When to use anterior segment optical coherence tomography

ABSTRACT

Introduction

Optical coherence tomography (OCT) has revolutionized patient care in ophthalmology within the last two decades. Initially conceptualized as a means to visualize the posterior segment, advances in OCT technology now allows enhanced, high-resolution imaging of the anterior segment (AS-OCT).

Areas covered

In this review, we begin by revisiting very briefly the history of OCT, it’s working principles and technical aspects specific for anterior segment imaging. We then provide an overview of diagnostic applications of AS-OCT in corneal diseases with clinical examples on how AS-OCT can be instrumental in the differential diagnosis, treatment monitoring, surgical planning, and prognostication. We proceed by summarizing its use as an adjunctive tool in the management of glaucoma including its complementary function in evaluating the iridocorneal angles and ancillary role in visualizing the internal structures of the bleb and the minimally invasive glaucoma implants.

Expert opinion

Although AS-OCT currently has a wide range of application areas, future research is expected to focus on improving acquisition speed, penetration, and image resolution further increasing the utility of AS-OCT in the clinic.

KEYWORDS:

• AS-OCT
• cornea
• glaucoma
• keratoconus
• keratitis
• ocular surface neoplasia
• corneal dystrophy
• MIGS
• glaucoma drainage devices

Article highlights

• AS-OCT has a wide range of utility in corneal diseases encompassing diagnosis, treatment monitoring, surgical planning, and prognostication.

• It is a useful adjunctive tool in the management of glaucoma including the evaluation of iridocorneal angles, and its role in visualizing the internal structures of the bleb and the minimally invasive glaucoma implants.

• Adaptive optics, micro-optical OCT and dynamic OCT are emerging concepts in the field that promise to address limitations of current OCT technology.

• Efforts that aim to implement artificial intelligence-related technologies in AS-OCT imaging is an exciting field of ongoing research that promises to cause significant paradigm shifts in ophthalmology.

Acknowledgments

The authors would like to thank the Eskisehir Osmangazi University Hospital Cornea Clinics for allowing them to reprduce Figure 1-9 from their database.

Figure 11. An ASOCT (Visante, Carl Zeiss Meditec) image image of a bleb with Ologen implant at 30 days. The Ologen implant (o) is visible over the scleral flap (f).

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 paper was not funded.