Elsevier

Ophthalmology

Volume 112, Issue 11, November 2005, Pages 1922.e1-1922.e15
Ophthalmology

Original article
Comparison of Ultrahigh- and Standard-Resolution Optical Coherence Tomography for Imaging Macular Pathology

Results presented in part at: Association for Research in Vision and Ophthalmology meeting, May, 2003; Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2005.05.027Get rights and content

Objective

To compare ultrahigh-resolution optical coherence tomography (UHR OCT) with standard-resolution OCT for imaging macular diseases, develop baselines for interpreting OCT images, and identify situations where UHR OCT can provide additional information on disease morphology.

Design

Cross-sectional study.

Participants

One thousand two eyes of 555 patients with different macular diseases including macular hole, macular edema, central serous chorioretinopathy, age-related macular degeneration (AMD), choroidal neovascularization, epiretinal membrane, retinal pigment epithelium (RPE) detachment, and retinitis pigmentosa.

Methods

A UHR ophthalmic OCT system that achieves 3-μm axial image resolution was developed for imaging in the ophthalmology clinic. Comparative studies were performed with both UHR OCT and standard 10-μm-resolution OCT. Standard scanning protocols of 6 radial 6-mm scans through the fovea were obtained with both systems. Ultrahigh-resolution OCT and standard-resolution OCT images were correlated with standard ophthalmic examination techniques (dilated ophthalmoscopy, fluorescein angiography, indocyanine green angiograms) to assess morphological information contained in the images.

Main Outcome Measures

Ultrahigh-resolution and standard-resolution OCT images of macular pathologies.

Results

Correlations of UHR OCT images, standard-resolution images, fundus examination, and/or fluorescein angiography were demonstrated in full-thickness macular hole, central serous chorioretinopathy, macular edema, AMD, RPE detachment, epiretinal membrane, vitreal macular traction, and retinitis pigmentosa. Ultrahigh-resolution OCT and standard-resolution OCT exhibited comparable performance in differentiating thicker retinal layers, such as the retinal nerve fiber, inner and outer plexiform, and inner and outer nuclear. Ultrahigh-resolution OCT had improved performance differentiating finer structures or structures with lower contrast, such as the ganglion cell layer and external limiting membrane. Ultrahigh-resolution OCT confirmed the interpretation of features, such as the boundary between the photoreceptor inner and outer segments, which is also visible in standard-resolution OCT. The improved resolution of UHR OCT is especially advantageous in assessing photoreceptor morphology.

Conclusions

Ultrahigh-resolution OCT enhances the visualization of intraretinal architectural morphology relative to standard-resolution OCT. Ultrahigh-resolution OCT images can provide a baseline for defining the interpretation of standard-resolution images, thus enhancing the clinical utility of standard OCT imaging. In addition, UHR OCT can provide additional information on macular disease morphology that promises to improve understanding of disease progression and management.

Section snippets

Materials and Methods

A prototype UHR OCT system suitable for performing studies in the ophthalmology clinic has been developed. In OCT imaging, the axial image resolution is determined by the coherence length of the light source, which is inversely proportional to the optical bandwidth of the light source. As the imaging light source for the UHR OCT system, we used a femtosecond titanium–sapphire laser specially developed by our laboratory that can generate a ∼125-nm bandwidth centered at a 815-nm wavelength. The

Results

We present a representative example of results from the following macular pathologies: full-thickness macular hole, central serous chorioretinopathy, macular edema, AMD (nonneovascular and neovascular), RPE detachment, epiretinal membrane, vitreomacular traction and retinitis pigmentosa, and chloroquine retinopathy.

It is helpful to first consider an UHR OCT image in a normal retina to facilitate the interpretation of UHR OCT and standard-resolution OCT images. Figure 1A shows a horizontal UHR

Patient 1: Full-Thickness Macular Hole

A 64-year-old woman with 20/50 vision in her left eye was diagnosed with a stage III macular hole upon clinical examination (Fig 2A). The standard-resolution StratusOCT and UHR OCT macular images in Figure 2B, C clearly visualized a full-thickness macular hole. Cystic structures associated with the macular hole are present and appear localized in the ONL and INL of the parafoveal region. The UHR OCT enables enhanced visualization of the smaller cystic structures in the ONL. External to the

Discussion

Ultrahigh-resolution OCT imaging of macular pathologies has been reported previously by Drexler et al.24 In that study, UHR OCT was used to image 56 eyes of 40 selected patients with different macular diseases, and it was found that UHR OCT can enhance visualization of intraretinal morphologic features and provide additional diagnostically important information.24 It was also demonstrated that UHR OCT can be used to evaluate the integrity of photoreceptor layers, their thickness changes, and

Acknowledgments

The authors gratefully acknowledge C. R. Baumal, T. R. Hedges III, C. Mattox, M. B. Raizman, E. Reichel, A. H. Rogers, O. S. Singh, and H. K. Wu of the New England Eye Center for providing patients for this study. They also thank A. Aguirre, S. Bourquin, R. Ghanta, P. Herz, and P. Hsiung for their participation in the development of UHR OCT imaging technology.

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    Manuscript no. 2005-4.

    Supported in part by the National Institutes of Health, Bethesda, Maryland (contract nos.: R01-EY11289, R01-EY13178, P30-EY13078); National Science Foundation, Arlington, Virginia (grant no.: ECS-0119452); Air Force Office of Scientific Research, Arlington, Virginia (contract no.: F49620-98-1-0139); Medical Free Electron Laser Program, Air Force Office of Scientific Research, Arlington, Virginia (grant nos.: F49620-01-1-0186, FWF P14218-PSY, FWF Y159-PAT, CRAF-1999-70549); Massachusetts Lions Eye Research Fund Inc., New Bedford, Massachusetts; Eye and Ear Foundation, Pittsburgh, Pennsylvania; Research to Prevent Blindness, New York, New York; and Carl Zeiss Meditec, Dublin, California.

    Drs Fujimoto and Schuman receive royalties from intellectual property licensed to Carl Zeiss Meditec. Dr Drexler is a consultant for Carl Zeiss Meditec.

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