Anterior Segment Oct

ANTERIOR SEGMENT OCT
Dr. A.C.RAGHU
GUIDE-Dr.S.K..SETHI
ASOCT (anterior segment optical coherence
tomography) provide detailed cross-sectional
images of the
• cornea,
• anterior chamber,
• angle,
• Iris.
• Anterior segment imaging using OCT was
first demonstrated in 1994 by Izatt, et al.
using light with a wavelength of 830 nm
Principle of OCT
The principle of OCT is based on Michelson’s
interferometry
Posterior segment OCT uses a lower wavelength of
light at 830 nm
ASOCT uses a higher wavelength 1310 nm
The anterior segment OCT (ASOCT) at 1310 nm
wavelength of light is better suited for AC angle
imaging due
1. Reduced scattering
ensures better penetration and hence a more
detailed AC angle morphology
2.More dissipation/absorption
The higher(1310 nm) wavelength light is strongly
absorbed by water in ocular media(vitreous) and
therefore, only 10% of the light incident on the cornea
reaches the retina causing no damage to the retina
The high-speed imaging helps in various ways:
1. Reduces examination time
2. Eliminates motion artifacts
3. Enables imaging of dynamic ocular events
4. Allows for rapid survey of relatively large areas.

The ASOCT has 6 imaging modes:
1. High-resolution cornea single

2. High-resolution cornea quad
3. Pachymetry
4. Anterior segment single
5. Anterior segment double
6. Anterior segment quad
single mode, only a single image will be
obtained at the desired angle.
1. Double mode takes images at the
preset angles of 20 to 200, &160 to
340
2. 1800 preset angle separation will
remain the same i.e.,when manually
changing the angle of image
capture, all angles will rotate
together
Quad mode of both high-
resolution cornea and AS
4 cross-sectional images are taken at
0 to 180, 45 to 225, 90 to 270,
and 135 to 315 degrees, and are
separated by
90 degrees.
Two resolution modes of imaging
Standard resolution imaging High/enhanced resolution

imaging
Broader view of AS More detailed imaging
16 mm width /6 mm depth 10 mm width/3 mm depth
Full overview of AS: Cornea and any segment
Cornea, anterior chamber, iris needing detailed evaluation
and both angles
256 scans 0.125 seconds 512 scans 0.250 seconds
Measurement tools
The different tools available are:
1. Calipers
2. Flap tool
3. Angle tools—ICAT (Iridocorneal angle tool) and ACA
(Anterior chamber angle) tools
4. Chamber tools for anterior chamber depth and width
measurements
5. Anterior segment refractive tool set.
(B) The flap tool;
(A) The caliper tool;

(D) The chamber tools:
1. Central corneal thickness;
2. Anterior chamber depth;
3. Angle to angle distance; and
4. Crystalline lens rise
(C) The iridocorneal angle tool;

Applications of ASOCT
can be broadly grouped into applications in:
•Cornea
•Biometry and phakic IOL
•Glaucoma
Applications in Cornea
1. LASIK
2. DSAEK
3. Dystrophies and degenerations
4. Corneal inflammatory and infltrative
disorders
5. Keratoplasty
6. Keratoconus
7. Intacs
8. Descemets detachment
Penetrating keratoplasty
INTACS
GRANULAR DYSTROPHY
Biometry in Postrefractive Surgery Cases
1.To measure the posterior corneal curvature
accurately,
2.To develop an IOL power formula based on
the ASOCT corneal power measurement.
Phakic Intraocular Lens
1. The ASOCT is looked upon with a great deal of
optimism regarding its
potential to guide the sizing of IOLs
Some of the Phakic IOL tools. It shows the “RAINBOW”
(0.5 mm, 1 mm and 1.5 mm from the cornea), “SAFETY” (distance from
cornea) at 180°, center and 0° and “VAULT” (distance between Phakic
IOL and crystalline lens) at 180°, center and 0°)
The use of the “flap tool” in post-LASIK cases to measure the precise
thickness;
(B) The global pachymetry map, which is formed from 16 modifed high
sresolution scans
Applications in Glaucoma
ASOCT is used:
• to study the normal anatomy and physiology
• for screening of the spectrum of angle-closure glaucoma
• to study plateau iris syndrome
• to study mechanism of malignant glaucoma
• to test the efficacy of laser peripheral iridotomy, and
• to test the patency of glaucoma drainage device.
ASOCT of the angle Gonioscopy
It is a non-technical device It requires technical skill
Objective test Subjective test
Comfortable procedure May be discomfortable
Non-contact procedure Contact procedure
Light , indentation, and
No light artifact
artifacts may be found
Control for focus is easy More difcult procedure technically
Able to document landmark Documentation is difficult
It is not a standardized Standardized procedure. Different
procedure grading systems and lenses are
required
expensive inexpensive
1.Angle-closure
Two photographs of the same angle

A.The photo on the left was taken with the room lights on and it shows a
clearly open angle.
B.The one on the right was taken after turning the lights off, which
demonstrates iris-cornea apposition anterior to the scleral spur which is
marked by the arrow i.e.,oppositional angle closure
subtle case of synechial
closure in an eye with a
plateau iris
case of synechiae angle closure

Laser Iridotomy
ASOCT images of an eye: (A) Before and; (B) After undergoing laser
iridotomy
The angle appears occludable before procedure, but it clearly
demonstrates that the iridotomy has increased the angle’s width
(A) The angle appears occludable before procedure; (B) The iridotomy
has increased the angle’s width
Defnitions
Angle Opening Distance
Angle opening distance (AOD500) is calculated as the
perpendicular distance measured from the TM at 500
µm anterior to the scleral spur to the anterior iris
surface.
Angle Recess Area
ARA is measured as described by Ishikawa, et al.
1. The defining boundaries of this triangular area are the
AOD 500 or AOD 750 (the base), the angle recess (the
apex), and the iris surface
and inner corneoscleral wall form sides of the triangle
2.The ARA is a better measurement parameter than the

AOD because it takes into account the whole contour of
the iris surface rather thannmeasuring at a single point on
the iris as is the case with the AOD.
B) Angle recess area
Trabecular Iris Space Area (TISA):
The defining boundaries of TISAa trapezoidal are as follows:
1. Anteriorly -the AOD 500 or AOD 750;
2. Posteriorly -a line drawn from the scleral spur
perpendicular to the
3. plane of the inner scleral wall to the opposing iris;
4. Superiorly -the inner corneoscleral wall;
a
5. inferiorly -the iris surface l
TISA excludes the nonfiltering
fi region behind the scleral spur.
Trabecular iris angle
defined as an angle measured with the apex in the iris recess and
the arms of the angle passing through a point on the TM 500 µm
from the scleral spur and a point on the iris perpendicularly
The composite image of all the parameters AOD, ARA and
TISA
A)figurative images of a normal eye
B)eye with plateau iris syndrome
Plateau iris syndrome (PIS)
d/to an abnormal anterior position of the ciliary body which alters
the position of the peripheral iris in relation to the trabecular
meshwork resulting in obstruction to aqueous outflow.
Slit lamp evaluation of patients with plateau iris configuration
usually shows a normal ACD(ant chamb depth) and a flat iris
plane.
On indentation gonioscopy a “double hump sign” is seen in PIS .
1. peripheral “hump” - ciliary body propping up the iris root
2. central “hump” - the central third of the iris resting over the
surface of the lens
ASOCT image of an eye with plateau iris
Malignant glaucoma :
It refers to a shallow or flat central and peripheral
anterior chamber caused by the forward movement of
the lens-iris and iris-hyaloid diaphragm accompanied
by elevated IOP, in the presence of a patent peripheral
iridectomy.
ASOCT findings include
1. irido-corneal touch,
2. anterior displacement of the iris root, and
3. appositional angle-closure.
Postoperative flat chamber: malignant
glaucoma
Bleb morphology
It is an indicator of bleb function and a predictor of
bleb- related complications such as bleb leak,
blebitis, and bleb-related endophthalmitis.
ASOCT has been used to image trabeculectomy bleb to
provide information about internal structure that is not
available at the slit lamp.
Successful blebs display conjunctival thickening as a
hallmark of success, regardless of degree of bleb
elevation. This reflects facility of transconjunctival
aqueous flow.
5. Highly elevated blebs sometimes display marked conjunctival
6. thickening and only a small cavity.
In failed blebs, ASOCT is particularly useful in imaging failed blebs to
7. demonstrate the level of failure.
Ostial closure, flap fibrosis and presumed episcleral fibrosis in the
8. absence of the former two situations are all clearly demonstrated.
In the early postoperative period, a failing bleb with a closely apposed
scleral flap may be resuscitated by suture lysis, resulting in a more
expanded bleb.
Hence ASOCT is a useful tool to imagetrabeculectomy
9. blebs and may aid the clinician in postoperative bleb management.
It can also image the intrascleral lake and implant used in non-
penetrating glaucoma surgery (deep sclerectomy) and glaucoma
drainage devices
Trabeculectomy bleb
Advantages
a.Non contact instrument
b.Quick
c.Repeatable and reproducable
d.Many measurement tools
THANK YOU

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ANTERIOR SEGMENT OCT

1. Reduces examination time

2. Eliminates motion artifacts

3. Enables imaging of dynamic ocular events

4. Allows for rapid survey of relatively large areas.

1. High-resolution cornea single

Standard resolution imaging High/enhanced resolution

The different tools available are:

(A) The caliper tool;

(C) The iridocorneal angle tool;

•Biometry and phakic IOL

Two photographs of the same angle

case of synechiae angle closure

2.The ARA is a better measurement parameter than the

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