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Reproduction in whole or in part without permission is prohibited. It’s just that the utility of this technology hasn’t yet been fully exploited. It lets them see if their targeted procedures have achieved the desired surgical outcomes, in terms of targeting the correct anatomy.”, • For patient education. With it, I can spare the patient some time, and also the contact procedure. It’s hard to argue with that, because gonioscopy involves a subjective judgment made by the observer. Of course, it only provides a structural assessment, not a functional assessment—it doesn’t tell you anything about the consequences of an angle narrowing, such as how much the IOP rises as a result. That’s most evident when you’re looking at angle structure; often, you can’t see into the recesses of the angle with the spectral domain devices.”, Both doctors note that anterior segment OCT’s ability to perform scans in the dark is a significant help with suspicious angle patients. “How much shadowing you see depends on how the images are acquired and the wavelength of the light; the longer the wavelength, the deeper into the angle you’ll be able to see. “Many devices have software that can help you analyze anterior segment images,” Dr. Schuman points out. It is easy to use, quick, and noninvasive . Ptosis or a Different Diagnosis: Asking the Right Questions Before Treatment. Several studies , , , , have described the use of anterior segment optical coherence tomography (AS-OCT) in evaluating punctal stenosis. Anterior segment optical coherence tomography (AS-OCT) produces high-resolution imaging of the cornea, iris, and anterior chamber (e.g.,Visante). Nevertheless, AS-OCT can usually distinguish between narrow angles and PAS if an expert evaluator examines the images.”, Dr. Schuman believes the tide may be shifting regarding whether gonioscopy or anterior segment imaging is the more reliable tool for evaluating the angle. I’ll perform UBM imaging in cases with persistent angle closure after iridotomy or cases in which I suspect an irido-ciliary mechanism such as cysts or plateau iris.”. In the future, we will see faster acquisition speeds, 3-D imaging and even higher resolution. There’s more justification for buying one.”. “Studies have shown that about 25 percent of angles still look narrow after an iridotomy. “The images are incredibly useful for teaching patients about their iridocorneal angle anatomy, especially if they’re asymptomatic,” says Dr. Chopra. (Faster scanning rates means more sampliing and denser data per volume scanned.). “Anterior segment OCT can measure almost anything in the front part of the eye,” says Joel S. Schuman, MD, FACS, Elaine Langone Professor and vice chairman for research in the department of ophthalmology, and professor of neuroscience and physiology, at NYU Langone Health, NYU Grossman School of Medicine, in New York City. Using time domain OCT technology (TD-OCT), the Visante® creates cross-sectional images of anterior segment structures (Figure 2). “If it’s been many months or even years since the original LASIK, it’s useful to use a Fourier domain OCT, which has higher resolution and will allow you to average a lot of scans. Of course, AS-OCT has other noteworthy limitations. Optovue uses optical coherence tomography (OCT) to perform SCODI-A with iVue ®, iScan™ and Avanti™. In plateau iris, you see a flat iris plane. I also show them an example of an open angle, which helps them to understand the difference between an open angle and an occludable angle. All rights reserved. One key use for anterior segment OCT is as an aid to detecting signs of early forme fruste keratoconus, particularly relevant for LASIK surgeons. “AS-OCT can reveal the differences between anterior corneal curvature and posterior corneal curvature,” he says. It also requires some light to visualize the angle.”, Drs. Dr. Chopra points out that AS-OCT and gonioscopy can be quite comparable when analyzing the angle. Anterior segment optical coherence tomography angiography technology. “However, I don’t find any of the quantitative tools offered for measuring the angle clinically useful. “They have other expenses that would show more return on investment.”, Because anterior segment OCT provides a detailed look at the. A lot of the value of gonioscopy at this point lies in revealing things that imaging can’t reveal. This non-invasive imaging technique is capable of providing high-quality cross-sectional images based on the reflectance of tissue using a near-infrared light, in contrast to UBM that uses sound. If an angle looks occludable to me by gonioscopy, I do the Visante as a confirmation. “This has been approved outside the United States for several years, but it’s more of a research application in the United States right now. Some biometry measurements, like sulcus-to-sulcus width, need that kind of penetration. “An angle that is occludable will be narrow or closed in the dark. “Anterior segment OCT can be useful if you’re a general ophthalmologist and don’t do gonioscopy too often,” says Dr. Radhakrishnan. “But by itself, that’s not enough. Given the advantages of AS-OCT, it’s worth asking why it’s catching on so slowly. “When discussing laser peripheral iridotomy, I bring these patients to the room where we perform Visante scanning,” she says. Here, surgeons discuss its advantages, how it compares to other technologies used for this purpose, and why they believe it’s taking a while to become popular. “You can get beautiful images and extract a lot of useful information with it. • When evaluating the condition of the angle. 2-4 Anterior segment imaging has a different set of requirements than posterior segment imaging. But I also use the OCT corneal power measurement that includes the posterior surface refractive power. Anterior segment OCT (AS-OCT) has come a long way in recent years. Optical coherence tomography (OCT) is a noncontact technology that produces high-resolution cross-sectional images of ocular tissues. Q What are the indications for SCODI of the anterior segment? Anterior segment OCT is a relatively new technology, and hardware and software updates continue to be unveiled. Surgeons are now using anterior segment OCT for several purposes: • When performing LASIK. “If you’re interested in looking at the palisades of Vogt, you can see that with anterior segment-OCT; in fact, our group recently received a patent for using anterior segment OCT to evaluate the stem cell niche. “One of the things he suggested was that gonioscopy—currently the gold standard for judging things like how open or closed the angle is—probably shouldn’t be the gold standard. “Sometimes you can see almost the whole angle, but you lose the most posterior portion that’s really of interest,” he explains. “UBM is harder to use because it requires eye contact, it’s messy and it’s not as good at measuring shape,” Dr. Huang points out. “It’s especially useful for teaching residents and Fellows. To investigate the imaging capabilities of anterior segment optical coherence tomography (AS OCT) in microbial keratitis and to assess whether measurements of the quantitative parameters, infiltrate thickness and corneal thickness, were possible. As today’s devices become more sophisticated, options designed to help those with limited vision are increasing. However, it may take doctors a long time to accept machine classification of angle status.”, “I think many glaucoma specialists believe that gonioscopy is easy and simple to perform,” Dr. Chopra says. “Anterior chamber OCT scans spot-by-spot, so until you have a very fast system, or a parallel system, it doesn’t cover as much area as quickly as some of the other technologies,” says Dr. Huang. The ANTERION is a swept-source OCT device with a 1300 nm light source, which allows for the acquisition of high-contrast anterior segment images along a large image depth. “This gets rid of the distortion due to the index transition at the air-cornea interface,” Dr. Huang explains. When managing keratoconus you can look at the tissue thickness and confirm the corneal structure, especially in the area of the cone. Reproduction in whole or in part without permission is prohibited. With the Visante I only look at four cuts out of a 360-degree circle, and I want to see a 360-degree view. • When performing cataract surgery. With the increase in popularity of anterior chamber imaging, and anterior segment OCT proving to be the best tool for high resolution biometry, Anterior Segment Optical Coherence Tomography is a must-have for anterior segment, refractive, cornea, and glaucoma surgeons. Areas in which anterior segment OCT is showing promise include evaluation of the angle in glaucoma patients; evaluation of the cornea in refractive surgery patients—particularly LASIK patients; measuring the anterior chamber for certain phakic intraocular lenses; and as an adjunct in other operations involving the cornea, such as PTK and corneal transplants. Dr. Chopra says he also uses AS-OCT to monitor corneal thinning in keratoconus patients. If I’m suspicious that there’s plateau iris, or a cyst or tumor pushing from behind causing the narrow angle or angle closure, then I’ll get a UBM.”, Dr. Schuman concurs. Angle that is occludable will be developed that kind of imaging or provide automated analysis and measurements Questions, the. Iridectomy is indicated to limited penetration through scattering tissue such as the sclera gonioscopy has some that... Are automatically corrected for those distortions forme fruste keratoconus when evaluating a potential of... 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