OCT and OCT Angiography in Retinal Disorders
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To our families who have sacrificed endlessly to allow us to pursue our dreams. Your love
and support have enriched every day of our lives.
To our mentors who selflessly provided us an invaluable foundation and opened countless
doors for our careers. You have collectively made us be er thinkers, be er observers, and
be er doctors.
ACKNOWLEDGMENTS
This project would not have been possible without an outstanding team of
individuals supporting it along the way. We want to thank all of the authors that
contributed to this project. Your time and dedication are what ultimately brought
this project together and elevated this book to a new level. The opportunity to
work with such an amazing network of friends, residents, fellows, mentors, and
colleagues made the project even more rewarding.
Our assistant editors, Nitish Mehta, Joseph Abraham, and Thuy Le, deserve
special a ention for the hundreds of hours logged critically editing and evaluating
each chapter.
Finally, we want to thank our families for supporting us through this process
and tolerating our countless hours spent on this project.
PREFACE
Optical coherence tomography (OCT) and most recently, optical coherence
tomography angiography (OCTA), have revolutionized the way that we practice.
Since the early 2000s when OCT entered our clinics, our understanding of retinal
disease has evolved exponentially. We are now evaluating the retina in three
dimensions, visualizing which layers are affected, and understanding how the
retina responds to therapy. Through this wealth of information, we are able to
diagnose patients sometimes exclusively based on OCT and OCTA imaging. This
provides an opportunity to prognosticate visual outcomes and, occasionally,
response to treatment. These imaging systems provide not only confirmation of
many routine clinical diagnoses, but also are the only way to make many
diagnoses that are not clinically apparent (eg, paracentral acute middle
maculopathy [PAMM]).
Additionally, we are learning about OCT features that portend a good or poor
prognosis. Disruption of the ellipsoid zone (EZ), external limiting membrane
(ELM), disorganization of the retinal inner layers (DRIL), and intraretinal
hyperreflective foci all provide prognostic information that apply to a host of
different disease states. Recognition of these alterations allows us to be er
communicate with our patients and provide realistic expectations regarding the
status of the disease.
In this handbook, we provide OCT and OCTA examples that are representative
of each disease state, highlight OCT driven prognostic factors, and demonstrate
responses to therapy where applicable. This is a synthesis of the most recently
described imaging features on each disease state and we present it in a brief and
digestible fashion. We all learned a tremendous amount pu ing this book
together, and we hope this resource will be as valuable to you as it is to us.
Happy reading!
CONTRIBUTORS
Aliaa Abdelhakim, MD, PhD
Vitreoretinal Fellow
Edward Harkness Eye Institute, Columbia University
New York University Department of Ophthalmology
New York, New York
Vitreoretinal Fellow
Ophthalmology
New York Presbyterial Hospital, Columbia University/New York University
Langone Medical Center
New York, New York
Joseph Abraham, MD
Research Fellow
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Sruthi Arepalli, MD
Vitreoretinal Fellow
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Amy S. Babiuch, MD
Assistant Professor
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Abhilasha Baharani, DNB, FRCS, FICO
Consultant Ophthalmologist
Uvea and Ocular Immunology
Neoretina Eyecare Institute
Hyderabad, Telangana, India
Irina Belinsky, MD
Clinical Assistant Professor of Oculoplastics
Ophthamalogy
NYU Langone Health
New York, New York
Audina M. Berrocal, MD
Professor of Clinical Ophthamology
Department of Ophthamalogy
Bascom Palmer Eye Institute, University of Miami, School of Medicine
Miami, Florida
Randy C. Bowen, MD, MS
Ophthalmic Oncology Fellow
Department of Ophthalmology
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Carmen Calabrise
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Jessica L. Cao, MD
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Nicole Cardwell
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Jay Chhablani, MD
Associate Professor
Ophthalmology
University of Pi sburgh
Pi sburgh, Pennsylvania
Faculty Physician
Ophthalmology
University of Pi sburgh Medical Center
Pi sburgh, Pennsylvania
Andrew X. Chen, BSE
Medical Student
School of Medicine
Case Western Reserve University
Cleveland, Ohio
Research Fellow
Center for Ophthalmic Bioinformatics
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Dinah K. Chen, MD
Resident
Department of Ophthalmology
New York University
New York, New York
Royce W. S. Chen, MD
Helen and Martin Kimmel Assistant Professor
Ophthamalogy
Columbia University Irving Medical Center
New York, New York
Netan Choudhry, MD, FRCSC
Vitreous Retina Macula Specialists of Toronto
Co-Founder & Medical Director
Toronto, Ontario, Canada
Vitreoretinal Surgeon
Ophthalmology
Cleveland Clinic Canada
Toronto, Ontario, Canada
Sara J. Coulon, MD
Resident Physician
Department of Ophthalmology
New York University
New York, New York
Jordan D. Deaner, MD
Uveitis Fellow
Department of Ophthalmology
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Meghan J. DeBenedictis, MS, LCGC, Med
Licensed, Certified Genetic Counselor
Department of Ophthalmology
Cleveland Clinic
Cleveland, Ohio
Vaidehi S. Dedania, MD
Assistant Professor
Department of Ophthalmology
New York University School of Medicine
New York, New York
Vlad Diaconita, MD, FRCSC
Vitreoretinal Fellow
Department of Ophthalmology
Columbia University
New York, New York
Anna T. Do, MD
Glaucoma Fellow
Ophthalmology
New York University
New York, New York
Eliot R. Dow, MD, PhD
Resident physician
Department of Ophthalmology
University of California
Los Angeles, California
Justis P. Ehlers, MD
The Norman C. and Donna L. Harbert Endowed Chair for Ophthalmic Research
Director, The Tony and Leona Campane Center for Excellence in Image-Guided
Surgery and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Natalia Figueiredo, MD
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Rod Foroozan, MD
Associate Professor
Ophthmalogy
Baylor College of Medicine
Houstan, Texas
John Gabriel
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Lediana Goduni, MD
Resident
Ophthalmology
NYU Langone Health
New York, New York
Doria M. Gold, MD
Clinical Assistant Professor
Department of Neurology
NYU Grossman School of Medicine
New York, New York
Vishal Govindahari, DNB
Consultant
Vitreoretina and Uveitis services
LV Prasad Eye Institute
Bhubaneswar, Odisha, India
Jenna M. Hach, BA
Research Coordinator
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Christopher R. Henry, MD
Clinical Assistant Professor
Ophthmalogy
Houston Methodist Institute for Academic Medicine
Retina Consultants at Houston
Houston, Texas
Heidi J. Huang, BA
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Yuji Itoh, MD, PhD
Assistant Professor
Ophthalmology
Kyorin University Hospital
Mitaka-Shi, Tokyo
Alice Jiang, MD
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research,
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Austen N. Knapp, MD
Resident Physician
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Thuy K. Le, BA
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Gerardo Ledesma-Gil, MD
Associate Professor
Retina Department
Institute of Ophthmalogy, Conde de Valencianc
Mexico City, Mexico
Henry Li, MS
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Phoebe Lin, MD, PhD
Associate Professor of Ophthalmology
Casey Eye Institute
Oregon Health & Science University
Portland, Oregon
Liang Liu, MD
Research Associate
Casey Eye Institute
Oregon Health & Science University
Portland, Orgeon
Leina M. Lunasco
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Brian Marr, MD
Director of Ophthalmic Oncology, Professor of Ophthamalogy
Ophthamology
Columbia University
New York, New York
New York Presbyterian
Director of Ophthalmic Oncology
Columbia University Medical Center
New York, New York
Kanwal Singh Matharu, MD
Resident
Cullen Eye Institute
Department of Ophthamalogy
Baylor College of Medicine
Houston, Texas
Nitish Mehta, MD
Clinical Assistant Professor
Ophthalmology
New York University
New York, New York
Thomas A. Mendel, MD, PhD
Vitreoretinal Surgery Fellow
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Ronald Walden Milam Jr, MD
Vitreoretinal Surgery Fellow
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Mihai Mititelu, MD, MPH
Associate Professor
Medical Director, Clinical Eye Research Unit
University of Wisconsin-Madison
Madison, Wisconsin
Yasha Modi, MD
Assistant Professor, Department of Ophthalmology
NYU Langone Eye Center
New York, New York
Prithvi Mruthyunjaya, MD
Vitreoretinal and Ocular Oncology Service
Stanford University Byers Eye Institute
Palo Alto, California
Ramsudha Narala, MD
Ocular Oncology Fellow
Ophthamology
Standard University Byers Eye Institute
Palo Alto, California
Archana Nair, MD
Resident Physician
Ophthalmology
New York University
New York, New York
Maura Di Nicola, MD
Clinical Fellow
Ocular Oncology Service
Department of Ophthalmology
University of Cincinnati
Cincinnati, Ohio
Carl Noble, DO, MBA
Surgical Retina Fellow
Ophthalmology
University of Cincinnati
Cincinnati Eye Institute
Cincinnati, Ohio
Yan Nuzbrokh, BS
Clinical Research Fellow
Medical Student
Department of Ophthalmology
Columbia University
New York, New York
Margaret O’Connell, BS
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery
and Advanced Imaging Research
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Sally Shin Yee Ong, MD
Vitreoretinal Fellow
Department of Ophthamology, Wilmer Eye Instiute
Johns Horkins University
Baltimore, Maryland
Joseph F. Panarelli, MD
Associate Professor
Ophthalmology
NYU School of Medicine
New York, New York
Dong-wouk Park, MD
Medical Retina Fellow
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Paula Eem Pecen, MD
Assistant Professor
Department of Ophthmology
University of Colorado
Aurora, Colorado
Marco Pellegrini, MD
Consultant – Head of Ocular Oncology Service
Department of Biomedical and Clinical Sciences “Luigi
Eye Clinic, Luigi Sacco Hospital
University of Milan
Milan, Italy
Prof. Giuseppe Querques, MD, PhD
Associate Professor
Ophthalmology
University Vita-Salute San Raffaele,
Milan, Italy
Aleksandra V. Rachitskaya, MD
Assistant Professor of Ophthamology
Cole Eye Institute, Cleveland Clinic
Cleveland, Ohio
Joseph James Raevis, MD
Surgical Retina Fellow
Ophthamology
University of Wisconsin
Madison, Wisonsin
Spoorti Krishna Reddy Mandadi, MS
Former fellow in Medical Retina and Uveitis
Department of Retina and Uveitis
L V Prasad Eye Institute, Kallam Anji Reddy Campus
Hyderabad, Telangana, India
Riccardo Sacconi, MD, FEBO
PhD Candidate
Ophthalmology
University Vita-Salute San Raffaele
Milan, Italy
Consultant
Ophthalmology
IRCCS San Raffaele Hospital
Milan, Italy
David Sarraf, MD
Clinical Professor of Ophthalmology
Jules Stein Eye Institute
University of California
Los Angeles, California
Jackson Scharf, BS
Medical Student
Vagelos College of Physicians and Surgeons
Columbia University
New York, New York
Research Fellow
Retina Disorders and Ophthalmic Genetics
Jules Stein Eye Institute
University of California
Los Angeles, California
loana Scherbakova, BFA
