Spectral Domain OCT in Diagnosis and Management of

Glaucoma NSD Raju

Ranjini Eye Hospital (NABH Accredited)

Introduction

• Advent of OCT• Ophthalmic armamentarium • SAP gold standard • Significant neuronal loss

Quigley et al 2006

• Early Diagnosis

• Detection of progression

Spectral Domain OCT

• Enhanced resolution 3 fold• Scan speed 100 fold• Denser sampling and 3 – dimensional imaging• Improved reproducibility, specificity and

sensitivity for glaucoma detection

Optical Coherence Tomography OCT

• Imaging technologies OCT• RFNL thickness• Quantitatve and qualitative• Healthy and unhealthy tissue• Progression of the disease

OCT in Glaucoma

• Pre perimetric Glaucoma• Initiate earlier treatment • Prevent neuronal loss• Monitor progression of the disease

Spectral Domain OCT

• Faster imaging speeds• 50 times as fast• Increases the resolution of the image• Subtle changes • Qualitative and quantitative assessment

OCT angle Evaluation

• Non invasive• Versus gonioscopy• Closed angle • Open Angle• Gonioscopy contra indicated

ONH Evaluation

• Structural Vs Functional • Optic Nerve head topography• High resolution sharp images • Bruchs membrane rim• Neuroretinal rim• Normative data • Structural damage, progression

A case of Angle closure Glaucoma

• Female 45 yrs Acute Angle closure Glaucoma not responding to medical regimen

• Cornea haze edema gonioscopy not possible• OCT revealed closed angle• Subsequent YAG iridectomy relieved A.closure

A case of Suspected Glaucoma

• Female aged 50 Large disc with 0.7 cup OU• SAP within normal limits • Applanation tension 15 mm Hg OU• ONH topography• RNFL analysis

OCT ONH Topography

OCT RNFL

A Case of Glaucoma Suspect

• Male 51 years a case of glaucoma suspecg• Suspicious cup of Of BE • OCT ONH and RNFL

OCT Clinical Correlation

• Disc changes • Visual field Changes

Summary

• A new era• Structural changes • Functional defects • Early Diagnosis• Early detection of Progression