Trust clinical correlations when using OCT to diagnose glaucoma
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NEW ORLEANS — It is important to trust clinical correlations when interpreting OCT scans to diagnose glaucoma, according to a speaker here at Glaucoma Subspecialty Day at the American Academy of Ophthalmology meeting.
When interpreting OCT scans, the first pearl Thasarat S. Vajaranant, MD, MHA, shared is to carefully examine the B-scans for associated pathologies, making careful note of the floor effect.
“The thickness should not go down to zero, and that’s because of the vascular tissue,” Vajaranant said. Sometimes, associated pathologies such as falsely higher retinal nerve fiber layer thickness due to schisis or vitreous traction can appear on the scan, possibly affecting measurements, she said.
Physicians should look for preferential retinal nerve fiber layer loss but should not solely rely on it.
“If you have solely temporal nasal lesions, it should raise your suspicions for things other than glaucoma,” Vajaranant said.
To avoid a false negative or false positive, it is important to look beyond preferential retinal nerve fiber layer thickness analyses and employ other techniques in addition to the OTC scan.
“You can use a macular scan as well, and these sometimes can help differentiate pathologies such as stroke or other neuropathy,” Vajaranant said.
Finally, it is important to trust clinical correlations over OCT scans on their own. Correlate clinical examinations with visual fields and have trust in those analyses, she said.
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Vajaranant TS. OCT interpretations: Basics and pearls. Presented at: American Academy of Ophthalmology meeting; Nov. 12-15, 2021; New Orleans.
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