Clinical applications and new developments of optical coherence tomography: an evidence-based review

Optical coherence tomography (OCT) is a new imaging modality that has increasingly become an indispensable tool in clinical practice for the diagnosis and management of ocular diseases involving the macula, optic nerve and anterior segment. The instrument is an advanced imaging technique that provides unprecedented high resolution and cross-sectional tomographic images of the ocular microstructure in situ, and in real time. Since its introduction about four years ago, a multitude of advantages has made OCT an essential instrument in ophthalmic imaging. The technique has fast image acquisition speed and non-contact, non-invasive applicability, allowing a non-excisional 'optical biopsy' to be performed. The purpose of this paper is to provide an evidence-based review of the increasing role of OCT in the diagnosis and management of ocular disorders, particularly in age-related macular degeneration, diabetic macular oedema, macular hole, epiretinal membrane and glaucoma. Being one of the first users of OCT in Australia, our clinical experiences will be highlighted and clinical examples of various conditions will be presented to provide an overview of the immense implications of OCT in practice. The latest developments of the OCT revolution, in relation to combining OCT with fundus photography and scanning laser ophthalmoscopy, will also be described. New developments of three-dimensional visualisation of tissue morphology with future models of ultra-high speed, ultra-high resolution OCT may further enhance the early diagnosis, monitoring of disease progression and assessment of treatment efficacy, facilitated by this powerful technology.