High resolution anterior segment optical coherence tomography of ocular surface lesions: a review and handbook

ABSTRACT

Introduction: High-resolution anterior segment optical coherence tomography (HR-OCT) has revolutionized the way by which clinicians can diagnose and differentiate ocular surface lesions. Careful interpretation of HR-OCT images can provide morphological information about the lesion of interest and help guide the diagnosis.

Areas covered: This paper reviews the steps to interpreting HR-OCT images of ocular surface lesions and summarizes their characteristic findings.

Expert opinion: Among the multiple modalities available to image the ocular surface and anterior segment, HR-OCT has emerged as an instrumental tool to obtain ‘optical biopsies’ of various ocular surface lesions. A step-by-step approach to acquiring and interpreting HR-OCT images can allow for accurate in-office characterization and diagnosis of both benign and malignant ocular surface lesions.

KEYWORDS:

• Anterior segment optical coherence tomography
• high-resolution optical coherence tomography
• ocular surface imaging
• ocular surface lesions
• ocular surface tumors
• hr-oct
• OCT

Financial Support

NIH Center Core Grant P30EY014801, RPB Unrestricted Award, Dr. Ronald and Alicia Lepke Grant, The Lee and Claire Hager Grant, The Robert Farr Family Grant, The Grant and Diana Stanton-Thornbrough, The Robert Baer Family Grant, The Emilyn Page and Mark Feldberg Grant, The Jose Ferreira de Melo Grant, The Richard and Kathy Lesser Grant, The Michele and Ted Kaplan Grant and the Richard Azar Family Grant (institutional grants).

Article Highlights

• This article provides a step-by-step approach for the acquisition and interpretation of high-resolution anterior segment optical coherence tomography (HR-OCT) images of benign and malignant ocular surface lesions.

• Ocular surface lesions that have distinctive findings on HR-OCT include pterygia, pinguecula, conjunctival nevi, conjunctival papilloma, ocular surface squamous neoplasia (OSSN), conjunctival lymphoma, conjunctival amyloidosis, primary acquired melanosis and conjunctival melanoma, as described in this paper.

• HR-OCT can allow clinicians to obtain in-office ‘optical biopsies.’ While optical biopsies do not always replace tissue biopsies, they can facilitate characterization and more expedient diagnosis of ocular surface lesions.

• HR-OCT can be utilized to detect sub-clinical disease, especially in cases of OSSN, and can help monitor response to medical and surgical therapy.

• Future research and clinical directions for HR-OCT include intra-operative mapping of tumor margins during surgical excision procedures, creation of artificial intelligence algorithms for the rapid interpretation of images and use of OCT angiography to identify angiographic characteristics of various ocular surface lesions.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has been funded by the following: NIH Center Core Grant P30EY014801, RPB Unrestricted Award, Dr. Ronald and Alicia Lepke Grant, The Lee and Claire Hager Grant, The Robert Farr Family Grant, The Grant and Diana Stanton-Thornbrough,The Robert Baer Family Grant, The Emilyn Page and Mark Feldberg Grant, , The Rosalyn Ziskin Grant, The Jose Ferreira de Melo Grant, The Richard and Kathy Lesser Grant, The Michele and Ted Kaplan Grant and the Richard Azar Family Grant (institutional grants).