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Imaging the optic nerve with optical coherence tomography

Eye (2024)Cite this article

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Abstract

Optical coherence tomography (OCT) is a non-invasive imaging technology, which may be used to generate in vivo quantitative and qualitative measures of retinal structure. In terms of quantitative metrics, peripapillary retinal nerve fiber layer (pRNFL) thickness provides an indirect evaluation of axonal integrity within the optic nerve. Ganglion layer measures derived from macular scans indirectly reflect retinal ganglion cell status. Notably, ganglion layer indices are platform dependent and may include macular ganglion cell inner plexiform layer (mGCIPL), ganglion cell layer (GCL), and ganglion cell complex (GCC) analyses of thickness or volume. Interpreted together, pRNFL thickness and ganglion layer values can be used to diagnose optic neuropathies, monitor disease progression, and gauge response to therapeutic interventions for neuro-ophthalmic conditions. Qualitative assessments of the optic nerve head, using cross-sectional transverse axial, en face, and circular OCT imaging, may help distinguish papilledema from pseudopapilloedema, and identify outer retinal pathology. Innovations in OCT protocols and approaches including enhanced depth imaging (EDI), swept source (SS) techniques, and angiography (OCTA) may offer future insights regarding the potential pathogenesis of different optic neuropathies. Finally, recent developments in artificial intelligence (AI) utilizing OCT images may overcome longstanding challenges, which have plagued non-vision specialists who often struggle to perform reliable ophthalmoscopy. In this review, we aim to discuss the benefits and pitfalls of OCT, consider the practical applications of this technology in the assessment of optic neuropathies, and highlight scientific discoveries in the realm of optic nerve imaging that will ultimately change how neuro-ophthalmologists care for patients.

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Fig. 1: Optical coherence tomography (OCT Spectralis, Heidelberg Engineering, Heidelberg, German) showing optic disc drusen with an infrared imaging (left) and EDI-OCT (right).
Fig. 2: A cross-sectional image of an optic nerve with optic disc drusen.
Fig. 3: Optic nerve head volume protocol on the spectralis Heidelberg engineeringTM OCT device shows resolution of papilloedema.
Fig. 4: Cross-sectional images of an optic nerve with moderate papilledema and peripapillary hyperreflective ovoid mass structure (PHOMS).
Fig. 5: Optical coherence tomography (Cirrus HD-OCT 5000, Carl Zeiss Meditec Inc., Germany) findings for a patient with bilateral optic neuropathy secondary to chiasmal compression from a pituitary adenoma.
Fig. 6: Optical Coherence Tomography (Spectralis, Heidelberg Engineering, Heidelberg, Germany) findings in a patient with left optic nerve compression from a tuberculum sella meningioma.
Fig. 7: A case of NA-AION with serous macular detachment caused by subretinal in the left eye.
Fig. 8: Optical coherence tomography (spectralis, Heidelberg engineering, Heidelberg, Germany) testing in a patient with optic neuropathy secondary to an ethambutol use.
Fig. 9: Representative case of paracentral acute middle maculopathy (PAMM) in the right eye.
Fig. 10: Optical coherence tomography (spectralis, Heidelberg engineering, Heidelberg, Germany) findings in a case of acute macular neuroretinopathy (AMN) affecting the left eye.
Fig. 11: A case of optic disc pit maculopathy in the left eye.

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Data sharing not applicable to this article as no datasets were generated or analyzed during the preparation of this review.

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Authors and Affiliations

  1. Konkuk University School of Medicine, Chungju city, Republic of Korea

    Hyun Jin Shin

  2. Department of Ophthalmology, Konkuk University Medical Center, Seoul, Republic of Korea

    Hyun Jin Shin

  3. Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea

    Hyun Jin Shin

  4. Institute of Biomedical Science & Technology, Konkuk University, Seoul, Republic of Korea

    Hyun Jin Shin

  5. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Fiona Costello

  6. Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Fiona Costello

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Shin, H.J., Costello, F. Imaging the optic nerve with optical coherence tomography. Eye (2024). https://doi.org/10.1038/s41433-024-03165-3

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