Types of scan
- scan may be
- wavy (due to movement)
- out of register
Macular oedema ...Case PFT
see PFT page OCT scans...2 scans thought the same eye, showing oedema in the foveal area. HbA1c was 5.9%. There has been no change over a year. Good vision (6/9). Other eye not affected. Enlarge
after Yag laser hyaloidotomy Subhyaloid haemorrhage explanation
Macular oedema 2
minimal oedema after laser
before laser lots of oedema Enlarge
Macula oedema from a macroaneurysm (superior retina). The oedema reduced over the 6 months after laser (then returned, not shown!). Enlarge
Macular oedema 3
Macula oedema: there is an intact RPE layer (differentiating the condition from ARMD) Enlarge
Macular oedema 4..diabetic retinopathy
Macula oedema: part of diabetic retinopathy Enlarge explanation
age 39 male,
Hba1c poorly controlled till 2012, went on dafne , now well controlled , hba1c 7, retinopathy now
much worse, BP has just gone up also,
PRP laser awaits anti-VEgf
Macular oedema and response to treatment
- Intraretinal cysts are predictive at week 4, so examine after 1 injection to determine prognosis.
- These are similar to the hyper-reflective spots in this paper Retina16 which predict a poorer response. If the spots reduce in number vision improves.
- Disrupted retinal inner layers (DRIL areas) indicate a worse prognosis see
- Observing retinal thickness after 3 injections: if there is no improvement there will be no benefit no benefit of continuing anti-VEGF.
- moderate specificity only 95% Eye14
Wet armd with neurosensory retinal detachment and a shallow PED (1 month after right photo). More anti-VEGF needed. Enlarge
Wet AMRD 2
Left: wet age 65y, male 6/18 vision. Neurosensory detachment (NSD/SRF) visible. explantation Enlarge
Right: Now 6/12. Some intraretinal fluid remains (regular Lucentis). Subsequently vision returned to 6/18 again.
neurosensory detachment and intraretinal fluid,
as part of a rap enlarge and OCT
Patient 86y, well controlled diabetes, 6/9 vision, other eye good. No change over 3 months, no treatment other than maintaining good glucose and blood pressure control.
Wet armd 3
Regular Lucentis 6/18 no treatment between these OCTs In retrospect The April (photo on the right) photos shows intraretinal fluid and Lucentis should have been given.
One month later there is subretinal fluid (neurosensory detachment) and more PED fluid, so 2 injections were given one month apart. Enlarge explanation
This April photo shows intraretinal fluid and lucent is was not given. In retrospect it should have been given as the left photo, one month later, shows increased leakage.
Wet armd 4..intraretinal fluid
August: after further Lucentis, less fluid (August).
June: intraretinal fluid present. (June) enlarge
Graph: Green..less fluid (August scan on extreme left) versus blue (June).
Outer retinal tubules
"Outer retinal tubules represent chronic degenerative changes, not active leakage (anti-VEGF treatment not needed)."
Some may disappear with anti-VEGF treatment BJO 16
Wet ARMD 5 ..very early
- This patient presented with good vision (6/6) in January with a little distortion.
- The condition was thought to be dry, and no treatment was offered (patient was asked to attend if sight became worse).
- In November there was definite wet ARMD (not illustrated here)
- In retrospect this patient probably had early wet ARMD in January as illustrated on this scan. Even if treatment was not offered, a repeat scan should have been arranged, 1-2 months later.
- This OCT has 2 cuts of the SAME scan.
.. a tiny break in the RPE/bruchs membrane
Wet ARMD 6
- female, age 58
- 2 weeks poor sight left eye, smokes 25, partner smokes
- at first examination of the OCT the macular looks dry, but fluid is clearly seen as the mouse is moved
- looks a little like CSR, but with very recent history, FFA not available, thought to be CNV (intraretinal fluid indicates wet CNV not CSR)
- Lucentis begun
but if you move the mouse up the fluid is clearly visible. PED, subretinal fluid (neurosensory detachment), and PED
Wet ARMD 7
- female, age 92, Regular lucent is with ~6/36 vision
- worse over last 2 months, today 6/120
- pin addtion to the wet ARMD, patient has developed a retinal vein occlusion, CRVO
- see new Central RVO
- high ESR (69)....looking for myeloma etc
November: lots of new subretinal fluid with lots of retinal haemorrhages...a new retinal vision occlusion Enlarge
October: wet ARMD with no fluid at this visit (regular Lucentis each time fluid reaccumulates)
Wet ARMD 8: vascularised PED: (Occult CNV type 1)
November, 7 months later, a PED has developed, with a retinal haemorrhage. Also, intraretinal and subretinal fluid. enlarge
Patient, age 86, April, reasonable vision
Photo and OCT shows drusen, hard and soft
Wet ARMD 9: occult, no PED
Classic with occult, no PED, a lot of vascular changes. So much exudate is unusual; responds temporarily to Lucentis, fluid comes and goes. 6/18 when dry, 6/36 when wet. Change to Eylea. explanation enlarge
Wet ARMD 10: with submacular haemorrhage
2 week history of loss of central vision 6/36). Lucentis carried out, (intravitreal streptokinase would not help as haemorrhage is submacular...streptokinase would help if preretinal haemorrhage. enlarge FFA (shows classic CCNV)
Wet ARMD 11: neurosensory detachment and pigment epithelial detachment
Wet ARMD 12: with bilateral submacular haemorrhage
top right eye...recent submacular haemorrhage; on warfarin (cause of haemorrhage?, 6/120 vision)
bottom left eye.........longstanding haemorrhage with subretinal fibrosis CF vision
Wet ARMD 13, intraretinal fluid
Patient is known to have definite wet ARMD, treated with Lucentis, being followed up with OCT. Right scan, previous month is definitely dry. The left scan his month has intraretinal fluid, (we believe), Lucentis...2 injections arranged. Change to Eylea at first opportunity. Explanation
Wet ARMD 14, PED, poor response
PED did not respond to treatment, right September, left October; there is probably IRF (intraretinal fluid). These findings (unresponsive PED) are common if there is a RAP.
Wet ARMD 15
intraretinal fluid: active leak, needs anti-VEGF treatment Explanation
Wet ARMD 16, subretinalfluid (neurosensory detachment)
Routine eye test, reported wavy lines on amsler grid. age 54. SRF/NSD Explanation
Wet ARMD 17, classic
Wet ARMD 18, intraretinal fluid
October... wet intraretinal fluid September dry
known Lucentis wet ARMD patient Explanation
Wet ARMD 19, macular haemorrhage
No obvious SRF, IRF, or PED, but there is a haemorhage so must be wet Explanation
Wet ARMD 20, dry this visit
Previously wet treated with Lucentis, dry this visit, so no Lucentis needed. Explanation
Wet ARMD 21, probably wet
Known wet ARMD with probable intraretinal fluid. Explanation
Drusenoid PED and epiretinal membrane left eye............
Drusenoid PED and ERM. The drusenoid PED may progress to produce and area of atrophy; the ERM is stable >66% patients. 6/24 (6/18 right) Explanation
...............right eye, drusenoid PED, same patient
Drusenoid PED Enlarge 6/18 right
Early epiretinal membrane,
Right eye healthy. Early ERM left eye Explanation
Macular holes, bilateral
top...left eye, macular hole, 2 years (declined surgery), 6/60 vision
bottom...right eye, macular hole and VMT referred for vitrectomy, reduced sight 2 months, 6/36 vision explanation
Tiny macula hole
a tiny hole, would orciplasmin help?
Branch retinal vein occlusion
- thick choroid is related to disease activity, VKH etc
- if thick don't reduce steroids
Minor distortion, no diagnosis made
disturbance of photoreceptors, Bruchs membrane, cause? explanation
a sharp near vertical edge to the CNV membrane the visit before
- Choroidal view..push camera close to eye and evert image
- choroidal thickness is related to ..age, refraction, site in eye, time of day
- Choroidal thickness decreases...vascular problems
- increases inflammation
- Age related choroidal atrophy
- Pachychoroidopathy and retinitis pigmentosa:
choriocapillaris is thin
- thick with central serous chorioretinopathy
and polypoidal choroidal vasculopathy
- thin with gyrate atrophy
- sacrs: Helpp sydrome..high bp and pregnant, leaves scars
- atrophy with ocular ischaemic syndrome
OCT optometry support ideas
- Funded at ~£45 by ccg?
- Need IT support setting up
- Example cases: patients who do not need or want to see ophthalmologist
- Csr, erm, dry amd with visual changes or anxiety or high risk,
- NO patient obviously wet requiring, wanting treatment
- macula hole patient just want confirmation but no treatment
- NO macula hole patient requiring, wanting treatment
- HCA = health care assistant
- Contact by email...all correspondence electronic. Form...attached
- Referral placed electronically on hospital note system.
- Hca to carry out visual acuity and oct and smoking counselling and blood pressure
- medisoft for data
- OCT ...technician to complete medisoft and Email photo and report to referrer and dk
- Medisoft letter with the photo
- Dk to assist with audit
Form for referral
- Box...patient agrees to referral and electronic correspondence
- Box...patient angle wide enough to safely dilate
- Box..patient informed not to drive and will need dilation
- text space
- past medial history
- Reason for referral
- If intervention may be needed do you want this to be initiated by hospital; if not, please state why.
Duration of prediabetes and diabetes
- retina thins with the duration of prediabetes and diabetes (until retinopathy develops)
Not described here
- Foveal hyplasia can be graded
- think of lymphoma in chronic uveitis OI14
- Undulating rpe when no AMD... Barry
- Hyper-reflective sub rpe infiltration
- Hyper-reflective pre rpe infiltration
- Hyper-reflective choroidal lesions