Optical coherence tomography (OCT) is a relatively new diagnostic modality that provides high-resolution, cross-sectional imaging of ocular tissues in vivo. It is predominantly used for posterior segment imaging to measure retinal and macula thickness and has been used to study and monitor diseases such as Glaucoma, vitreomacular traction, epiretinal membranes, macular holes and macular edema in diabetes, vein occlusions, and uveitis. We brought this technology into our practice in 2004 and have found that it dramatically enhances our ability to refine our understanding of what is happening inside your eyes, non-invasively, layer by layer. We use the Stratus OCT by Humphries Zeiss.
OCT is a technique for obtaining sub-surface images of translucent or opaque materials at a resolution equivalent to a low-power microscope. It is effectively ‘optical ultrasound’, imaging reflections from within tissue to provide cross-sectional images.
OCT is attracting interest among the medical community, because it provides tissue morphology imagery at much higher resolution (better than 10 µm) than other imaging modalities such as MRI or ultrasound.
The key benefits of OCT are:
- Live retinal surface images at near-microscopic resolution
- Instant, direct imaging of tissue morphology, or changes
- No preparation of the sample or subject
- No ionizing radiation
OCT delivers high resolution because it is based on light, rather than sound or radio frequency. An optical beam is directed at the tissue, and a small portion of this light that reflects from sub-surface features is collected. Note that most light is not reflected but, rather, scatters. The scattered light has lost its original direction and does not contribute to forming an image but rather contributes to glare. The glare of scattered light causes optically scattering materials (e.g., biological tissue, candle wax, or certain plastics) to appear opaque or translucent even while they do not strongly absorb light (as can be ascertained through a simple experiment — e.g., shining a red laser pointer through one's finger). Using the OCT technique, scattered light can be filtered out, completely removing the glare. Even the very tiny proportion of reflected light that is not scattered can then be detected and used to form the image in, e.g., a scanning OCT system employing a microscope.
The physics principle allowing the filtering of scattered light is optical coherence. Only the reflected (non-scattered) light is coherent (i.e., retains the optical phase that causes light rays to propagate in one or another direction). In the OCT instrument, an optical interferometer is used in such a manner as to detect only coherent light. Essentially, the interferometer strips off scattered light from the reflected light needed to generate an image. In the process depth and intensity of light reflected from a sub-surface feature is obtained. A three-dimensional image can be built up by scanning, as in a sonar or radar system.
Within the range of noninvasive three-dimensional imaging techniques that have been introduced to the medical research community, OCT as an echo technique is similar to ultrasound imaging. Other medical imaging techniques such as computerized axial tomography, magnetic resonance imaging, or positron emission tomography do not utilize the echo-location principle.
The technique is limited to imaging 1 to 2 mm below the surface in biological tissue, because at greater depths the proportion of light that escapes without scattering is too small to be detected. No special preparation of a biological specimen is required, and images can be obtained ‘non-contact’ or through a transparent window or membrane. It is also important to note that the laser output from the instruments is low – eye-safe near-infra-red light is used – and no damage to the tissue occurs.