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OCT improves diagnosis, monitoring of neuro-ophthalmic diseases
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LAS VEGAS — OCT is increasingly useful in diagnosing disorders that affect optical pathways to the brain, a speaker told colleagues.
“[OCT technology] is really affecting the way that we approach patients and diagnose their problems. Some of them can be life-threatening in neuro-ophthalmology,” Randy H. Kardon, MD, PhD, said during a press briefing on “Innovations in vision: Nanotech, nearsightedness and neuro-ophthalmology imaging.”
“We’re trying to localize the damage. ... We’re using OCT in neuro-ophthalmology to define different layers in the retina to point to where the cause is, whether it’s in the retina itself, whether it’s in the optic nerve or whether it’s in the brain, or where the visual pathways go into the brain,” Kardon said.
Kardon described a case in which OCT angiography showed an aneurism near the optic chiasm in a patient with suspected glaucoma.
“If it wasn’t discovered by an OCT, I think he would have just gone on until, eventually, there was a good chance that this would rupture and cause a large amount of morbidity or even kill him,” Kardon said. “It’s amazing that you can take a less than 1-second scan on a patient that is asymptomatic and the pattern of nerve loss in the macula points a big arrow right toward where the problem is.”
En face OCT shows the pattern of nerve fiber layer loss.
OCT angiography can show a loss of capillary flow in the area if there is nerve loss.
“That has very important implications. We call it neurovascular coupling. There’s a very tight association between the circulation of nervous tissue and its metabolic function. This is going to be a very important emerging area of combining capillary flow, nerve function and nerve loss in all kinds of disorders in ophthalmology,” Kardon said.
OCT is also used to quantify papilledema.
“It’s very difficult for clinicians to grade the amount of papilledema. Even trained neuro-ophthalmologists don’t agree all the time,” Kardon said. – by Matt Hasson
Disclosure: Kardon reports he has received funding from the National Eye Institute, Veterans Administration and Department of Defense.