) on the reproducibility of the mean macular thickness, macular volume, and a few sectors of the macular map. No significant dilation effect was found for any of the macular parameters. The best intraclass correlation coefficient (ICC; 94%) for macular scans was found for dilated high-density scanning, with an intervisit SD of 2.4 micro m and an intravisit SD of 2.2 micro m. The mean NFL thickness for standard scanning was 98 +/- 9 micro m. NFL reproducibility showed mixed results and had interactions between scan density and dilation for some parameters. For most of the NFL parameters, reproducibility was better with dilated standard-density scanning. The mean NFL thickness ICC for dilated standard scanning was 79%, with an intervisit SD of 2.5 micro m and an intravisit SD of 1.6 micro m. For the ONH analysis, the reproducibility was better for dilated standard-density scanning for almost all the parameters, except for disc area, horizontal integrated rim volume, and vertical integrated rim area, which were better before dilation. The best reproducibility was found for cup-to-disc ratio (ICC = 97%, with intervisit SD of 0.04 micro m and intravisit SD of 0.02 micro m). CONCLUSIONS StratusOCT demonstrated reproducible measurements of NFL thickness, macular thickness, and optic nerve head parameters. The best reproducibility was found for dilated standard scanning for NFL and ONH parameters and for dilated high-density scanning for macular parameters.

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Reproducibility of nerve fiber thickness, macular thickness, and optic nerve head measurements using StratusOCT.

Optical coherence tomography to detect and manage retinal disease and glaucoma.

Subjects and Methods: Forty-one patients with early to moderate glaucomatous visual field loss and 50 healthy subjects were included in the study. The HRT, GDx, and OCT imaging and visual field testing were completed on 1 eye from each subject within a 6-month interval. Statisticaldifferencesinsensitivityatfixedspecificitiesof85%,90%, and 95% were evaluated. In addition, areas under the receiver operating characteristic (ROC) curve were compared. Results: No significant differences were found between the area under the ROC curve and the best parameter from each instrument: OCT thickness at the 5-o’clock inferior temporal position (mean ±S E, 0.87 ±0 .04), HRT mean height contour in the nasal inferior region (mean±SE, 0.86 ±0 .04), and GDx linear discriminant function (mean±SE, 0.84±0.04). Twelve HRT, 2 GDx, and 9 OCT parameters had an area under the ROC curve of at least 0.81. At a fixed specificity of 90%, significant differences were found between the sensitivity of OCT thickness at the 5-o’clock inferior temporal position (71%) and parameters with sensitivities less than 52%. Qualitative assessment of stereophotographs resulted in a sensitivity of 80%. Conclusion: Although the area under the ROC curves was similar among the best parameters from each instrument, qualitative assessment of stereophotographs and measurements from the OCT and HRT generally had higher sensitivities than measurements from the GDx.

/pdf/discriminating-between-normal-and-glaucomatous-eyes-using-ti9qaprnhg.pdf

Discriminating between normal and glaucomatous eyes using the Heidelberg Retina Tomograph, GDx Nerve Fiber Analyzer, and Optical Coherence Tomograph.

In the past decade we have observed a rapid development of ultrahigh-speed optical coherence tomography (OCT) instruments, which currently enable performing cross-sectional in vivo imaging of biological samples with speeds of more than 100,000 A-scans/s. This progress in OCT technology has been achieved by the development of Fourier-domain detection techniques. Introduction of high-speed imaging capabilities lifts the primary limitation of early OCT technology by giving access to in vivo three-dimensional volumetric reconstructions on large scales within reasonable time constraints. As result, novel tools can be created that add new perspective for existing OCT applications and open new fields of research in biomedical imaging. Especially promising is the capability of performing functional imaging, which shows a potential to enable the differentiation of tissue pathologies via metabolic properties or functional responses. In this contribution the fundamental limitations and advantages of time-domain and Fourier-domain interferometric detection methods are discussed. Additionally the progress of high-speed OCT instruments and their impact on imaging applications is reviewed. Finally new perspectives on functional imaging with the use of state-of-the-art high-speed OCT technology are demonstrated.

High-speed optical coherence tomography: basics and applications.

Optical coherence tomography (OCT) is a novel technique that allows cross-sectional imaging of the anterior and posterior eye. OCT has a resolution of approximately 10 microns, with extremely high sensitivity (approximately 10(-10) of incident light). OCT is analogous to computed tomography, which uses x-rays, magnetic resonance imaging, which uses spin resonance, or B-scan ultrasound, which uses sound waves, but OCT uses only light to derive its image. OCT is a noncontact, noninvasive system by which retinal substructure may be analyzed in vivo. OCT is useful in the evaluation of retinal pathologies and glaucoma. In retinal disease, entities such as macular holes, macular edema, central serous chorioretinopathy, retinal vascular occlusion and other factors have been examined. Separation between the posterior vitreous and retina, or lack thereof, are seen and quantitated. In glaucoma, retinal nerve fiber layer (NFL) thickness is measured at standardized locations around the optic nerve head. A circular scan produces a cylindrical cross-section of the retina, from which the NFL can be analyzed. In addition, radial scans through the optic nerve head are used to evaluate cupping and juxtapapillary NFL thickness. OCT, a new imaging technology by which the anterior and posterior segment are seen in cross-section, may permit the early diagnosis of glaucoma, and the early detection of glaucomatous progression.

Adarsh V. Arya

Papers

Optical coherence tomography: a new tool for glaucoma diagnosis.