DICOM PS3.17 2019b - Explanatory Information

U.3 Ophthalmic Tomography Use Cases (Informative)

Optical tomography uses the back scattering of light to provide cross-sectional images of ocular structures. Visible (or near-visible) light works well for imaging the eye because many important structures are optically transparent (cornea, aqueous humor, lens, vitreous humor, and retina - see Figure U.3-1).

Schematic representation of the human eye

Figure U.3-1. Schematic representation of the human eye


To provide analogy to ultrasound imaging, the terms A-scan and B-scan are used to describe optical tomography images. In this setting, an A-scan is the image acquired by passing a single beam of light through the structure of interest. An A-scan image represents the optical reflectivity of the imaged tissue along the path of that beam - a one-dimensional view through the structure. A B-scan is then created from a collection of adjacent A-scan images - a two dimensional image. It is also possible to combine multiple B-scans into a 3-dimensional image of the tissue.

When using optical tomography in the eye it is desirable to have information about the anatomic and physiologic state of the eye. Measurements like the patient's refractive error and axial eye length are frequently important for calculating magnification or minification of images. The accommodative state and application of pupil dilating medications are important when imaging the anterior segment of the eye as they each cause shifts in the relative positions of ocular structures. The use of dilating medications is also relevant when imaging posterior segment structures because a small pupil can account for poor image quality.

U.3.1 Anterior Chamber Tomography

U.3.1.1 Anterior Chamber Exam For Phakic Intraocular Lens Surgery Planning

Ophthalmic tomography may be used to plan placement of a phakic intraocular lens (IOL). A phakic IOL is a synthetic lens placed in the anterior segment of the eye in someone who still has their natural crystalline lens (i.e., they are "phakic"). This procedure is done to correct the patient's refractive error, typically a high degree of myopia (near-sightedness). The exam will typically be performed on both eyes, and each eye may be examined in a relaxed and accommodated state. Refractive information for each eye is required to interpret the tomographic study.

A study consists of one or more B-scans (see Figure U.3-2) and one or more instances of refractive state information. There may be a reference image of the eye associated with each B-scan that shows the position of the scan on the eye.

U.3.1.2 Anterior Chamber Angle Exam

The anterior chamber angle is defined by the angle between the iris and cornea where they meet the sclera. This anatomic feature is important in people with narrow angles. Since the drainage of aqueous humor occurs in the angle, a significantly narrow angle can impede outflow and result in increased intraocular pressure. Chronically elevated intraocular pressures can result in glaucoma. Ophthalmic tomography represents one way of assessing the anterior chamber angle.

B-scans are obtained of the anterior segment including the cornea and iris. Scans may be taken at multiple angles in each eye (see Figure U.3-2). A reference image may be acquired at the time of each B-scan(s). Accommodative and refractive state information are also important for interpretation of the resulting tomographic information.

Tomography of the anterior segment showing a cross section through the cornea

Figure U.3-2. Tomography of the anterior segment showing a cross section through the cornea


Note in the Figure the ability to characterize the narrow angle between the iris and peripheral cornea.

U.3.1.4 Corneal Exam

As a transparent structure located at the front of the eye, the cornea is ideally suited to optical tomography. There are multiple disease states including glaucoma and corneal edema where the thickness of the cornea is relevant and tomography can provide this information using one or more B-scans taken at different angles relative to an axis through the center of the cornea.

Tomography is also useful for defining the curvature of the cornea. Accurate measurements of the anterior and posterior curvatures are important in diseases like keratoconus (where the cornea "bulges" abnormally) and in the correction of refractive error via surgery or contact lenses. Measurements of corneal curvature can be derived from multiple B-scans taken at different angles through the center of the cornea.

In both cases, a photograph of the imaged structure may be associated with each B-scan image.

DICOM PS3.17 2019b - Explanatory Information