Optical Coherence Tomography: Essential Tool in Macular Hole Management

Abstract

Optical coherence tomography (OCT) is a noninvasive, diagnostic technique for accu- rately identifying and quantitatively characterizing macular holes. OCT is crucial in assessing fellow eyes of patients with a macular hole to detect preclinical changes leading to subsequent hole formation. The tomographic information provided by OCT, akin to an in vivo biopsy, has led to a better understanding of the pathogenesis of hole formation. The cross-sectional view produced by OCT effectively distinguishes full-thickness macu lar holes from mimicking conditions like lamellar holes, macular pseudoholes, and cysts, which may sometimes be difficult to differentiate clinically. This information enables early diagnosis and can guide the intervention of choice when treatment is deemed nec- essary. OCT is useful to prognosticate cases, thereby facilitating discussions with patients and managing visual expectations preoperatively. Intraoperative OCT (iOCT) can iden- tify intraoperative changes in the macular anatomy during surgery that can influence functional outcomes. Postoperatively, OCT is extremely useful for documenting serial changes in the foveal architecture and is helpful in correlating functional and anatomic outcomes. As the technology continues to improve, OCT has become indispensable for all aspects of patient care for macular holes.