Table Of Contentbiological and medical physics,
biomedical engineering
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biological and medical physics,
biomedical engineering
Thefieldsofbiologicalandmedicalphysicsandbiomedicalengineeringarebroad,multidisciplinaryand
dynamic.Theylieatthecrossroadsoffrontierresearchinphysics,biology,chemistry,andmedicine.The
BiologicalandMedicalPhysics,BiomedicalEngineeringSeriesisintendedtobecomprehensive,coveringa
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Booksintheseriesemphasizeestablishedandemergentareasofscienceincludingmolecular,membrane,
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Editor-in-Chief:
EliasGreenbaum,OakRidgeNationalLaboratory,OakRidge,Tennessee,USA
EditorialBoard:
MasuoAizawa,DepartmentofBioengineering, MarkS.Humayun,DohenyEyeInstitute,
TokyoInstituteofTechnology,Yokohama,Japan LosAngeles,California,USA
OlafS.Andersen,DepartmentofPhysiology, PierreJoliot,InstitutedeBiologie
Biophysics&MolecularMedicine, Physico-Chimique,FondationEdmond
CornellUniversity,NewYork,USA deRothschild,Paris,France
RobertH.Austin,DepartmentofPhysics, LajosKeszthelyi,InstituteofBiophysics,Hungarian
PrincetonUniversity,Princeton,NewJersey,USA AcademyofSciences,Szeged,Hungary
JamesBarber,DepartmentofBiochemistry, RobertS.Knox,DepartmentofPhysics
andAstronomy,UniversityofRochester,Rochester,
ImperialCollegeofScience,Technology
NewYork,USA
andMedicine,London,England
AaronLewis,DepartmentofAppliedPhysics,
HowardC.Berg,DepartmentofMolecular
HebrewUniversity,Jerusalem,Israel
andCellularBiology,HarvardUniversity,
Cambridge,Massachusetts,USA StuartM.Lindsay,DepartmentofPhysics
VictorBloomfield,DepartmentofBiochemistry, andAstronomy,ArizonaStateUniversity,
UniversityofMinnesota,St.Paul,Minnesota,USA Tempe,Arizona,USA
RobertCallender,DepartmentofBiochemistry, DavidMauzerall,RockefellerUniversity,
NewYork,NewYork,USA
AlbertEinsteinCollegeofMedicine,
Bronx,NewYork,USA EugenieV.Mielczarek,DepartmentofPhysics
andAstronomy,GeorgeMasonUniversity,Fairfax,
StevenChu,LawrenceBerkeleyNational
Virginia,USA
Laboratory,Berkeley,California,USA
MarkolfNiemz,MedicalFacultyMannheim,
LouisJ.DeFelice,DepartmentofPharmacology,
UniversityofHeidelberg,Mannheim,Germany
VanderbiltUniversity,Nashville,Tennessee,USA
V.AdrianParsegian,PhysicalScienceLaboratory,
JohannDeisenhofer,HowardHughesMedical
NationalInstitutesofHealth,Bethesda,
Institute,TheUniversityofTexas,Dallas,
Maryland,USA
Texas,USA
LindaS.Powers,UniversityofArizona,
GeorgeFeher,DepartmentofPhysics,
Tucson,Arizona,USA
UniversityofCalifornia,SanDiego,LaJolla,
California,USA EarlW.Prohofsky,DepartmentofPhysics,
PurdueUniversity,WestLafayette,Indiana,USA
HansFrauenfelder,
LosAlamosNationalLaboratory, AndrewRubin,DepartmentofBiophysics,Moscow
LosAlamos,NewMexico,USA StateUniversity,Moscow,Russia
IvarGiaever,RensselaerPolytechnicInstitute, MichaelSeibert,NationalRenewableEnergy
Troy,NewYork,USA Laboratory,Golden,Colorado,USA
SolM.Gruner,CornellUniversity, DavidThomas,DepartmentofBiochemistry,
Ithaca,NewYork,USA UniversityofMinnesotaMedicalSchool,
Minneapolis,Minnesota,USA
JudithHerzfeld,DepartmentofChemistry,
BrandeisUniversity,Waltham,Massachusetts,USA
Rui Bernardes
Jose´ Cunha-Vaz
Editors
Optical Coherence
Tomography
A Clinical and Technical Update
With 124 Figures
123
Editors
RuiBernardes
Jose´Cunha-Vaz
IBILI, Faculty of Medicine, University of Coimbra and AIBILI
AzinhagaSta.Comba,Celas,3000-548Coimbra,Portugal
BiologicalandMedicalPhysics,BiomedicalEngineering ISSN1618-7210
ISBN978-3-642-27409-1 ISBN978-3-642-27410-7 (eBook)
DOI10.1007/978-3-642-27410-7
SpringerHeidelbergNew York Dordrecht London
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Preface
This book has been written to provide readers with a set of complementary
viewpoints and perspectives on what is probably the most impressive imaging
techniquecurrentlyavailable,opticalcoherencetomography(OCT). The speedof
data acquisition,its noninvasiveimaging,and its excellentimage resolution make
thistechniquedistinctinanyfieldofmedicine.
Two different communities contributed to the contents of the book. Part I
providesviewpointsontheimpactthatOCThasmadeonimagingthehumanretina
in vivo from reputed ophthalmologists,its users. In Part II, leading experts in the
fielddiscussthetechniqueitselfanddescribedevelopmentsoffurtherpotential.In
addition,newapplicationsarediscussedthatcanopenOCTtoanevenbroaderuse
inophthalmologyfromthetraditionalstructuralapplication.
Wehopethatreadersinterestedinthismethodologyfindthatthisbookcombines
both the medical and technical information required to understand the principles
andtheapplicationofthisnotabletechniquethathascompletelymodifiedtheway
informationonthelivinghumanretinacanbeobtained.
Weareverygratefultoallofourcolleagueswhohavecontributedinmakingthis
bookpossible.
Coimbra,Portugal RuiBernardes
Coimbra,Portugal Jose´ Cunha-Vaz
v
•
Contents
1 DiabeticMacularEdema .................................................. 1
Conceic¸a˜oLobo,IsabelPires,andJose´ Cunha-Vaz
1.1 Introduction........................................................... 1
1.2 PathophysiologyofRetinalEdema.................................. 2
1.3 ExtracellularEdema.................................................. 2
1.4 Starling’sLaw........................................................ 3
1.5 IncidenceandPrevalenceofDME .................................. 3
1.6 ClinicalEvaluationofMacularEdema.............................. 4
1.7 DiagnosisandClassification......................................... 4
References.................................................................... 18
2 Ischemia ..................................................................... 23
SukHoByeon,MinKim,andOhWoongKwon
2.1 RetinalIschemia...................................................... 23
2.2 BriefAnatomyofRetinalCirculation............................... 24
2.3 FluoresceinAngiography(FA)andOpticalCoherence
Tomography(OCT):AnatomicCorrelations ....................... 24
2.4 “ExternalFovea”inOCT............................................ 26
2.5 DetectionofIschemicRetinalArea:Comparisons
BetweenFluoresceinAngiographyandOCT....................... 27
2.6 PathologicChangesandRelevantOCT Findings
inIschemicTissues................................................... 28
2.7 ProminentMiddleLimitingMembrane............................. 28
2.8 RetinalArteryOcclusion............................................. 29
2.9 CentralRetinalArteryOcclusion.................................... 29
2.10 CRAOwithCilioretinalArterySparing............................. 32
2.11 CilioretinalArteryOcclusion........................................ 33
2.12 BranchedRetinalArteryOcclusion................................. 33
2.13 OphthalmicArteryOcclusion ....................................... 33
2.14 CottonWoolSpots ................................................... 35
2.15 CombinedCRAOandCRVO........................................ 36
vii
viii Contents
2.16 OcularIschemicSyndrome.......................................... 37
2.17 EvaluationofRetinalPerfusionStateonOCT ..................... 37
2.18 Centralretinalveinocclusion(CRVO).............................. 37
2.19 Centralretinalveinocclusion........................................ 40
2.20 DiabeticRetinopathy................................................. 41
2.21 DiabeticIschemicMaculopathy..................................... 41
2.22 ChoroidalIschemia................................................... 43
References.................................................................... 45
3 OpticalCoherence Tomography and Visual Acuity:
PhotoreceptorLoss......................................................... 51
Adzura Salam, Ute Ellen Kathrin Wolf-Schnurrbusch,
andSebastianWolf
3.1 Introduction........................................................... 52
3.2 PrincipleofSD-OCT................................................. 52
3.3 SD-OCTinNormalEyes ............................................ 53
3.4 SD-OCTinRetinalDiseases ........................................ 53
3.5 CorrelationBetween Visual Acuityand Integrity
ofPhotoreceptorinRetinalDiseases................................ 54
3.5.1 Photoreceptor............................................... 54
3.5.2 DiabeticMacularEdema................................... 54
3.5.3 RetinalVeinOcclusion..................................... 59
3.5.4 RetinalArteryOcclusion................................... 62
3.5.5 Age-RelatedMacularDegeneration....................... 65
3.5.6 CentralSerousChorioretinopathy......................... 71
3.5.7 RetinitisPigmentosa........................................ 71
3.5.8 FovealMicrostructureandVisualAcuityin
SelectedSurgicalRetinaCases ............................ 75
3.6 Conclusion............................................................ 81
3.7 SummaryforDoctor ................................................. 81
References.................................................................... 81
4 OpticalCoherenceTomographyUpdatesonClinical
and Technical Developments. Age-RelatedMacular
Degeneration:DrusenandGeographicAtrophy........................ 87
MonikaFleckenstein,SteffenSchmitz-Valckenberg,and
FrankG.Holz
4.1 Introduction........................................................... 87
4.2 EarlyAMD........................................................... 88
4.2.1 In Vivo Visualization of Drusen and
PigmentaryChangesbySpectral-Domain
OpticalCoherenceTomography........................... 88
4.2.2 Quantification of Drusen Volume by
Spectral-DomainOpticalCoherenceTomography........ 91
Contents ix
4.3 GeographicAtrophy.................................................. 93
4.3.1 Phenotypic Features of Atrophy and
Identificationof Predictive Markersby
Spectral-DomainOpticalCoherenceTomography........ 93
4.3.2 CorrelationwithOtherImagingModalities............... 94
4.3.3 Quantificationof Atrophyby Spectral-
DomainOpticalCoherenceTomography
Imaging ..................................................... 100
4.4 FuturePerspectives................................................... 102
References.................................................................... 103
5 OpticalCoherenceTomographyinGlaucoma .......................... 109
FatmireBerisha,EstherM.Hoffmann,andNorbertPfeiffer
5.1 Introduction........................................................... 109
5.2 ImaginginGlaucoma................................................ 110
5.3 Time-DomainOpticalCoherenceTomographyinGlaucoma...... 111
5.4 SpectralDomainOpticalCoherenceTomographyinGlaucoma... 112
5.5 DiagnosticAbilityofSpectralDomainOCTinGlaucoma ........ 117
5.6 FutureDirectionsofOpticalCoherenceTomography
inGlaucoma.......................................................... 119
References.................................................................... 120
6 AnteriorSegmentOCTImaging.......................................... 125
Alexandre Denoyer, Antoine Labbe´, and Christophe
Baudouin
6.1 Introduction........................................................... 125
6.2 PrinciplesofAnteriorSegmentOCT................................ 126
6.3 ClinicalApplications................................................. 127
6.3.1 CornealThicknessAssessment ............................ 127
6.3.2 CornealGrafts .............................................. 127
6.3.3 CornealRefractiveSurgery ................................ 128
6.4 PhakicIntraocularLens.............................................. 131
6.5 Glaucoma............................................................. 132
6.6 Conclusion............................................................ 137
References.................................................................... 137
7 OpticalCoherenceTomography:AConceptReview................... 139
PedroSerranho,Anto´nioMiguelMorgadoandRuiBernardes
7.1 Introduction........................................................... 139
7.2 TheGenesisofOCT ................................................. 141
7.3 ThePhysicalPrinciple ............................................... 142
7.4 Low-CoherenceLightInterferometer............................... 144
7.5 Time-DomainOpticalCoherenceTomography..................... 146
7.6 Spectral-DomainOpticalCoherenceTomography................. 147
7.7 Swept-SourceOpticalCoherenceTomography..................... 148
7.8 Polarization-SensitiveOpticalCoherenceTomography............ 149
x Contents
7.9 Full-FieldOpticalCoherenceTomography......................... 150
7.10 QuantumOpticalCoherenceTomography.......................... 151
7.11 LatestDevelopmentsandFutureDirections........................ 152
References.................................................................... 153
8 EvaluationoftheBlood–RetinalBarrierwithOptical
CoherenceTomography.................................................... 157
RuiBernardesandJose´Cunha-Vaz
8.1 Introduction........................................................... 157
8.2 Blood–RetinalBarrier................................................ 158
8.3 ClinicalEvaluationoftheBlood–RetinalBarrier .................. 159
8.4 QuantitativeEvaluationoftheBlood–RetinalBarrier.............. 159
8.4.1 ConfocalScanningLaserOphthalmoscopy............... 160
8.5 RetinalLeakageAnalyzer ........................................... 161
8.6 NoninvasiveEvaluationofBlood–RetinalBarrierwithOCT...... 163
8.6.1 DataofHealthyVolunteersvs.PatientData .............. 163
8.6.2 DifferencesWithintheSameEyeandScan............... 164
8.6.3 AutomaticClassification ................................... 168
8.7 Conclusions........................................................... 172
References.................................................................... 173
9 PolarizationSensitivity..................................................... 175
U. Schmidt-Erfurth,F. Schlanitz, M. Bolz, C. Vass, J.
Lammer,C.Schu¨tze,M.Pircher,E.Go¨tzinger,B.Baumann,
andC.K.Hitzenberger
9.1 Polarization-SensitiveOpticalCoherenceTomography............ 175
9.1.1 PrinciplesofPolarization-SensitiveOCT ................. 176
9.1.2 PolarizationPropertiesofOcularStructures.............. 179
9.1.3 SegmentationAlgorithms.................................. 182
9.2 ImagingoftheEyewithPolarization-SensitiveOCT.............. 186
9.2.1 Age-RelatedMacularDegeneration....................... 187
9.2.2 Glaucoma ................................................... 193
9.2.3 DiabeticMaculopathy...................................... 196
9.3 ConclusionandFutureDirections................................... 198
References.................................................................... 199
10 AdaptiveOpticsinOcularOpticalCoherenceTomography .......... 209
EnriqueJosuaFerna´ndezandPabloArtal
10.1 Introduction........................................................... 209
10.2 TheEyeasanOpticalSystemandAdaptiveOptics................ 211
10.3 TransverseResolutioninOCT....................................... 212
10.4 EffectofAberrationCorrectioninContrastandResolution....... 216
10.5 CorrectionofOcularMonochromaticAberrationsinOCT........ 219
10.5.1 TimeDomain ............................................... 219
10.5.2 FrequencyDomain ......................................... 221
