Spectralis Optical Coherence Tomography Device Research Articles

Choroidal modifications assessed by means of choroidal vascularity index after oral eplerenone treatment in chronic central serous chorioretinopathy.

To investigate choroidal vascularity index (CVI) changes after oral eplerenone treatment in chronic central serous chorioretinopathy (cCSC) using the Spectral-domain (SD)-Optical Coherence Tomography (OCT) with enhanced depth imaging (EDI) mode. Thirty-six eyes of 18 patients suffering from cCSC with monolateral foveal subretinal fluid (FSRF) successfully treated with oral eplerenone treatment and 18 age-matched healthy subjects were enroled in this retrospective study. EDI-OCT images obtained using Heidelberg Spectralis OCT device in patients with cCSC and FSRF (group 1); fellow eye (group 2) or healthy patients (healthy) were exported and then imported into image analysis ImageJ software for subsequent quantitative analysis. The main outcome measures were luminal area (LA) and CVI. A higher value of CVI was detected in group 1 compared to healthy eyes (p = 0.006). LA and CVI significantly reduced during follow up in group 1 and group 2. LA at 120 days was significantly lower compared to all previous time points both in group 1 and group 2 (p < 0.001). Median and [1st -3rd quartile] CVI values were 0.8 [0.7; 1.1] at baseline, 0.8 [0.7; 0.9] at 30 days; 0.7 [0.6; 0.9] at 60 and 90 days and 0.6 [0.5; 0.8] at 120 days in group 1 (p = 0.007) and 0.7 [0.6; 0.9] at baseline, 0.7 [0.7; 0.8] at 30 days; 0.7 [0.6; 0.7] at 60 and 90 days and 0.6 [0.6; 0.7] at 120 days in group 2 (p = 0.018). Choroidal vascularity index reduced in cCSC patients after oral eplerenone treatment during follow up both in eyes with SRF and fellow eyes thus demonstrating the effectiveness of mineral corticoid receptor antagonists in recovering choroidal morphology.

Dual effect of the Valsalva maneuver on autonomic nervous system activity, intraocular pressure, Schlemm\u2019s canal, and iridocorneal angle morphology

BackgroundThe Valsalva maneuver (VM) is widely used in daily life, and has been reported to cause high intraocular pressure (IOP). This study aimed to assess changes in IOP, the Schlemm’s canal (SC), autonomic nervous system activity, and iridocorneal angle morphology in healthy individuals during different phases of the VM.MethodsThe high frequency (HF) of heart rate (HR) variability, the ratio of low frequency power (LF) and HF (LF/HF), heart rate (HR), IOP, systolic (SBP) and diastolic blood pressure (DBP), the area of SC (SCAR), pupil diameter (PD), and some iridocorneal angle parameters (AOD500, ARA750, TIA500 and TISA500) were measured in 29 young healthy individuals at baseline, phase 2, and phase 4 of the VM. SBP and DBP were measured to calculate mean arterial pressure (MAP) and mean ocular perfusion pressure (MOPP). HF and the LF/HF ratio were recorded using Kubios HR variability premium software to evaluate autonomic nervous system activity. The profiles of the anterior chamber were captured by a Spectralis optical coherence tomography device (anterior segment module).ResultsCompared with baseline values, in phase 2 of the VM, HR, LF/HF, IOP (15.1 ± 2.7 vs. 18.8 ± 3.5 mmHg, P < 0.001), SCAR (mean) (7712.112 ± 2992.14 vs. 8921.12 ± 4482.79 μm2, P = 0.039), and PD increased significantly, whereas MOPP, AOD500, TIA500, and TISA500 decreased significantly. In phase 4, DBP, MAP, AOD500, ARA750, TIA500and TISA500 were significantly lower than baseline value, while PD and HF were remarkably larger than baseline. The comparison between phase 2 and phase 4 showed that HR, IOP (18.8 ± 3.5 vs. 14.7 ± 2.9 mmHg, P < 0.001) and PD decreased significantly from phase 2 to phase 4, but there were no significant differences in other parameters.ConclusionsThe expansion and collapse of the SC in different phases of the VM may arise from changes in autonomic nervous system activity. Further, the effects of the VM on IOP may be attributed to changes in blood flow and ocular anatomy.Trial registrationThis observational study was approved by the ethics committee of Tongji Hospital (Registration Number: ChiCTR-OON-16007850, Date: 01.28.2016).

Topographic correlation and asymmetry analysis of ganglion cell layer thinning and the retinal nerve fiber layer with localized visual field defects

PurposeTo evaluate the accuracy of the measurement of the ganglion cell layer (GCL) of the posterior pole analysis (PPA) software of the Spectralis spectral-domain (SD) optical coherence tomography (OCT) device (Heidelberg Engineering, Inc., Heidelberg, Germany), the asymmetry of paired GCL sectors, the total retinal thickness asymmetry (RTA), and the peripapillary retinal nerve fiber layer (pRNFL) test to discriminate between healthy, early and advanced glaucoma eyes.MethodsThree hundred eighteen eyes of 161 individuals with reliable visual fields (VF) were enrolled in this study. All participants were examined using the standard posterior pole and the pRNFL protocols of the Spectralis OCT device. VF impairment was graded in hemifields, and the GCL sectors were correlated with this damage. Thicknesses of each GCL, the GCL map deviation asymmetry and the pRNFL were compared between control and glaucomatous eyes. The area under the receiver operating characteristic curve (AUC) of these analyses was assessed.ResultsFourteen of the 16 sectors of the GCL and pRNFL were significantly thinner in eyes with glaucoma than in control eyes (p<0.006). Similarly, the GCL map deviation showed a significant difference between these eyes and both the control eyes as well as the eyes with early glaucoma (p = 0.001 and p = 0.039, respectively). The highest values of AUC to diagnose both early and advanced glaucoma corresponded to the average pRNFL analysis and the GCL map deviation (AUC>0.823, p<0.040 and AUC>0.708, p<0.188, respectively).ConclusionsAlthough 16 central sectors of the GCL observed with PPA showed good correlation with VF damage, the pRNFL and the GCL map deviation were more effective for discrimination of glaucomatous damage.

Regional alterations in human choroidal thickness in response to short-term monocular hemifield myopic defocus.

To examine the regional changes in human choroidal thickness following short-term exposure to hemifield myopic defocus using optical coherence tomography (OCT). The central 26˚ visual field of the left eye of 25 healthy young adults (mean age 26±5years) was exposed to 60min of clear vision (control session), +3 D full-field, +3 D superior retinal and +3 D inferior retinal myopic defocus, with the right eye occluded. Choroidal thickness across the central 5mm (17°) macular region was examined before and after 60min of defocus using a high-resolution, foveal centred vertical OCT line scan, with optical defocus simultaneously imposed using a Badal optometer and cold mirror system mounted on a Spectralis OCT device. Averaged across the central 5mm macular area, choroidal thickness decreased by -4±7μm during the control session (p=0.01), most likely due to the unique stimulus conditions of this study. The mean macular choroidal thickness increased during full-field (+2±8μm), inferior retinal (+3±7μm) and superior retinal myopic defocus (+5±9μm), representing a significant thickening of the choroid compared to the control session (all p<0.05). The defocus induced changes in macular choroidal thickness differed between the superior and inferior hemiretinal regions (F2.26, 54.27 =29.75, p<0.001). When only the superior retina was exposed to myopic defocus, the choroid thickened in the superior region (+7±8μm, p<0.001), but did not change significantly in the inferior region (+3±9μm, p=0.12). When only the inferior retina was exposed to myopic defocus, the choroid thickened inferiorly (+4±8μm, p=0.005), with no significant change observed in the superior region (+1±8μm, p=0.46). These findings provide evidence supporting a local regional choroidal response to myopic defocus in the human eye, with hemifield myopic defocus leading to significant thickening of the choroid localised to the retinal region exposed to defocus. The novel finding of a localised response of the human choroid to hemifield myopic defocus, particularly in the superior hemiretina, may have important implications in optimising the optical design of myopia control interventions.

Influence of the Water-Drinking Test on Intraocular Pressure, Schlemm's Canal, and Autonomic Nervous System Activity.

To assess changes in Schlemm's canal (SC), intraocular pressure (IOP), and autonomic nervous system activity in healthy individuals after performing the water-drinking test (WDT). The SC area (SCAR), trabecular meshwork (TM) thickness, IOP, high frequency (HF) of heart rate variability (HRV), heart rate (HR), and systolic (SBP) and diastolic blood pressure (DBP) were measured in 22 young healthy participants before and after the WDT, which involved drinking a 1-liter water load in 5 minutes.The SC and TM profiles were captured using a Spectralis optical coherence tomography device (anterior segment module). HF was recorded using Kubios HRV Premium software to evaluate parasympathetic nervous system activity. Compared with baseline values, IOP increased significantly (14.9 ± 2.7 mm Hg vs. 18.4 ± 3.3 mm Hg; P < 0.001), whereas HF (1587 ± 930 ms2 vs. 2193 ± 863 ms2; P < 0.001), mean SCAR (6521 ± 1360 μm2 vs. 5180 ± 1455 μm2; P < 0.001), and HR (69 ± 9.7 beats/min vs. 63 ± 8.9 beats/min; P < 0.001) values decreased significantly by 15 minutes after water-loading. Least significant difference pairwise comparison revealed significant fluctuations of all parameters (SCAR, IOP, HF, and HR) at 15 minutes and their recovery at 30-minutes post-WDT. TM thickness, SBP, and DBP post-WDT did not differ significantly. The increase in IOP (r = -0.4047; P = 0.010) and HF (r = -0.386; P = 0.014) correlated significantly with the decrease in SCAR. The WDT may cause parasympathetic nervous system stimulation, leading to the collapse of SC, which leads to increased IOP.

Diagnostic ability of inner macular layers to discriminate early glaucomatous eyes using vertical and horizontal B-scan posterior pole protocols.

PurposeTo evaluate the diagnostic ability of macular ganglion cell (mGCL) and macular retinal nerve fiber (mRNFL) layers, to detect early glaucomatous eyes, using the new segmentation software of Spectralis optical coherence tomography (OCT) device (Heidelberg Engineering).MethodsA total of 83 eyes from 83 subjects were included in this observational, prospective cross-sectional study: 43 healthy controls and 40 early primary open-angle glaucoma (POAG) patients. All participants were examined using the Horizontal and Vertical Posterior Pole protocols, and the peripapillary RNFL (pRNFL) protocol of Spectralis OCT device. The new automated retinal segmentation software was applied to horizontal and vertical macular B-scans to determine mGCL and mRNFL thicknesses in each one of the 9 sectors of the Early Treatment Diagnostic Retinopathy Study circle. Thickness of each layer was compared between groups, and the sectors with better area under the receiver operating characteristic curve (AUC) were identified.ResultsmGCL was significantly thinner in the POAG group, especially in outer and inner temporal sectors (p<0.001); and mRNFL was significantly thinner in the POAG group in the outer inferior and the outer superior sector (p<0.001). Diagnostic accuracy of inner macular layers was good, and in general mGCL was superior to mRNFL. pRNFL obtained the best diagnostic capability (AUC, 0.886). Horizontal and vertical Posterior Pole protocols performed similarly.ConclusionsInner macular layers using either horizontal or vertical B-scans, especially temporal sectors of mGCL, have good diagnostic capability to differentiate early glaucomatous eyes from control eyes; however, pRNFL has the highest diagnostic sensitivity for glaucoma detection.

Diagnostic Accuracy of Spectralis SD OCT Automated Macular Layers Segmentation to Discriminate Normal from Early Glaucomatous Eyes

To evaluate the accuracy of the macular retinal layer segmentation software of the Spectralis spectral-domain (SD) optical coherence tomography (OCT) device (Heidelberg Engineering, Inc., Heidelberg, Germany) to discriminate between healthy and early glaucoma (EG) eyes. Prospective, cross-sectional study. Forty EG eyes and 40 healthy controls were included. All participants were examined using the standard posterior pole and the peripapillary retinal nerve fiber layer (pRNFL) protocols of the Spectralis OCT device. Using an Early Treatment Diagnostic Retinopathy Study circle at the macular level, the automated retinal segmentation software was applied to determine thicknesses of the following parameters: total retinal thickness, inner retinal layer (IRL), macular retinal nerve fiber layer (mRNFL), macular ganglion cell layer (mGCL), macular inner plexiform layer (mIPL), macular inner nuclear layer (mINL), macular outer plexiform layer (mOPL), macular outer nuclear layer (mONL), photoreceptors (PR), and retinal pigmentary epithelium (RPE). The ganglion cell complex (GCC) was determined by adding the mRNFL, mGCL, and mIPL parameters and the ganglion cell layer-inner plexiform layer (mGCL-IPL) was determined by combining the mGCL and mIPL parameters. Thickness of each layer was compared between the groups, and the layer and sector with the best area under the receiver operating characteristic curve (AUC) were identified. Comparison of pRNFL, IRL, mRNFL, mGCL, mIPL, mGCC, mGCL-IPL, mINL, mOPL, mONL, PR, and RPE parameters and total retinal thicknesses between groups for the different areas and their corresponding AUCs. Peripapillary RNFL was significantly thinner in the EG group globally and in all 6 sectors assessed (P< 0.0005). For the macular variables, retinal thickness was significantly reduced in the EG group for total retinal thickness, mIRL, mRNFL, mGCL, and mIPL. The 2 best isolated parameters to discriminate between the 2 groups were pRNFL (AUC, 0.956) and mRNFL (AUC, 0.906). When mRNFL, mGCL, and mIPL measurements were combined (mGCC and mGCL plus mIPL), then its diagnostic performance improved (AUC, 0.940 and 0.952, respectively). Macular RNFL, mGCL-IPL, and mGCC measurements showed a high diagnostic capability to discriminate between healthy and EG participants. However, macular intraretinal measurements still have not overcome standard pRNFL parameters.

Results from the treatment of refractory diabetic macular oedema with Bevacizumab in a clinical setting

AbstractPurpose To evaluate the outcome of the treatment of patients with refractory diabetic macular oedema with intravitreal bevacizumab (Avastin).Methods Prospective data was entered into an in house database of all patients being treated for refractory diabetic macular oedema at the Ophthalmology Department, Central Middlesex Hospital, London, UK. All patients received bevacizumab on a pro re nata basis after an initial loading phase of three injections. Best corrected visual acuity (BCVA) on the logMAR chart and the central retinal thickness (CRT) on the optical coherence tomography (OCT) scan were recorded at each visit. OCT was performed with the Spectralis OCT device (Heidelberg Engineering, Heidelberg, Germany) using the standard protocol of the clinic. Statistical analysis involved the Wilcoxon signed rank test and Spearman correlation test.Results 64 eyes of 48 patients were included in this study. The mean age was 68 years (range 45 ‐ 87). Patients received a mean of 3 bevacizumab (range 1‐10) injections. The follow‐up time was up to 15 months. The mean logMAR BCVA at baseline for Avastin was 0.74. At 2, 3, 7, and 11 months the mean BCVA was 0.77, 0.75, 0.67, and 0.69 respectively (p=0.01, 0.006, 0.02 and 0.05). There was no significant difference between baseline and any period thereafter during follow‐up to 15 months. Mean CRT at baseline was 527μm. The mean CRT at months 1‐4 were 456, 491, 490 and 480μm respectively and were significantly different for baseline, (p=0.001, 0.01, 0.03 and 0.04). CRT for months 5 to 15 were not significantly different from baseline.Conclusion The treatment of refractory diabetic macular oedema with intravitreal bevacizumab made little difference to improving the BCVA and CRT of the patients.

Retinal thinning and correlation with functional disability in patients with Parkinson's disease

AimsTo determine whether there is an association between retinal thinning and functional rating scales in patients with Parkinson's disease (PD).Materials and methodsPatients with PD (n=153) and controls (n=242) underwent evaluations...

USE OF SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY TO DIFFERENTIATE ACQUIRED RETINOSCHISIS FROM RETINAL DETACHMENT IN DIFFICULT CASES

This study presents a series of 10 patients who posed a diagnostic challenge regarding the diagnosis of acquired retinoschisis (RS) or retinal detachment (RD), where spectral-domain optical coherence tomography (OCT) with the Spectralis HRA and OCT device (Heidelberg Engineering, Heidelberg, Germany) was able to help make a correct diagnosis. Ten patients (five with acquired RS and five with RD) were referred to a vitreoretinal clinic at Moorfields Eye Hospital for definitive diagnosis and further management. All patients underwent scans with the Spectralis HRA and OCT device. The Spectralis HRA and OCT was able to make a clear diagnosis of RS or RD in all patients. Of the five patients with RS confirmed on OCT, two were referred with RD, and of the five patients with RD, four were referred with RS. New OCT features of RS include the double schisis cavity phenomenon, intraretinal pillars through the schisis cavity, and irregularity of the inner surface of the attached outer leaf. Spectral-domain OCT is a useful tool in distinguishing RS from RD, eliminating previous diagnostic uncertainty. The Spectralis HRA and OCT device has the added advantages of being able to reliably image anterior retinal pathology and produce high-definition images.

Ability and Reproducibility of Fourier-Domain Optical Coherence Tomography to Detect Retinal Nerve Fiber Layer Atrophy in Parkinson's Disease

To evaluate and compare the ability of 3 protocols of Fourier-domain optical coherence tomography (OCT) to detect retinal thinning and retinal nerve fiber layer (RNFL) atrophy in patients with Parkinson's disease (PD) compared with healthy subjects. To test the intrasession reproducibility of RNFL thickness measurements in patients with PD and healthy subjects using the Cirrus (Carl Zeiss Meditec Inc., Dublin, CA) and Spectralis (Heidelberg Engineering, Inc., Heidelberg, Germany) OCT devices. Observational, cross-sectional study. Patients with PD (n = 75) and age-matched healthy subjects (n = 75) were enrolled. All subjects underwent three 360-degree circular scans centered on the optic disc by the same experienced examiner using the Cirrus OCT instrument, the classic glaucoma application, and the new Nsite Axonal Analytics of the Spectralis OCT instrument. Differences between the eyes of healthy subjects and the eyes of patients with PD were compared using the 3 protocols. The relationship between measurements provided by each OCT protocol was evaluated. Repeatability was studied by intraclass correlation coefficients and coefficients of variation. Retinal nerve fiber layer atrophy was detected in eyes of patients with PD (P = 0.025, P=0.042, and P < 0.001) with the 3 protocols used, but the Nsite Axonal Analytics of the Spectralis OCT device was the most sensitive for detecting subclinical defects. In eyes of patients with PD, RNFL thickness measurements determined by the OCT devices were correlated, but they were significantly different between the Cirrus and Spectralis devices (P = 0.038). Reproducibility was good with all 3 protocols but better using the Glaucoma application of the Spectralis OCT device. Fourier-domain OCT can be considered a valid and reproducible device for detecting subclinical RNFL atrophy in patients with PD, especially the Nsite Axonal Analytics of the Spectralis device. Retinal nerve fiber layer thickness measurements differed significantly between the Cirrus and Spectralis devices despite a high correlation of the measurements between the 2 instruments.

Use of Nonmydriatic Spectral-Domain Optical Coherence Tomography for Diagnosing Diabetic Macular Edema

To evaluate the accuracy of 3 spectral-domain (SD) optical coherence tomography (OCT) devices (Topcon 3D-1000 [Topcon]; Cirrus HD [Carl Zeiss Meditec, Inc], and Spectralis OCT [Heidelberg Engineering]) before and after mydriasis for the diagnosis of diabetic macular edema. Cross-sectional study. Sixty-two eyes of 62 consecutive patients with diabetes without recent loss of vision referred for retinal control were assessed. Two scans were performed for each SD OCT instrument. Central retinal thickness was measured before and after pupil dilation. Pupil dynamic was studied using pMetrics pupillometer (iVIS Technologies), and lens opacity was measured by Pentacam densitometry (Oculus). The diagnostic accuracy of SD OCT devices was assessed by sensitivity, specificity, and area under the receiver operating characteristic curve. Logistic regression analysis was used to assess the effect of pupil size and lens opacity on the reliability of SD OCT in the acquisition of adequate images. The area under the receiver operating characteristic curve for the Topcon 3D OCT device was 0.84, that for the Cirrus HD OCT device was 0.93, and that for the Spectralis OCT device was 0.91. Significant differences in area under the receiver operating characteristic curve before and after pupillary dilatation were not found. Sensitivity and specificity associated with the cutoff value for the best performance were 82% and 74% for the Topcon 3D OCT device, 90% and 87% for the Cirrus HD OCT device, and 90% and 84% for the Spectralis OCT device, respectively. The Topcon 3D OCT device had an 11.3% segmentation algorithm failure rate for the central millimeter of the fovea, and the nuclear lens density was significantly greater in these eyes than in those without failure (17.1 ± 1.1 mm vs 10.4 ± 0.2 mm; P < .05). SD OCT is a useful tool to detect and to measure diabetic macular edema without the need for pupil dilatation.