Our perception of macular dystrophies has evolved overtime from collective grouping into hereditary disorders of unclear etiology and no effective treatment to avid search for the underlying pathogenic mechanism that would provide base for future therapy. A causal conjunction between abnormalities in the photoreceptors layer and the RPE—Bruch’s membrane complex and abnormal profile of the retinal vascular plexuses and the choriocapillaris—stands out as a plausible theory of pathogenesis. The recently introduced swept-source optical coherence tomography (SS-OCT) technology incorporates long-wavelength (1050-nm) scanning light, less susceptibility to sensitivity roll-off, and ultrahigh-speed image acquisition. These features enabled in vivo noninvasive visualization of different strata of the outer retina and the choriocapillaris with unprecedented finesse. Furthermore, the SS-OCT technology incorporated a blood flow detection algorithm; OCTARA that in tandem with the deeper penetration and superior axial resolution of SS-OCT enabled detailed assessment of the retinal capillary plexuses and the choriocapillaris in terms of structure and density. This novel technology could help explore yet undiscovered frontiers in the pathophysiology of macular dystrophies and guide future therapeutic approaches. This chapter includes a review of literature along with the authors’ experience in imaging selected macular dystrophies using SS-OCT and SS-OCT angiography (SS-OCTA).
Part of the book: OCT
The pathogenesis of uveitis entails changes in the structural morphology of the macula, choroid, and choroidal perfusion. Documentation of these pathologic alterations is pivotal in making a proper diagnosis and in follow-up of outcomes of therapy. The newly-introduced swept-source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (SS-OCTA) were harbingers of a whole new era of noninvasive in vivo layer-to-layer dissection of macular and choroidal structural changes in uveitis and of disease-related vascular profile patterns. This new information unraveled new aspects of the underlying pathogenetic mechanisms in different uveitides and added to our understanding of the disease process. Monitoring choroidal thickness was introduced as a novel sensitive index for evaluation and titration of treatment response. Moreover, the ensuing complications of uveitis as poor pupillary dilatation due to posterior synechiae and mild to moderate opacities due to cataract or vitritis that frequently posed pertinacious impediments for reproducible imaging were overcome by SS-OCT features notably long-wavelength scanning laser and reduced sensitivity roll-off features. In the current manuscript we present our experience in diagnosis and management of selected posterior uveitides using SS-OCT and SS-OCTA.
Part of the book: A Practical Guide to Clinical Application of OCT in Ophthalmology