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The  Complete  Idiot’s  Guide  to  Macular  OCT  Interpreta;on  

Richard  E.  Cas;llo,  OD,  DO  The  Oklahoma  College  of  Optometry  

Northeastern  State  University  

 

OCT  Provides:  

•  Ultrastructural  informa;on  

•  Quan;ta;ve  informa;on  

•  Today’s  diagnos;c  modality  of  choice  

Macular  OCT:    Anatomical  Correlates  

•  Nerve  fiber  layer  (NFL):    High  Reflec;vity  (RED)  

•  Sensory  Re;na  (Green)  •  Re;nal  pigment  epithelium/choriocap-­‐illaris  complex:    High  Reflec;vity  (Red)  

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Keys  to  Interpreta;on  

•  Four  Ques;ons  –  How  does  the  vitreore;nal  interface  appear?  

– What  is  the  foveal  contour  like?  

–  Is  re;nal  architecture  altered?  

–  Is  the  uniformity  of  the  RPE-­‐CC  complex  layer  disrupted?  

Normal  vitreore;nal  interface  

•  Op;cally  clear  vitreous  •  Highly  reflec;ve  NFL  below  

Vitreore;nal  interface  abnormali;es  

•  Single  membrane  •  Double  membrane  

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Membrane  a^achments    

•  No  a^achments  •  Par;al  a^achment  •  Total  a^achment  

Normal  foveal  contour  

•  V-­‐shaped  depression  

Oblitera;on  of  normal  foveal  contour  

•  Pulling  from  overlying  membrane  

•  Pushing  from  underlying  re;nal  fluid  

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Widening  of  foveal  contour  

Macular  Holes    

•  Full  thickness  •  Inner  lamellar  •  Outer  lamellar  

Inner  lamellar  hole  vs.  pseudo-­‐hole  

•  Steep  wall  configura;on  in  pseudo-­‐hole  

•  Inverted  mushroom  configura;on  in  inner  lamellar  hole  

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Intra-­‐re;nal  fluid  accumula;on  can  be:  

Abnormali;es  of  Re;nal  Architecture  

•  Hard  exudates  –  Spots  of  increased  reflec;vity  

–  Shadowing  •  Schisis  cavity  is  readily  apparent  

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Re;nal  RPE/CC  complex  can  be  disrupted  by:  

•  Bumps  (drusen)  •  Fusiform  thickening  (CNVM)  

•  Eleva;on  (PED)  

Serous  PED  

•  Op;cally  clear  space  •  Dis;nct  green  band  (Choroid)  

 

Hemorrhagic  PED  

•  Absent  reflec;vity  of  underlying  choroids  green  band  due  to  shadowing  effect  of  the  blood  beneath  the  RPE  

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Fibrovascular  PED  

•  Mul;ple  medium  reflec;vity  echos  (indis;nct  green  band)