august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 1

OCT and OCT Angiography

in Glaucoma

Disclosure Statement(next slide)

Greg Caldwell, OD, FAAOOptometric Education Consultants

August 29, 20/20

1

Disclosures- Greg Caldwell, OD, FAAO

$ Will mention many products, instruments and companies during our discussion¬ I don’t have any financial interest in any of these products, instruments or companies

$ Pennsylvania Optometric Association –President 2010 2 POA Board of Directors 2006-2011

$ American Optometric Association, Trustee 2013-2016 $ I never used or will use my volunteer positions to further my lecturing career$ Lectured for: Aerie, Alcon, Allergan, BioTissue, OptoVue$ Advisory Board: Allergan, Maculogix, Sight Sciences, Sun, Takeda $ Envolve: PA Medical Director, Credential Committee

$ Optometric Education Consultants- Scottsdale, St. Paul, Quebec City, Nashville, and Orlando/Disney OCT Users meeting; Owner

2

OCT Anterior Segment Applications in Glaucoma

4

OCT for Pachymetry in Glaucoma

5

PachymetryUltrasonic versus Optical versus OCT

6

Anterior Segment ImagingPachymetry

7

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 2

55 Year Old Men500 microns CCT and 21 mm Hg with Goldmann

What is the true IOP?1. 18 mm Hg2. 21 mm Hg3. 24 mm Hg

4. Don’t Know

600 microns CCT and 21 mm Hg with Goldmann

What is the true IOP?1. 18 mm Hg2. 21 mm Hg3. 24 mm Hg

4. Don’t Know

Corneal CurvatureCorneal ThicknessCorneal Rigidity

8 9

Less Than 15 Degrees Get Consult

10

Closed Angle

11

Overlay of the RNFL and GCC

RNFL

GCC

12

Normal

Glaucoma with thinner GCC

GCC Thinning in Glaucoma

13

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 3

Green, Red, Yellow, and BlueDisease

Physiologically NormalOCT measure structure

14

Green, Red, Yellow, and Blue DiseaseHints to this Disease

$If the disease is a bilateral disease¬ Glaucoma

2 It is usually asymmetric

$If the scans are symmetric ¬ Then it most likely not disease – physiologically normal¬ Anatomical variation

2 Normal for that patient

$Another hint is the GCC expected values ¬ 85-100 microns ¬ 92-95 microns

15

Symmetry and What is Being Tested

16

46-year-old woman with red-yellow disease

$OD -0.75 20/20$OS -1.25 20/20

$Systemic hx: thyroid dysfunction, high cholesterol¬ Medications for the above

$IOPs 15 mm Hg OU 8:30 am

17

18

63-year-old woman with red, yellow, blue, and green disease

$OD plano/ +2.00 20/20$OS -0.50/ +2.00 20/20

$IOPs 15-18 mm Hg OU 2011-2015

19

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 4

2015 2016

20

58-year-old with yellow disease

$OD +1.00 20/20$OS +1.25 20/20

$IOPs: 13/15 mm Hg at 11:24 am

$(pay attention to FLV and GLV)

21

22

40 yo man with red, blue, green disease

$OD -7.50 – 0.75 x 110 20/20$OS -7.50 – 0.75 x 105 20/20

$IOPs: 15/13 mm Hg at 6:30 pm

23

March 16, 2015

24

January 9, 2017

25

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 5

22 months apart

26

79 year-old-woman with DM

27

Glaucoma

28

NFL and GCC

29

30 31

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 6

32 33

POAG

34

POAG

35

POAG

36

Glaucoma Suspect strong family history

37

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 7

Next Generation Glaucoma Analysis with OCT + OCTA

38

Learn What Normal Looks Like

Retina:Superficial Vascular

Complex

Disc: Radial Peripapillary

Capillaries

OD OS

39

What Does Glaucoma Look Like? Normal Moderate Glaucoma Advanced Glaucoma

Disc

Retina

40

Glaucoma

41

$Shows early changes in the retina and optic disc

$Adds new information to the diagnosis

$Aids in progression detection

How Does OCTA Change the Way You See Glaucoma?

42

Review of Normal25-year-old man

43

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 8

Review of Normal60-year-old man

44

60-Year-Old Montage OD

45

60-Year-Old Montage OS

46

60-Year-Old Montage OU

47

68-year-old woman with glaucoma$Wants second opinion for glaucoma management$Recently had cataract surgery OS with iStent

¬ September 25, 2017¬ Dorzolamide 2% BID OS, Lumigan 0.01% QD OS

$Our practice recently performed cataract surgery and Kahook dual blade (KDB) MIGS¬ July 24, 2018

$IOPGAT: 12 and 16 at 11:27 am

48

OCT for Pachymetry in Glaucoma

49

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 9

OCT GCC and NFL

50

Visual Fields

51

Angiography and AngioAnalytics of Disc

52

En Face Radial Peripapillary Capillaries (RPC)

53

Angiography and AngioAnalytics of Retina

54

Montage OD

55

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 10

Montage OS

56

Montage OU

57

$POAG, OS > OD$Lumigan 0.01% QD OU

$Combigan BID OU

74-year-old man

58

VF OD and OS 1-26-2018

59

VF OD and OS GPA 1-26-2018

60

OCT NFL and GCC 9-25-2018

61

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 11

Change Analysis NFL-GCC

62

OCT-A 9-25-2018POAG OS > OD

63

OCT-A 9-25-2018POAG OS > OD

64

Montage OD

65

Montage OS

66

Montage OU

67

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 12

They do read their EHR communication

68

$ Ocular Hypertension since 2014¬ No treatment

$ Pigment Dispersion

$ Baseline IOP or Tmax 26/26¬ 2014— March 2018

$ Today 30/32, new Tmax 9-25-18

49 year old man

69

VF 24-2 Sita-Faster9-25-2018

70

OCT NFL and GCC3-22-18

71

OCT-A 9-25-2018

72

OCT-A 9-25-2018

73

august 30, 2020

Greg Caldwell, OD, FAAO Grubod@gmail.com 814-931-2030 cell 13

Montage OD

74

Montage OS

75

Montage OU

76

$Shows early changes in the retina and optic disc

$Adds new information to the diagnosis

$Aids in progression detection

How Does OCTA Change the Way You See Glaucoma?

77

Glaucoma versus Other Optic Neuropathy

78

Hope You EnjoyedThank You!

Greg

79