The Role of Optical Coherence Tomography Raster Imaging as a Valuable Diagnostic Tool in the Differential Between Optic Disc Hemorrhage and Vitreopapillary Traction

Abstract

An acute presentation of an optic disc hemorrhage can indicate true optic nerve head damage or can be a result of tractional forces on the vitreopapillary interface. An isolated optic disc hemorrhage secondary to vitreopapillary traction (VPT) can mimic the clinical presentation of a glaucomatous process or that of an underlying ocular or systemic condition. This article highlights the use of spectral domain optical coherence tomography (SD-OCT) 5 line raster (5LR) in differentiating true optic disc hemorrhages from those as a result of tractional forces. Two examples are given of patients presenting to our clinic with unilateral optic disc hemorrhages and various underlying disease processes as risk factors. With the use of SD-OCT 5LR imaging, VPT was implicated as the cause of the disc hemorrhages in both patients. Although this imaging tool alone is not enough to rule out a disease process such as glaucoma or prevent the need for additional diagnostic testing, SD-OCT 5LR is a noninvasive and valuable clinical tool in distinguishing VPT from other etiologies of an optic nerve hemorrhage.

Clinical translation of handheld optical coherence tomography: practical considerations and recent advancements

“…Engineers designing systems for use in QC 188 , 189 or low-resource settings 190 – 193 have to meet certain requirements for reliable and nearly continuous operation in daily practice. However, in various clinical scenarios 194 – 196 or military applications in the field, 197 users require an even more portable system that can be carried and utilized over a significant period of time in a wider variety of situations and use cases. Systems such as these can be brought to patients, rather than having to bring patients to instruments, which overcomes a significant hurdle that often exists in the delivery of more advanced healthcare.…”

The vitreopapillary interface in healthy and glaucoma: posterior vitreous detachment in the vitreopapillary interface study

“…This is illustrated by numerous publications investigating the relationship between vitreopapillary adhesion (VPA) and macular hole, diabetic retinal oedema, macular oedema associated with premacular membrane (PMM) and retinal vein occlusion (Chauhan et al 2000;Rumelt et al 2003;Karatas et al 2005;Sebag et al 2009;Wang et al 2009;Krebs et al 2011;Romano et al 2015;Sebag 2015). Furthermore, there are case reports suggesting that VPT could cause optic nerve head elevation and haemorrhages, and even visual field defects (Katz & Hoyt 1995;Wisotsky et al 1998;Kokame et al 2004;Sibony et al 2008;Nomura et al 2010;Wong et al 2012;Hwang & Lin 2014). Indeed, Kim et al (2014) reported significantly lower mean deviations (MD) on automated perimetry in PMM patients with VPT compared to those without.…”