[optimal] Re: Scanning for mac hole with Heidelberg

  • From: "Bennett, Timothy" <tbennett1@xxxxxxxxxxx>
  • To: "'optimal@xxxxxxxxxxxxx'" <optimal@xxxxxxxxxxxxx>
  • Date: Wed, 26 Feb 2014 22:05:28 +0000

Stu,

I'd be curious to see the FA in question.

I disagree with most of the advice given so far. I use raster patterns or cube 
scans for volumetric data, not to identify pathology like a macular hole. I 
wouldn't worry about the number of lines or the spacing. I would go after a 
suspected hole with a single high-res line scan. Lock the tracking & then move 
the line through the fovea or area of interest. If it's there, you'll find it 
easily.

I would also not be a slave to the ART setting.  Be aware that sampling 
artifacts can occur when using ART. I've seen very small macular holes 
disappear while locked on. If sampled too long, you can see the hole begin to  
"fill" in with false data. A hovering operculum can also invert in the scan 
window and begin fill in the hole. ART is a great tool, but like any tool there 
are times it doesn't work well. Quite often you reach a point of diminishing 
return. You should watch the scan and capture when the image looks good.

Finally, if it truly is a full thickness macular hole, autofluorescence imaging 
would identify it. The absence of retinal tissue over the bare RPE will cause a 
hyperfluorescent spot. If your Spectralis has FAF capability, you could do 
AF+OCT & register the line scan over the hyperfluorescent hole.

Hope this helps,

tim


From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On 
Behalf Of Eric Kegley
Sent: Wednesday, February 26, 2014 4:21 PM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: Scanning for mac hole with Heidelberg

Stuart,

I agree with both Denice and Jocelyn. You have to have more scan lines than 
just 25 IMHO. We typically make the scan area much smaller and "cram" the scan 
line right against one another. Also like Jocelyn said, lock the tracking and 
then you can move the scan lines through the macula to find the hole. Certainly 
much easier than when we were using the Stratus.

Thanks,
EK

[cid:image001.png@01CF3312.933A67A0]Eric Kegley, CRA, COA
Director of Ophthalmic Imaging
Retina Consultants of Houston
6560 Fannin St., Suite 750
Houston, TX 77030

Main  713 524-3434
Fax      713 524-3220
www.houstonretina.com<http://www.houstonretina.com/>
www.facebook.com/RetinaConsultantsofHouston<http://www.facebook.com/RetinaConsultantsofHouston>


________________________________
From: optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxxx> 
[mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of Jocelyn Gajeway
Sent: Wednesday, February 26, 2014 3:04 PM
To: optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>
Subject: [optimal] Re: Scanning for mac hole with Heidelberg
In dealing with macular holes, and other finely detailed pathology, selecting a 
scan that has the lines closer together will make it easier to catch what 
you're looking for. Higher ART levels and the High Resolution settings will 
also increase image quality.

In the situation you've described, I would do and FA+OCT, so I had a clear 
visual of the hole location, select the "Detail" preset, turn on the tracking, 
then move the scan pattern so it is directly centered over the macular hole. 
Once that's done, acquire the scan. EVen if the patient shifts fixation at that 
point, the scan will remain "locked" to the landmarks, and not shift away from 
the pathology in question.

Thanks!
Jocelyn
Jocelyn Gajeway
Instructional Designer and Application Specialist
Heidelberg Engineering, Inc
1808 Aston Ave | Suite<x-apple-data-detectors://1> 130 | Carlsbad, CA |  92008
www.HeidelbergEngineering.com<http://www.heidelbergengineering.com/>
Tel:  760-536-7104 | 800-931-2230 x1104
Mobile: 760-331-9615
Email: 
jgajeway@xxxxxxxxxxxxxxxxxxxxxxxxx<mailto:jgajeway@xxxxxxxxxxxxxxxxxxxxxxxxx>


On Wed, Feb 26, 2014 at 12:57 PM, Stuart Alfred 
<stuart.alfred@xxxxxxxxx<mailto:stuart.alfred@xxxxxxxxx>> wrote:
Spoke with one of our retina specialists today who explained how my FA showed 
proof of the mac hole, but the accompanying OCT missed it.
I recall discussion of this issue at the last scientific session, which was 
relayed to me from an attendee.  Is perhaps Duke or anyone else coming up with 
a protocol to combat this?
My typical scan (this one in question) is:  20 degree x 20 degree, 25 line @ 15 
ART, High Speed, Eye length Medium.

--
Stuart Alfred, CRA, OCT-*C*
*
cell 317 517-9455<tel:317%20517-9455>
528 N. Bauman St.
Indianapolis, IN 46214-3618
*

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