Berks County Medical Society Medical Record Fall 2019 - 18

m E d i C a l r E C o r d F E at u r E

Optical Coherence
Tomography and Impact
on Patient Care
in Ophthalmology
by Komal Joshi, M.D.
Retina Specialist
Eye Consultants of Pennsylvania

O

ptical Coherence Tomography
(OCT) is an imaging
technique that has transformed
retinal and ophthalmic patient care.
First introduced in 19911, OCT is
a non-invasive diagnostic test that
utilizes the concept of inferometry to
create a cross-sectional image of the
retina and other tissues in the eye.
Since its inception the technology has
evolved to give high resolution images
that are accurate to 3 microns within
minutes.2 Images from the OCT are
comparable to an in-vivo tissue biopsy
(Figure 1). With such high-resolution and quick images, OCT
allows ophthalmologists to perform a more efficient and quantitative
analysis of the retina.

Prior to the advent of OCT, diagnosis of retinal pathology relied
heavily on clinical examination, fluorescein angiography and fundus
photographs. For example, treatment thresholds for one of the most
common diagnoses, retinal edema from diabetic retinopathy, was
defined in terms of clinically significant macular edema (CSME).
The clinician performs a biomicroscopic examination using the slit
lamp and indirect ophthalmoscopy to determine the presence of
CSME. Treatment was only initiated when CSME was present. This
method is not only subjective but also requires that macular edema
be clinically apparent to initiate treatment. Experienced examiners
cannot see macular edema until it is ≥ 300 um.
OCT provides a qualitative and quantitative measure of diabetic
macular edema. Qualitatively you can see structural changes such
as cystoid macular edema, retinal swelling and subretinal fluid.
Quantitatively the OCT measures retinal thickness in microns
and generates a thickness map (Figure 2). Diabetic macular edema
is diagnosed much earlier with OCT than with clinical exam.
Furthermore, with sequential OCTs you can quantitatively measure
a patient's response to treatment. OCT's quantitative analysis ability
provides a way to standardize diagnosis and treatment which has led
to advances in clinical research and in turn contributed to advances
in ophthalmology.
Besides diabetic macular edema, OCT is utilized to analyze a
wide range of retinal pathology including macular degeneration,
macular hole, vitreomacular traction, detachment of the
neurosensory retina and much more. Other fields in ophthalmology
also depend on OCT. OCT is used to monitor glaucoma, optic
neuropathies and anterior segment pathology. While it was

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Berks County Medical Society Medical Record Fall 2019

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