Abstract
The current field of posterior pole and retinal imaging of the human eye has expanded into detailed analyses of the macula, retinal periphery, individual retinal layers, vitreoretinal interface, imaging of the choroid and the optic nerve head. The challenge in retinal imaging is the enduring pursuit of deeper penetration into tissues, increased resolution to the cellular level, and interpretation of observations. How much deeper can we go and with what resolution and reproducibility? These are fundamental questions for experts in search of novel imaging modalities. New discoveries may resolve existing controversies, but inevitably stimulate new questions. Emerging technologies in retinal imaging include adaptive optics retinal imaging and optical coherence tomography-based retinal angiography.In this review, the focus of our discussion will be the discrepancy between the findings (interpretation) of one imaging technology that do not agree or are not even found with a complementary technology. If a clearly seen abnormality is present with one technology but absent in another, what are the possible explanations? Following is a summary of key concepts of retinal and optic nerve imaging modalities and current controversies regarding their interpretation and/or limitations.
Highlights
The two most common imaging modalities utilized to detect macular edema due to various etiologies include fluorescein angiography (FA) and optical coherence tomography (OCT)
Traditional camera-based systems use blue light to illuminate the retina and detect fluorescein emission. Enhancements to this have surfaced in recent years through the use of confocal scanning laser ophthalmoscopy that emits a very precise laser wavelength designed to achieve peak emission from the fluorescein
Macular leakage detected by FA and macular thickness as measured by OCT are caused by the same pathology but have different impacts on our diagnosis and treatment [20]
Summary
Background The two most common imaging modalities utilized to detect macular edema due to various etiologies include fluorescein angiography (FA) and optical coherence tomography (OCT). Spectral domain OCT (SD-OCT) and noninvasive fundus autofluorescence imaging can provide additional anatomical information beyond the FA, including visualization of the layer of the retina and choroid involved with the neovascular membrane [9, 10]. OCT has gained popularity for the diagnosis and management of AMD because of its non-invasive nature and ability to produce cross-sectional images of the neurosensory retina, the subretinal space, retinal pigment epithelium, Bruch membrane and inner choroid.
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