[optimal] Re: Scanning for mac hole with Heidelberg

  • From: Sandor Ferenczy <sandorferenczy@xxxxxxxxx>
  • To: "optimal@xxxxxxxxxxxxx" <optimal@xxxxxxxxxxxxx>
  • Date: Wed, 26 Feb 2014 17:56:15 -0500

+1 on Tim's request of the associated imaging.


When we are looking for something specific, i tend to take a single line
scan and drag it around the scan area (click and drag with the mouse) to
obtain a cursory view of the pathology. This allows you to narrow down the
playing field.  I would also skip EDI, as you may be able to pick up
traction associated with the hole. I have had operculum disappear in EDI
mode.

I would still think the OCT would be the winner of definitively proving a
full thickness hole. There have been pseudo-holes clinically misdiagnosed
as full thickness holes.

http://www.revophth.com/content/d/retinal_insider/i/1296/c/24953/


-sandor




On Wed, Feb 26, 2014 at 5:05 PM, Bennett, Timothy <tbennett1@xxxxxxxxxxx>wrote:

>  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*
>
>
>
> *Eric Kegley, CRA, COA*
>
> *Director of Ophthalmic Imaging*
>
> *Retina Consultants of Houston*
>
> *6560 Fannin St., Suite 750*
>
> *Houston, TX 77030*
>
>
>
> *Main  713 524-3434 <713%20524-3434>*
>
> *Fax      713 524-3220 <713%20524-3220>*
>
> *www.houstonretina.com* <http://www.houstonretina.com/>
>
> *www.facebook.com/RetinaConsultantsofHouston*<http://www.facebook.com/RetinaConsultantsofHouston>
>
>
>
>
>  ------------------------------
>
> *From:* optimal-bounce@xxxxxxxxxxxxx 
> [mailto:optimal-bounce@xxxxxxxxxxxxx<optimal-bounce@xxxxxxxxxxxxx>]
> *On Behalf Of *Jocelyn Gajeway
> *Sent:* Wednesday, February 26, 2014 3:04 PM
> *To:* 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 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
>
>
>
>
>
> On Wed, Feb 26, 2014 at 12:57 PM, Stuart Alfred <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
> 528 N. Bauman St.
> Indianapolis, IN 46214-3618
> *
>
>
>
>
>
>

PNG image

Other related posts:

  1. Home
  2. optimal
  3. Archive
  4. 02-2014