august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 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
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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
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OCT Anterior Segment Applications in Glaucoma
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OCT for Pachymetry in Glaucoma
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PachymetryUltrasonic versus Optical versus OCT
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Anterior Segment ImagingPachymetry
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 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
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Less Than 15 Degrees Get Consult
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Closed Angle
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Overlay of the RNFL and GCC
RNFL
GCC
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Normal
Glaucoma with thinner GCC
GCC Thinning in Glaucoma
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 3
Green, Red, Yellow, and BlueDisease
Physiologically NormalOCT measure structure
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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
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Symmetry and What is Being Tested
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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
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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
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 4
2015 2016
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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)
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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
$IOPs: 15/13 mm Hg at 6:30 pm
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March 16, 2015
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January 9, 2017
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 5
22 months apart
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79 year-old-woman with DM
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Glaucoma
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NFL and GCC
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 6
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POAG
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POAG
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POAG
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Glaucoma Suspect strong family history
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 7
Next Generation Glaucoma Analysis with OCT + OCTA
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Learn What Normal Looks Like
Retina:Superficial Vascular
Complex
Disc: Radial Peripapillary
Capillaries
OD OS
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What Does Glaucoma Look Like? Normal Moderate Glaucoma Advanced Glaucoma
Disc
Retina
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Glaucoma
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$Shows early changes in the retina and optic disc
$Adds new information to the diagnosis
$Aids in progression detection
How Does OCTA Change the Way You See Glaucoma?
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Review of Normal25-year-old man
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 8
Review of Normal60-year-old man
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60-Year-Old Montage OD
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60-Year-Old Montage OS
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60-Year-Old Montage OU
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68-year-old woman with glaucoma$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
$IOPGAT: 12 and 16 at 11:27 am
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OCT for Pachymetry in Glaucoma
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 9
OCT GCC and NFL
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Visual Fields
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Angiography and AngioAnalytics of Disc
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En Face Radial Peripapillary Capillaries (RPC)
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Angiography and AngioAnalytics of Retina
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Montage OD
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 10
Montage OS
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Montage OU
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$POAG, OS > OD$Lumigan 0.01% QD OU
$Combigan BID OU
74-year-old man
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VF OD and OS 1-26-2018
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VF OD and OS GPA 1-26-2018
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OCT NFL and GCC 9-25-2018
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 11
Change Analysis NFL-GCC
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OCT-A 9-25-2018POAG OS > OD
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OCT-A 9-25-2018POAG OS > OD
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Montage OD
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Montage OS
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Montage OU
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 12
They do read their EHR communication
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$ 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
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VF 24-2 Sita-Faster9-25-2018
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OCT NFL and GCC3-22-18
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OCT-A 9-25-2018
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OCT-A 9-25-2018
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august 30, 2020
Greg Caldwell, OD, FAAO [email protected] 814-931-2030 cell 13
Montage OD
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Montage OS
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Montage OU
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$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?
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Glaucoma versus Other Optic Neuropathy
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Hope You EnjoyedThank You!
Greg
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