UU.4 Axial Measurements

The innermost (anterior) layer of the retina, the internal limiting membrane (ILM) is often intensely hyperreflective and defines the innermost border of the nerve fiber layer. The nerve fiber layer (NFL) is bounded posteriorly by the ganglion cell layer and is not visible within the central foveal area. In high quality OPT scans, the sublamina of the inner plexiform layer may be identifiable. The external limiting membrane is the subtle interface between the outer nuclear layer and the photoreceptors. The junction between the photoreceptor inner segments and outer segments (IS/OS junction) is often intensely hyperreflective and in time domain OPT systems, was thought to represent the outermost boundary of the retina. Current thought, however, suggests that the photoreceptors extend up to the next bright interface, often referred to as the retinal pigment epithelium (RPE) interdigitation. This interface may be more than 35 micrometers beyond the IS/OS junction. When three high intensity lines are not present under the retina, however, this interdigitation area may not be visible. The next bright region typically represents the RPE cell bodies, which consist of a single layer of cuboidal cells with reflective melanosomes oriented at the innermost portion of the cells. Below the RPE cells is a structure called Bruch's membrane, which is contiguous with the outer RPE cell membrane.

The axial thickness and volume of tissue layers can be measured using the boundaries defined above. For example, the nerve fiber layer is typically measured from the innermost ILM interface to the interface of the NFL with the retina. Time domain OPT systems measure retinal thickness as the axial distance between the innermost ILM interface and the IS/OS junction. However, high resolution OPT systems now offer the potential to measure true retinal thickness (ILM to outermost photoreceptor interface) in addition to variants that include tissue and fluid that may intervene between the retina and the RPE. The RPE layer is measured from the innermost portion of the RPE cells, which is the hyper reflective melanin-containing layer to the outermost highly reflective interface. Pathologic structures that may intervene between normal tissue layers may obscure their appearance but often can be measured using the same methods as normal anatomic layers.