oct – introduction and macular disorders
TRANSCRIPT
![Page 1: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/1.jpg)
OCT – Introduction & Macula
Dr. Sajjan SangaiDept. Of OphthalmologyMGM Medical College and Hospital, Aurangabad
![Page 2: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/2.jpg)
Introduction
Retina is a multi layered tissue with each layer having a different reflectance pattern thus by this principle OCT permits recognition of multiple retinal layers in vivo.
![Page 3: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/3.jpg)
Optical Coherence Tomography
Optic
al Related
to light and optics
Cohe
renc
e Two light beams of the same wavelength in phase To
mog
raph
ySectioning /Cutting
Non-Excisional Optical Biopsy
![Page 4: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/4.jpg)
Normal Retinal Anatomy
![Page 5: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/5.jpg)
Macular Anatomy
![Page 6: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/6.jpg)
Retina Framework
Horizontal Structures • Inner and Outer
Plexiform layer • Inner and Outer
Limiting Membrane• Pigment epithelium
Vertical Structures• Müllers fibres • Cell chains
containing of photoreceptor to bipolar and ganglion cells
Hyper reflective Hypo reflective
![Page 7: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/7.jpg)
Retinal Anatomy & OCT
![Page 8: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/8.jpg)
Optical Principles of OCT
Imaging with OCT is based on Michelson's Interferometer and includes complex analysis of reflections of LOW COHERENCE LIGHT from the ocular tissue ( low coherence interferometry)
![Page 9: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/9.jpg)
Optical Principles of OCT
Low coherence infrared light 840 nm
Reflected by different retinal tissue layers
![Page 10: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/10.jpg)
840 nm
![Page 11: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/11.jpg)
Optical Principles of OCT
The reflected light from the retinal
tissue and reference mirror interacts to form
an
Step 3
Distance between the light source
and reference mirror
Step 2
Distance between the light source
and retinal tissue
Step 1
INTERFERENCE PATTERNThis interference pattern is processed into a signal
![Page 12: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/12.jpg)
Image formation
The signal is analogous to that obtained with A Scan Ultrasonography.
A 2D image is built as the light source is moved across the retina and then the series of stacked and aligned A scans produce a 2dimensional cross sectional image resembling a HISTOLOGIC SECTION
![Page 13: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/13.jpg)
Image formationTransverse scanning at multiple sequential points (A-Scans)
2 Dimensional data collection
Generation of Cross sectional map
Display in pseudo colours
![Page 14: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/14.jpg)
Basic Concepts
The infrared image has a field of 30˚ .
OCT operates like a fundus camera but resolves like a USG machine .USG OCT
Source Sound waves Infrared light waves
Resolution 150µ 10µPatient Contact Needed Non- Invasive
![Page 15: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/15.jpg)
Indications of OCT
Macular hole
Macular edema
Central serous retinopathy
Epiretinal membranes
Diabetic retinopathy
Age-related macular degeneration
Scars, Foveal burns
http://www.aao.org/eye-health/treatments/what-does-optical-coherence-tomography-diagnose
![Page 16: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/16.jpg)
Advantages of OCT
Non contact Non invasive
High Resolution
Real time Imaging
![Page 17: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/17.jpg)
Limitations of OCT
Corneal Opacities, Cataract
Poor patient cooperation
Asteroid hyalosis, Vitreous
Haemorrhage
Intraocular Gas
(SF6 ,C2F6,C3F8 )
![Page 18: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/18.jpg)
Types of OCT
Time domain OCT Spectral domain OCT
![Page 19: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/19.jpg)
Optical Principle – TD vs. SD OCT
![Page 20: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/20.jpg)
Time Domain OCT - Principle Time-domain devices can provide
400 A scans per second with a maximal axial resolution of 8-10µm
High quality images require longer time to create. Therefore time is the major limitation of this technique.
![Page 21: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/21.jpg)
Spectral Domain OCT- Principle Absence of movable mirror speeds up
the image acquisition up to 50 times. This technique enables to obtain large numbers of A-scans that allows creating high resolution images.
SD devices can provide 20.000-52.000 A-scan per second with a 5-7µm resolution
Such a speed reduces the eye movement artefacts.
![Page 22: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/22.jpg)
TD OCT vs. SD OCT
![Page 23: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/23.jpg)
TD OCT vs. SD OCTTIME DOMAIN OCT SPECTRAL DOMAIN OCT
RESOLUTION : 10µ 5-7µm2 Dimensional images 2 D and 3 D
Low coherence Interferometry Low coherence interferometryUses fixed wavelength Broad wavelength spectrum
Lower speed 400-512 A scan/sec High speed : 52000 A scans/ sec
![Page 24: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/24.jpg)
Scanning protocolsTOPCON
![Page 25: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/25.jpg)
Scanning protocols
Zeiss
![Page 26: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/26.jpg)
Retinal scan protocolScan Utility
Line Multiple line scans can be obtained without returning to main window
Radial Lines Determines entire macular thickness/ volume
Raster lines Entire area of pathology can be scanned
Repeat scan Monitoring change during follow-up
Macular thickness Determines entire macular thickness/ volume
Fast macular thickness Allows comparative thickness/ volume analysis
![Page 27: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/27.jpg)
Analysis
Qualitative •Morphological changes•Reflectivity•Shadowing•Structure microstructure segmentation- alteration/ deformation/ loss of structure.
Quantitative
•Retinal Map•Retinal Thickness•Retinal Volume
![Page 28: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/28.jpg)
Patterns of Abnormalities
Retinal edema-1.CME2. Vitreoretinal traction leading to edema
Retinal atrophy secondary to 1.Laser2.Trauma3.Inflammations
Increased
Thickness
Decreased
Thickness
![Page 29: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/29.jpg)
Patterns of AbnormalitiesHigh Reflectivity:(Red and Yellow): Superficial: 1. Epiretinal/ vitreal membranes2. Sub hyaloid / Sub ILM haemorrhage3. Cotton Wool Spot’s 4. Myelinated nerve fibres.
Epiretinal MembraneSub Hyaloid hemorrhageCotton Wool spots
![Page 30: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/30.jpg)
Patterns of Abnormalities Intraretinal: 1. Hard exudates, 2. Intraretinal haemorrhages 3. fibrosis and scarring
Intraretinal Hemorrhage
![Page 31: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/31.jpg)
Patterns of Abnormalities Deep:1. Drusen 2. RPE Hyperplasia3. Scarring , atrophy4. Sub retinal neovascular membrane 5. Deep pigmented lesion e.g. Nevus
Drusen
![Page 32: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/32.jpg)
Patterns of AbnormalitiesLow reflectivity: ( Black and
Blue)1. Gross separation of cellular
elements and fluid present either in form of cystoid spaces
2. Neurosensory detachment3. RPE detachment
results in decreased reflectivity
![Page 33: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/33.jpg)
Patterns of AbnormalitiesShadowing: Dense highly reflective elements
produce a kind of blockage of light waves by attenuation
This appears a shadow that conceals the element lying behind it
E.g. Haemorrhage's, Hard exudates, cotton wool spots, dense pigmented lesion or scar, retained foreign body.
![Page 34: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/34.jpg)
Diseases of Macula Age related Macular Degenerationa) Dry / non-neovascular AMD: Drusenb) Wet / neovascular AMD: CNV and PED
Epiretinal Membrane
Full Thickness Macular Hole
Central Serous Chorioretinopathy
Cystoid Macular Edema
![Page 35: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/35.jpg)
Age related Macular Degeneration Degenerative disorder affecting
macula Clinical classification of AMD:Category Definition, based on lesion ( within 2DD of
fovea)No apparent ageing change
No drusenNo AMD pigmentary abnormalities
Normal ageing changes
Only drupletsNo AMD pigmentary abnormalities
Early AMD Medium drusen (>63 m - < 125 m)No AMD pigmentary abnormalities
Intermediate AMD
Large drusen (>125m)Any AMD pigmentary abnormalities
Late AMD Neovascular AMD and/or any geographic atrophy
![Page 36: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/36.jpg)
Drusen Extracellular deposits located at the
interface between the RPE and Brusch membrane.
Derived from immune mediated and metabolic processes in RPE.
On OCT:Medium sized and large drusen are seen
as hyper reflective irregular nodules beneath the RPE
![Page 37: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/37.jpg)
Drusen• Small drusen/ Hard drusen• Well defined , whitish yellow lesion• < 63 m
• Fairly well defined yellow white focal deposits
• Measuring between 63 m - 125 mIntermediate Drusen
• Large drusen/ Soft drusen• Less well delineated yellow white
deep retinal lesion • >125m
![Page 38: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/38.jpg)
Choroidal Neovascularisation Causes:
Degenerative
Inflammatory
Traumatic
Neoplastic
Brusch memb./ RPE
Compromised by
![Page 39: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/39.jpg)
Choroidal Neovascularisation ( CNV) Types: Classified according to Macular
Photocoagulation Study (MPS): Based on FA
Classic CNV (20%): well defined lacy pattern during early transit of dye subsequently leaking to sub retinal space.
Occult CNV (80%): Limits cannot be fully defined on FA
Predominantly / Minimally classic CNV: Classic element is grater or less than 50 % of total lesion
![Page 40: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/40.jpg)
Choroidal Neovascularisation ( CNV)On OCT: CNV is shown as 1. thickening and fragmentation
of RPE and Choriocapillaries2. Sub retinal, Sub-RPE fluid, 3. Blood and scarring are demonstrated.
![Page 41: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/41.jpg)
Choroidal Neovascularisation ( CNV)
![Page 42: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/42.jpg)
Retinal Pigment Epithelial Detachment (PED) Thickened and dysfunctional Brusch
membrane impending movement of fluid from RPE towards the choroid PED.
On OCT : PED shows Separation of RPE from the Brusch membrane by an optically empty area
Clinically: Orange dome shaped lesion
FA: Well demarcated Hyperfluroscent pooling
ICGA: HypofluroscenceOCT: Optically empty area below RPE
![Page 43: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/43.jpg)
Epiretinal Membrane
Sheet like fibro cellular structure that develops over surface of retina.
Proliferation of cellular component and contraction of membrane leads to visual symptoms.
On OCT-o Highly reflective surface layer
associated with retinal thickening.o Useful to exclude significant VMT .
![Page 44: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/44.jpg)
Epiretinal Membrane
![Page 45: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/45.jpg)
Full Thickness Macular Hole Pathogenesis:The vitreofoveal traction is central to development of a full thickness macular hole. Gass: Proposed that contraction of
prefoveolar cortical vitreous results in tangential traction
![Page 46: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/46.jpg)
Full Thickness Macular Hole Classification:1. Gass classification scheme on
Biomicroscopy, 2. New OCT based classification- IVTS-
(International Vitreomacular Traction Study)
![Page 47: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/47.jpg)
Idiopathic Macular Hole
![Page 48: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/48.jpg)
Gass Classification
Gass Classification
![Page 49: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/49.jpg)
Full Thickness Macular Hole
![Page 50: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/50.jpg)
![Page 51: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/51.jpg)
Full Thickness Macular Hole
Differential Diagnosis1. Lamellar hole2. Pseudo hole3. ERM4. CME5. CSR with central yellow spot
![Page 52: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/52.jpg)
Central Serous Chorioretinopathy Idiopathic Characterised by local serous
detachment of the sensory retina at the macula secondary to leakage from choriocapillaries through one or more hyper permeable RPE sites
Affects young , middle aged men Risk factors: Steroid administration,
Cushing syndrome, H. Pylori infection, pregnancy, psychological stress, sleep apnoea.
![Page 53: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/53.jpg)
Central Serous ChorioretinopathyOn OCT:Optically empty neurosensory elevation,Other findings – one or more smaller RPE detachments , precipitates on posterior surface of detached retina , thickened choroid.On FA:Hyperfluroscent spot that enlarges- Ink BlotVertical column- Smoke stack
![Page 54: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/54.jpg)
Central Serous Chorioretinopathy
![Page 55: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/55.jpg)
Cystoid Macular Edema
Accumulation of fluid in outer plexiform layer and inner layers of retina with formation of tiny cyst like cavities.
Fluids may initially accumulate intracellularly in Müller cells with subsequent rupture.
![Page 56: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/56.jpg)
Cystoid Macular Edema-Causes:1. Ocular Surgery and Laser.2. Retinal Vascular Disease: Diabetic
retinopathy, Retinal Vein occlusions.3. Inflammation: Intermediate Uveitis4. Drug induced: topical prostaglandin
derivatives.5. Retinal dystrophies: Retinitis pigmentosa6. Conditions having VMT: ERM7. CNV8. Tumours: Retinal capillary haemangioma9. Systemic diseases : CRF
![Page 57: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/57.jpg)
Cystoid Macular Edema
On OCT:Retinal thickening with cystic hypo reflective spaces, and loss of foveal depression.Lamellar holes may be demonstrated in advanced cases.On FA:A petalloid pattern is seen due to dye accumulation in microcytic spaces in outer plexiform layer
![Page 58: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/58.jpg)
![Page 59: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/59.jpg)
Recent Advances
Various newer OCT systems are:1. Ultra high resolution OCT2. Doppler OCT3. CAS OCT- Visante OCT4. Combined FFA and en-face OCT5. Intraoperative OCT
![Page 60: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/60.jpg)
Ultra high resolution OCT (UHR OCT) Axial resolution of 3 µm Transverse resolution of 15-20 µm Useful for visualization ofa) External limiting membraneb) Ganglion cell layerc) Photoreceptor layer
![Page 61: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/61.jpg)
Colour Doppler OCT
Technique that combines laser doppler velocimetry and OCT for imaging the depth , diameter flow rate, retinal haemodynamic characteristic
Only possible in larger vessels Not well suited for angiography of
retinal and choroidal microvasculature, where vessels are nearly perpendicular to the OCT beam.
![Page 62: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/62.jpg)
Intraoperative OCT
Surgical microscope integrated with OCT to perform simultaneous imaging and en face visualization
Uses are: Macular hole surgery,ERM peeling,Sub retinal surgery
Zeiss OPMI LUMERA® 700 and RESCAN™ 700
![Page 63: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/63.jpg)
OCT Angiography
Doppler OCT uses the Doppler phase shift to quantify blood flow in larger vessels and measure total retinal blood flow
OCTA is more concerned about separating moving scatters from static background tissue to create angiograms.
![Page 64: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/64.jpg)
OCT Angiography
![Page 65: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/65.jpg)
![Page 66: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/66.jpg)
![Page 67: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/67.jpg)
![Page 68: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/68.jpg)
Bibliography Principles and Practices of Ophthalmology, Vol. 2 ,
Third edition, Albert and Jacobiec’s. RETINA, Vol.1 , Fifth edition, Ryan.S.J. Kanski’s Clinical Ophthalmology, 8th edition,
Bowling B. Practical Handbook of OCT , Lumbroso.B, Rispoli M. Step by Step Optical Coherence Tomography.
![Page 69: OCT – Introduction and Macular disorders](https://reader036.vdocuments.us/reader036/viewer/2022062523/58f9b11f760da3da068bbd9c/html5/thumbnails/69.jpg)