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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)