OCT Macula

Presenter: Dr. Md. As-Aad Habib

MS Ophthalmology resident, Phase B
Moderator: Dr. Liza, MS resident, Phase B
Chairperson: Prof. Dr. Mostak Ahmed
Professor and Head
Department of Ophthalmology
DMCH
 Definition
• Optical coherence tomography (OCT) is a non-
invasive, non-contact imaging system
providing high resolution cross-sectional
images of the retina and anterior segment.

• It is an optical analogue to ultrasound

imaging, using near-infrared light
interferometry instead of sound.
Basic principle of OCT
 Wavelength
• The distance over which the wave shape
repeats.
 Frequency
• It is the number of occurrences of a repeating
event per unit of time.
• Wavelength is inversely proportional to
frequency.
 Coherence
• Coherence describes the
ability of light to produce
interference phenomena.
• In physics two waves are
coherent if they have a
constant phase difference
and same frequency and
are non coherent if there
is a constant changing
phase difference.
 Interference
• It reveals the correlation between light waves

• Occurs when 02 light waves are brought together

(superposition of waves) and depending on their
relative phase they can-
• Reinforce each other and result in a wave of greater
amplitude (i.e., constructive or additive interface)
• Subtract from each other and result in a wave of lower
amplitude (destructive or subtractive interface)
• Fig A: Waves overlap in phase –
peeks coincide with peeks and
troughs with troughs -
producing a resultant wave of
twice the amplitude.

• Fig B: Waves overlap out of

phase – peek of one wave
coincide with trough of the
other – and the waves cancel.

• Fig C: Waves partially overlap –

neither completely in or out of
phase – producing a wave of
intermediate amplitude.
 Basic principle of OCT
• It utilizes –
Interferometry, and
Low-coherence light , in near-infrared range.

• A broadband width near-infrared light

(820nm) is projected.
• The beam is split to the tissue of
interest (say retina), called as probe
beam, and to a reference mirror at a
known variable position (reference
beam)

• The light is reflected back from the

boundaries between the
microstructures and is also
scattered differently from tissues
with different optical properties.

• The echo time delay from various

layers of retina is compared with
echo time delay of light reflected
from reference mirror.
• A positive interference is produced
when light reflected from retina and
the reference mirror arrives
simultaneously or within short
coherence length of each other.

• This interference is measured by a

photodetector which finally produces
a range of time delays for comparison.

• The interferometer integrates several

data points over 2mm of depth to
construct a tomogram of retinal
structures. It is a real time tomogram
using false color scale. Different colors
represent light backscattering from
different depths of the retina.
Different types of OCT
 Time domain OCT
• In TD-OCT, a mirror in the reference
arm of the interferometer is moved to
match the delay in various layers of
the sample.
• The resulting interference signal is
processed to produce the axial scan
wavefrom.
• The reference mirror must move one
cycle for each axial scan. The need for
mechanical movement limits the
speed of image acquisition.
• Furthermore, at each moment the
detection system only collects signal
from a narrow range of depth in the
sample. This serial axial scanning in
inefficient.
 Spectral domain OCT (Fourier domain)
• In SD-OCT, the reference mirror is
kept static. The spectral pattern of the
interference between the sample and
reference reflections is measured.

• The spectral interferogram is Fourier

transformed to provide an axial scan.
The absence of moving parts allows
the image to be acquired very rapidly.

• Furthermore, reflections from all

layers in the sample are detected
simultaneously. This parallel axial scan
is much more efficient, resulting in
both greater speed and higher signal-
to-noise ratio.
 Newer OCTs
• Enhanced depth imaging
• En face OCT
• Time-encoded frequency domain OCT (Swept-source
OCT)
• Adaptive optics OCT
 The OCT machine
The OCT system comprises of
the following-

• Fundus viewing unit

• Interferometric unit
• Computer display
• Control panel, and
• Color inkjet printer
 Generations
Generations of commercially available OCT machine
include:
• OCT 1, i.e. 1st generation of OCT machine has a
transverse and axial resolution of 20 and 10 micron,
respectively.
• OCT 2, i.e. 2nd generation OCT machine has a similar
resolution as OCT 1 but with an improved user
interface.
• OCT 3, i.e. 3rd generation OCT unit has improved axial
resolution of 7-8 micron and acquires 512 vertical
scans.
 Color coding in OCT
• Highly reflective structures are shown in bright
colors (white and red):
• Nerve fiber layer
• Retinal pigment epithelium
• Junction of the inner and outer segments (called outer
segment ellipsoid zone)
• Low reflectivity structures are represented by dark
colors (black and blue).
• Intermediate reflectivity is shown green to yellow.
OCT scan protocols in macula

• Line
• Circle
• Radial lines
 Line scan
• Multiple line scans can be acquired
without returning to main window.

• Default angle is 0 degree.

• Default length is 5mm.

• Length and angle can be altered to

acquire multiple scans of different
parameter.

• If length of the scan is increased,

resolution decreases.
 Circle scan
• Scans in a circle instead
of a line.
 Radial lines
• Consists of 6-24 equally
spaced line scans that pass
through a central common
axis.

• Length of these line scans can

be changed depending upon
the desired size of the circle.

• Useful for acquiring macular

scan and retinal
thickness/volume analysis.
 Fast macular thickness scan
• Quick protocol, takes only
1.92s.

• 06 scans of 06mm length

each are acquired, these are
equally spaced, 30 ° apart.

• When scanning the macula,

the patient simply looks at
the fixation target.
 Other protocols
• Raster lines:
• Provides option of acquiring series of lines that are parallel,
equally spaced and 6-24 in number.
• These multiple line scans can be placed over a rectangular region,
it can be adjusted to cover the whole area of pathology.
• Useful for- Choroidal neovascular membrane

• Repeat scan:
• Repeats previously saved scans.

• 3D scan:
• 3D volumetric analysis.
 Procedure
• Activation of the machine and entering the patient’s
data.
• Patient’s pupils are dilated.
• Patient is seated comfortably.
• The patient is asked to look into the target light in
the ocular lens.
• Discouraged to blink.
• Selection of required protocol and moving on with
the procedure.
 Interpretation of OCT (macula)
• Vitreo retinal interface
• Foveal contour
• Retinal architecture
• Uniformity of RPE-
Choriocapillary complex
• Choroid
 Vitreous and VR interface
• Vitreous (hypo-reflective space)
• Premacular bursa (hypo-reflective layer in front of
the macula)
• Posterior hyloid (hyper-reflective continuous line)
Interpretation of normal OCT (macula)
 Inner retinal layers
• Inner retinal layers appear as hypo- and hyper-
reflective bands:

• Inner limiting membrane – Hyper-reflective

• Nerve fiber layer – Hyper-reflective
• Ganglion cell layer – Hypo-reflective
• Inner plexiform layer – Hyper-reflective
• Inner nuclear layer – Hypo-reflective
• Outer plexiform layer – Hyper-reflective
• Outer nuclear layer – Hypo-reflective
 Outer retinal layers
Outer retinal layers appear as four distinct hyper-
reflective bands:

• External limiting membrane

• Ellipsoid zone
• Interdigitation zone
• Retinal pigment epithelium/ Bruch’s membrane complex
• External limiting membrane:
• Located at the boundary between the cell bodies
(nuclei) and the inner segmengts of photreceptors
• Comprises clusters of junctional complexes between
the Mullar cells and the photoreceptors

• Ellipsoid zone:
• Previously referred to as the photoreceptor inner
segment/ outer segment (IS/OS) junction.
• Now it is thought to be formed mainly by mitochondria
within the ellipsoid layer of the outer portion of the
inner segments of photoreceptors.
• Interdigitation zone:

• Contact cylinder represented by the apices of the RPE

cells that encase part of the cone outer segment.

• Previously referred to as cone outer segment tips or rod

outer segment tips, and now it is not always
distinguishable from the underlying RPE layer, even in
normal subjects.
• RPE-Bruch’s membrane complex:

• The retinal pigment epithelium band is formed by the

RPE and Bruch’s membrane (indistinguishable from
each other in a normal state using current SD-OCT
system)

• In the fovea this band is thicker, which indicates that

choroidal structures may also contribute to the hyper-
reflectivity of the RPE band at this location.
 Choroid

• Choriocapillaries ( capillaries adjacent to Bruch’s

membrane)
• Sattler’s layer (medium and small-sized vessels of the
choroid)
• Haller’s layer (outer choroidal layer containing large
choroidal vessels)
 Abnormalities detected in OCT
(Macula)

• Pre-retinal
• Intra-retinal
• Sub-retinal
• Choridal
 Pre-retinal
• Epiretinal membrane
• Vitreomacular traction
• Macular holes
• Lamellar holes
• Pseudo-hole
• Macular cyst
 Epiretinal membrane
• It is a result of proliferation of abnormal tissue on the
surface of the retina.
• Semitranslucent
• Proliferates on the surface of internal limiting
membrane
• Consists of glial cells, RPE cells, macrophages,
fibrocytes and collagen fibers.
• On OCT – appears as a highly reflective, thick
membrane on the surface of the retina.
• It’s reflectivity is more than posterior hyloid.
 Vitromacular traction
• Defines as the presence of retinal changes on OCT
with evident perifoveal (within 3mm) PVD.
 Macular holes

• A – Normal.

• B – Vitreomacular traction

• C – Small full thickness

macular hole with VMT
 Macular holes

• D – Large FTMH with VMT

• E – Large FTMH without

VMT but with operculum

• F – After surgical closure of

FTMH
 Lamellar hole
• Partial thickness defect of the inner retina at the
fovea but with maintenance of an intact
photoreceptor layer.
 Macular pseudo-hole
• Mimics the clinical appearance of FTMH
• No loss of retinal tissue
• Near normal foveal thickness
• Intact photoreceptor layer
 Intraretinal
• Macular oedema
• Retinal exudates
 Macular oedema
• Characterized by intraretinal areas of decreased
reflectivity and retinal thickening.

• Round, optically clear areas within the neurosensory

retina are noted in cystoid macular oedema,

• Quantitative measurement of retinal thickness can

be used to monitor the course of macular oedema
secondary to various causes.
 Macular oedema
• OCT can aid in differentiating the cause of
macular oedema by identifying cystic spaces in
CME or by visualizing the posterior hyloid in
case of VMT.
 Retinal exudates
• On OCT, exudative lesions appear as highly reflective
areas that cause a shadowing effect of the underlying
retinal layers.
 Subretinal
• Subretinal fluid
• Pigment epithelial detachment
• RPE tear
 Subretinal fluid
• Causes a separation of neurosensory retina from the
underlying RPE.

• On OCT, an optically empty space can be seen between the

detached retina and RPE. The cavity is filled with serous fluid.

• Casues -
o Retinal detachment
o Central serous chorioretinopathy
o Choroidal neovascular membrane.
 Pigment epithelium detachment
• A pigment epithelium detachment occurs by
the separation of RPE from Bruch’s membrane
because of the presence of sub-RPE fluid,
blood, fibrovascular membrane or drusenoid
material.
• Serous PED:
• On OCT, an optically empty area separates the RPE from the
Bruch’s membrane.

• Drusenoid PED :
• Homogenous hyper-reflectivity within the PED, in contrast to
optically empty serous PED. There is commonly no sub-retinal
fluid.
 RPE tear
• Potentially devastating complication of PED.

• Occurs at the junction of attached and detached PED

.
• Caused by contraction and retraction of the elevated
PED, leading to absence of RPE underneath the
neurosensory retina.

• OCT – Loss of normal dome shape of the PRE layer in

the PED, with hyper-reflectivity of the folded RPE.
 Choroidal pathology
• Choroidal neovascularization:

• CNV is shown as a thickening or fragmentation of the

RPE and choriocapillaries. Subretinal and sub-RPE fluid,
blood and scarring are demonstrated. Outer retinal
tubulation ay be present.

• On OCT, the classification is based on location of the

pathology.
 Artifacts
• TD-OCT:
• Motion artifacts are commonly encountered.
• Related to errors in acquisition or interpretation.
• Acquisition errors are caused by – speed of obtaining
the image, presence of media opacities or optical
aberrations.

• SD-OCT:
• Motion artifacts are minimized compared to TD-OCT.
• Acquisition artifacts can still occur due to poor
centration of the image of presence of media opacities.
 Advantages of OCT
• Non-invasive
• Non-contact
• Easy to operate
• Short scanning time
• Minimal cooperation needed
• Best axial resolution available so far
• Tissue sections comparable to histopathology
sections
• Scans various ocular structures
 Limitations of OCT
• Penetration depth of OCT is limited
• Limited by media opacities
• Each scan must be taken in range and in focus
• OCT images can not be interpreted in isolation
• Requires pupil diameter >4mm
Thank you