Standard staging of AMD is based on clinical examination-primarily focusing on the size of macular drusen and the presence or absence of macular pigmentary changes. The bottom images show a patient with a frank area of GA that is visible clinically but seen even more easily with FAF. In this region on the OCT, there is atrophy of the outer nuclear layer also suggestive of early GA. The FAF shows diffuse alterations to the RPE with areas of hypo-autofluorescence suggestive of early GA. Top images show a patient who would be categorized clinically as intermediate-stage AMD due to pigmentary changes. OCT-A (top right), however, shows an extensive choroidal neovascular network underlying the PED. OCT shows an elongated pigment epithelial detachment (PED) with minimal evidence of overlying exudation such as subretinal or intraretinal fluid. AMD patient with a disc-shaped region of pigmentary abnormalities on clinical exam, also demonstrated on the FAF (top middle image). Nevertheless, older diagnostic tools such as visual field testing, B-scan ultrasound, fluorescein angiography (FA) and indocyanine green angiography (ICGA) can still provide critical information.įig. Notice how advances in these technologies such as OCT with enhanced-depth imaging (EDI) and the ability to obtain widefield imaging in technology such as FAF is changing how we view the retina. Inspect the cases and examples below to see how diagnostic testing can be used to further understand a pathology or to arrive at a correct diagnosis or treatment plan.Įxamine how newer technologies such as optical coherence tomography (OCT), fundus autofluorescence (FAF) and OCT angiography (OCT-A) have changed how we understand and visualize posterior segment pathology. Additionally, more complicated pathologies often require a battery of tests to eliminate differentials and arrive at the correct diagnosis.

Some conditions may be diagnosed and managed based on the clinical examination alone, but even in common conditions such as age-related macular degeneration (AMD) and diabetic retinopathy (DR), diagnostic imaging may show unique aspects of the disease that cannot be seen clinically. When diagnosing and managing posterior segment pathology, a wide variety of technologies aid us, including posterior segment imaging, neuroimaging and tests of visual function.

Normal retina pictures