Table Of ContentGabriel COSCAS
OCT in AMD
Optical Coherence Tomography in Age-Related Macular Degeneration
OPTICAL COHERENCE TOMOGRAPHY
in
AGE-RELATED MACULAR DEGENERATION
O C T A M D
in
Gabriel COSCAS
Florence COSCAS, Sabrina VISMARA
and
Alain ZOURDANI and C. Iole Li CALZI
(Créteil and Paris)
With the participation of
Gisèle SOUBRANE (Créteil, France), Eric SOUIED (Créteil, France)
Cynthia TOTH (Durham, North Carolina, USA), Yasuo TANO (Osaka, Japan),
Marc De SMET (Amsterdam, The Netherlands),
Giovanni STAURENGHI (Milan, Italy), Bruno LUMBROSO (Rome, Italy)
and the help of
Giuseppe CARELLA (Piacenza, Italy), Michael REGENBOGEN (Tel Aviv, Israel), Joël UZZAN (Rouen, France)
ANNUAL REPORT OF THEFRENCH OPHTHALMIC SOCIETY
English-language translation and review were performed by Anthony Saul, Ricky Zolf,
Jean Pierre Hubschman, and Irena Tsui. Editing wwwas provided by Tina-Marie Gauthier.
123
Gabriel COSCAS
Professeur Emérite des Universités
Hôpital de Créteil. Département d’ophtalmologie de Créteil
Université Paris XII – Val de Marne
[email protected]
ISBN 978-3-642-01468-0 Springer Medizin Verlag Heidelberg
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V
To my grandson, Gabriel
To my wife and family
To Créteil
VII
Preface
Gisèle SOUBRANE
Over recent decades, as a result of progress in basic and clinical research, our knowledge on age-related
macular degeneration (AMD) has been improved and refined, leading to a renewed interest in this dis-
ease.
However, the etiology, pathophysiology, clinical features, and natural history of AMD remain unclear. Until
these unknowns can be elucidated, the primary objective for all ophthalmologists is to diagnose AMD as
early as possible in order to optimize the use of new treatment options.
Gabriel COSCAS has trained a large number of ophthalmologists and whole generations of retinal special-
ists all over the world. He is renowned in France and worldwide for his remarkable clinical knowledge of
AMD, which is based on his considerable personal experience.
This book provides precise and sometimes surprising answers to our questions. As an experienced, critical,
and well-informed clinician, he provides us yet again with a book that illustrates his exceptional capacity for
analysis, classification, and synthesis. All aspects that ophthalmologists need to understand are explained by
rich imaging, based on all types of imaging modalities and supported by OCT.
A wide range of fundus imaging modalities are now available, and this book explains the respective value
of each technique. The information provided by OCT is presented logically by comparison with plain films,
autofluorescence, fluorescein angiography, or indocyanine green angiography. Meticulous biomicroscopic
examination of macular changes and the essential value of fluorescein angiography for the detection of ana-
tomical alterations of the macula and for precise evaluation of lesions and their course by indocyanine green
angiography have naturally led Gabriel COSCAS to analyze the new data provided by OCT.
As a result of an original and often innovative approach combined with an acute sense of clinical observa-
tion, Gabriel COSCAS has described and classified new clinical signs.
The retina exerts a continuous fascination for clinicians who specialize in this field. In particular, the mac-
ula is the subject of intellectual curiosity reflected by an urgent desire to understand the physiological and
pathological mechanisms and to continually develop new treatments.
Gabriel COSCAS has always expressed his passion for this tiny zone, which allows for the miracle of read-
ing. This book should trigger a renewed interest in AMD, stimulated by the author’s relevant comments and
discussions.
Rapid or even dramatic progress has been made in the field of AMD over recent years, leading to a constant
revision of our basic concepts. The research subtending this progress has also revealed unexpected aspects
of this disease. The pathogenesis of AMD is being completely restructured, which will probably lead to a
new definition of this disease.
Current treatment modalities for neovascularization have provided a definite advancement, but response
to treatment is difficult to analyze. A large part of this book is therefore devoted to recent therapeutic ap-
proaches and assessment of response after the various treatments.
The meticulous analysis of a series of clinical cases will undoubtedly be highly appreciated, as it provides
the reader with a real reflection of the author’s extensive clinical experience. These new treatment mo-
dalities require particularly attentive and specific follow-up to determine the optimal strategy. Precise
analysis of imaging signs guides the choice of first-line treatment and subsequent treatments in the case
VIII Preface
of relapse or recurrence. The ophthalmologist’s clinical skills and experience are an essential part of this
approach.
Today, all ophthalmologists are responsible for the diagnosis and choice of treatment for patients with
AMD, which means that all practitioners must be familiar with the signs of the most recent or sophisti-
cated morphological and functional examinations, including OCT, and with the most recent treatment
modalities.
This book is both scientific, as it analyzes data concerning the most recent, more sophisticated OCT sys-
tems, and practical, as it provides the reader with a reasonable body of easily accessible knowledge. This
book will allow each practitioner to understand, interpret, and adapt treatment in their patients’ best in-
terests.
Following his previous publications, Gabriel COSCAS once again shares his knowledge not only at the Cré-
teil School but with all readers. The quality of the images and the text clearly reflect the extent of his skills
and the precision of his knowledge, continuously refined by clinical observation.
Such books would be impossible without the serene enthusiasm, cheerful energy, and confident humanity of
Gabriel COSCAS and his colleagues.
IX
Foreword
Gabriel COSCAS
It is a great pleasure for me to address, in the context of this Annual Report, all of my French and interna-
tional ophthalmology friends and all those who want to share the recently acquired information provided
by optical coherence tomography.
These Annual Reports have become a French tradition, based on an in-depth study over several years to
clarify the clinical results of a new method of investigation. A teamwork approach progressively collected
the elements of a prolonged clinical experience, then analyzed and summarized these data to illustrate, by
means of selected images, the main signs visualized by OCT that has rapidly become a field of major interest
to ophthalmologists.
It is an even greater pleasure for me and for all of the Créteil School, in that we experienced and have tried
to share, the clinical and scientific revolution of the era of angiography and laser, which allowed us to visual-
ize retinal capillaries and choroidal neovascularization and attempt to halt the progression of these lesions
by photocoagulation.
The “era” of OCT appears us to have evolved in three phases:
The first phase consisted of visualization of indirectsigns: exudates and fluid accumulation, so inappropri-
ately called “retinal” thickening.
The second phase was that which provided, by means of Spectral-Domain technology, much sharper images
of lesions, detachments, and inflammatory reactions. In particular, this new imaging modality allows exact
correlations with angiography on each examination and during follow-up.
The third phase has just begun, with analysis and monitoring of alterations of the outer layers and photore-
ceptor cell damage.
Major advancements have already been made, as OCT now combines the data of morphological imaging
and functional imaging to provide real “non-invasive optical biopsies.”
With this tradition and with this future, this book is therefore dedicated to all those who inspired me with
my love for this field, all those who taught me, all those who have accompanied me for more than fifty years
of ophthalmology, and of course, to all of the younger generations.
The tenderness, advice, and confidence of my mother and father are still very clear in my mind: they still
help me, guide me, and accompany me with the same tenderness and same confidence as that of my par-
ents-in-law.
My wife Gisèle, my daughtersFlorence and Brigitte, and each of my five grandchildren form my family circle.
I compensate for my lack of time by my intense love and recognition for their tenderness and for the pride
that they inspire in me. Each one leads his or her own life, but we are all united to overcome our difficulties
and share our happiness. Their support, their affection, their understanding, and the interest that they have
shown in this new project have been extremely valuable to me.
Créteil has remained at the center of my work. My continued participation in the work of the Créteil
Schoolthat I love so much, and in the innovations provided by Gisèle Soubrane, has been a privilege and
a source of happiness. This school is a place of permanent and daily enrichment, due to its warm and
unending welcome, its original points of view, and our fascinating discussions. My friendly discussions
X Foreword
with Eric Souïed, particularly on his recent studies, have highlighted the role of genetics and nutritional
and environmental factors. Each new generation of associate professors, assistants, interns, and residents
from all over the world has provided new points of view and all therefore participated in the elaboration
of this book.
I would also like to thank the leading international experts who contributed to the prestige of this “Report”
and the Sociétés d’Ophthalmologie de France, such as Professors Cynthia Toth from Durham, Yasuo Tano*
from Osaka, Marc De Smett from Amsterdam, Giovanni Staurenghi from Milan, Bruno Lumbroso from
Rome, and Giuseppe Carellafrom Milan.
My four closest colleagues,Florence Coscas, Sabrina Vismara, Alain Zourdani, and C. Iole Li Calzi, accompa-
nied me daily and contributed their youth, their effort,and their assistance to collect and select an immense
amount of documentation. It was a true pleasure to work with them and nothing could have been done
without them. I would also like to thank all of my colleagues at Créteil and at the Odéon Center, and all of
the ophthalmologists who sent me their clinical cases or valuable comments.
Christian Lamy was an efficient, intelligent, and understanding publisher for the French edition of this book.
For the English edition, I am thankful to have had the guidance and support of Hanna Hensler-Fritton and
the rest of my colleagues at Springer Publishing, who worked so diligently to bring this book to fruition.
I would like to acknowledge the contribution of Ricky Zolf, Anthony Saul, Jean Pierre Hubschman, Irena
Tsui, and Tina-Marie Gauthier, who assisted me in the preparation of this book, providing English-language
translation, review, and editing.
The Sociétés d’Ophthalmologie de France and their presidents, and President Christophe Baudouin and Sec-
retary-General Pierre Larricart in Paris, have once again entrusted me with this task and have provided me
with continuing friendship and support. This tradition of Annual Reports will surely continue.
While writing this book, I thought of you dear Readers each day, and it is a great pleasure to dedicate this book
to each of you!
*Professor Yasuo Tano passed away on January 31, 2009. In addition to his valuable contribution to this book,
Professor Tano will be remembered for his leadership in the global advancement of ophthalmology.
XI
Contents
INTRODUCTION – 1
G. COSCAS (France) ................................................................................................................
IMAGING MODALITIES
CONTRIBUTION OF OCT
OPTICAL SECTIONS IN OCT
BASIS OF INTERPRETATION
RESPONSE TO TREATMENT
FUTURE DIRECTIONS
REFERENCES
CHAPTER 1 – 5
G. COSCAS (France) ................................................................................................................................
PRINCIPLES OF OCT – EXAMINATION TECHNIQUES – MAIN OCT SYSTEMS
PRINCIPLES OF TIME-DOMAIN AND SPECTRAL-DOMAIN OCT ...................................................6
CONVENTIONAL (TIME-DOMAIN) OCT ................................................................................................6
SPECTRAL-DOMAIN OCT ..........................................................................................................................8
FUTURE DIRECTIONS ...............................................................................................................................12
Technological Parameters
Ultrahigh-Resolution OCT
Correlation Studies
3D OCT
Segmentation
Imaging of the Choroid
Adaptive Optics
Functional OCT
CONCLUSION .............................................................................................................................................14
REFERENCES ...............................................................................................................................................14
CHAPTER 2 – 15
C. A. TOTH, S. FARSIU, A. KHANIFAR, G. CHONG (USA) .....................................................................
APPLICATIONS OF SPECTRAL-DOMAIN OCT IN AMD
INTRODUCTION ........................................................................................................................................17
Time-Domain OCT
Spectral-Domain OCT
ADVANTAGES OF SD-OCT IN AMD ....................................................................................................20
Macula
Retinal Layer Segmentation
Drusen
Choroidal Neovascularization
Geographic Atrophy
COMPARATIVE ANALYSIS .......................................................................................................................28
IMAGE PROCESSING ................................................................................................................................30
CHALLENGES AND FUTURE DIRECTIONS IN SD-OCT IMAGING ..............................................30
CONCLUSION .............................................................................................................................................32
REFERENCES ...............................................................................................................................................32
