Oct in glaucoma
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Dr. Jagdish Dukre
Senior Resident,
Regional Institute Of Ophthalmology, Allahabad
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Peri papilaryNerve fiber layer
Macular thickness
Optic nerve head
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OCT Software analyses-
Macula Thickness
Retinal Nerve Fibre Layer (RNFL)
Optic Nerve Head (ONH)
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Ganglion cells- 30-35% of total retinal thickness at macula upto 50%of ganglion cells in maculaglaucoma preferentially involves the ganglion cell complex (GCC).
Macula Thickness Analysis
Glaucoma with thinner GCC
Normal
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RNFL analysis
Circular scanning around ONH at a radius of 1. 73mm
Three scans are acquired and data is averaged and compared with normative data base of age matched subjects
Scan begins temporally
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RNFL thickness average analysis printout -7 zones Zone -1-Pt. I.D
Zone -2-TSNIT with age matched normative data base
Zone-3-TSNIT overlap of two eyes
Zone -4-circular scan-quadrant/clockwise
Zone-5-DATA TABLE-ratio/average
Zone-6-RED FREE PHOTOGRAPH-position
Zone-7-PERCENTILE COLOR CODING
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Optic nerve head analysisOptic nerve head scans are
composed of six linear scans in a spoke pattern separated by 30-degree intervals centered on the ONH
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Cup/disk ratios and cup VolumesDisc size: by measuring the distance
between the terminal ends of the choriod at the level of the pigment epithelium (green line)
Cup: determined by drawing a line
b/w both sides of the cup at a point 140um above the green line.
Area below the line is cup and above is neuroretinal rim
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Case 1-(Structure Function Correlation)
56 year old female with open angle glaucoma
NFL lesion at inferior pole of ONH
Superior defect in perimetry
Thinning of RNFL in OCT
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Case 2 (early glaucoma) 59 year old male with suspicious optic nerve
Normal perimetry
Normal IOP
No positive family history
Thinning of NRR clinically
Nasal step in SWAP
RNFL thinning in OCT
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Case 3-(Unilateral Open Angle Glaucoma)
54 year old female
Unilateral exfoliative glaucoma
IOP- 33 mmHg
Thinning of NRR in sup, inf and temporal
Inferior arcuate defect in perimetry
RNFL thinning in sup and inf pole in OCT
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Case 4-Glaucoma suspect 62 year old female
Large C:D ratio
B/L with positive family history
Normal IOP
Normal achromatic and FDP
Normal RNFL and large disc area and increased C:D ratio on OCT
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Case 5 (Ocular Hypertension) Suspicious optic nerve head
Perimetry normal
Borderline FDP
Borderline thickness values with more thinning at superior and inferior pole on OCT
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DOPPLER OCT(F-Domain)
Retinal blood flow measurement with Doppler OCT may helpus understand the role of perfusion in the causation and treatmentof glaucoma, other optic neuropathies and retinal diseases
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