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Foveal thickness A and central foveal thickness B. In B, central foveal thickness is defined as the mean thickness measured at the point of intersection of the 6 radial scans on optical coherence tomography. Macular thickness measurements for a healthy eye population in this study, displayed as the mean and standard deviation in 9 regions, as defined in the Early Treatment Diabetic Retinopathy Study A and a false-color map for a prototypical healthy eye B.

I indicates inferior; N, nasal; S, superior; and T, temporal. Regression plot of foveal thickness vs age. The optical coherence tomographic OCT image A , the fundus image B , and the false-color map and numeric printout C for the right eye of a healthy patient who did not have well-aligned scans.

In C, the central blue area corresponding to the fovea is off center superiorly. Misaligned scans may give falsely elevated values. Copyright American Medical Association. Six radial scans, 6 mm in length and centered on the fovea, were obtained using the OCT3. Retinal thickness was automatically calculated by OCT mapping software.

Macular thickness measurements were thinnest at the center of the fovea, thickest within 3-mm diameter of the center, and diminished toward the periphery of the macula. The temporal quadrant was thinner than the nasal quadrant. This discrepancy should be considered when interpreting OCT scans. Macular edema is a common cause of visual loss.

Abnormal fluid accumulation within the retina and a concomitant increase in retinal thickness usually result from the breakdown of the blood-retinal barrier. This process can be found in those with diabetic retinopathy, retinal vein occlusion, uveitis, and other ocular disorders.

However, it has been observed repeatedly in clinical practice that the presence of macular edema does not necessarily preclude good vision. Traditional methods for evaluating macular edema, such as slitlamp biomicroscopy, stereoscopic photography, and fluorescein angiography, are relatively insensitive to small changes in retinal thickness and are qualitative at best.

Based on our experience with the OCT3 and previous versions of the system, we observe that the macular thickness measurements for healthy eyes are higher than the values obtained using earlier versions of the instrument, including the prototype OCT.

Recently, Frank et al 23 compared macular thickness measurements from 2 versions of OCT scanners: Scans were acquired from both eyes of 8 consecutive patients with suspected macular edema. The measurements from the 2 instruments were statistically different.

Therefore, as the OCT3 becomes more widely available and used, normative data will be important in interpreting pathological features of the macula. This study measures and defines normal macular thickness values in healthy eyes using OCT3 mapping software. To our knowledge, this is the first study to provide normative macular thickness data for the OCT3 system. All participants engaged in an informed consent process and signed a written consent document before study procedures were carried out.

All subjects underwent a complete ophthalmologic examination, including a medical and family history, best-corrected visual acuity testing with Early Treatment Diabetic Retinopathy Study charts, Humphrey SITA standard visual field testing, applanation tonometry, slitlamp biomicroscopy, indirect ophthalmoscopy, and color fundus photography.

The macular thickness map scan protocol on the OCT3 was used to obtain 6 consecutive macular scans, 6 mm in length, centered on the fovea, at equally spaced angular orientations. The cross-sectional images were analyzed using OCT3 mapping software that used an edge detection technique to locate the strongest 2 edges in each tomogram, presumed to be at the vitreoretinal interface and the anterior surface of the retinal pigment epithelial—choriocapillaris region.

Retinal thickness was measured as the distance between these 2 interfaces at each measurement point along the scan's x-axis. Bilinear interpolation in polar coordinates was used to estimate the thickness of the wedges between each consecutive OCT scan.

We selected the retinal map analysis protocol on the OCT3 to reconstruct a surface map as a false-color topographic image displayed with numeric averages of the measurements for each of the 9 map sectors as defined by the Early Treatment Diabetic Retinopathy Study. Central foveal thickness was defined as the mean thickness at the point of intersection of the 6 radial scans Figure 1 B. In addition, the OCT3 mapping software was used to manually locate the minimum value along each radial scan using the raw data.

All 6 values were averaged to determine the mean central foveal thickness for each subject. The relationship between foveal thickness and age was investigated using linear regression analysis.

Statistical analysis was performed with a commercially available software program SPSS Thirty-seven healthy eyes from 37 healthy subjects were examined clinically and by the OCT3. The patients were aged 22 to 71 years median, 43 years. The mean and standard deviation retinal thickness by sector are shown in Figure 2 and Table 1. As expected, macular thickness was thinnest at the center, thickest within 3-mm diameter of the center, and diminished toward the periphery of the macula.

The superior and nasal quadrants were thickest overall. The standard deviation of the 6 central macular measurements provided a simple estimate of the measurement reproducibility for a given patient. A summary of previous studies that have measured retinal thickness in healthy eyes using OCT is shown in Table 2 for comparison with this study. Optical coherence tomography has emerged as a useful imaging technique by providing new high-resolution cross-sectional information about various pathological features of the macula.

Our results are different from previously published values obtained using earlier versions of the device. These discrepancies may be a direct result of the greater resolution achieved by the more recent OCT systems. Less movement by the patient because of faster scanning times and more refined algorithms have allowed better image quality.

We found that the thickness measurements in the 4 peripheral outer quadrants on the OCT3 were thinner than those reported in the literature. This may reflect the difference in scan length between the OCT3 and previous versions of the instrument.

As a result, the OCT3 scans more peripheral regions of the retina that are anatomically thinner. The 4 outermost zones measured by the OCT3 are thinnest, as expected from histological examination of the eye. In previous reports, 9 , 16 the superior and inferior quadrants were thickest, presumably from the superior and inferior arcuate bundling of the nerve fibers. Our findings show that the superior and nasal quadrants were thickest. We identified the nasal quadrant as the thickest region within the central 3-mm diameter.

This is consistent with the anatomical relationship of the converging of nerve fibers with the optic disc. Most of the OCT studies 6 , 8 , 11 - 15 , 17 - 20 in the literature report central foveal thickness only. Investigators have shown that central foveal thickness is significantly correlated with best-corrected visual acuity in healthy and diabetic eyes.

However, foveal thickness may be more indicative of changes in the macula than central foveal thickness for several reasons. Foveal thickness is determined from many more data points than central foveal thickness.

For example, each radial scan on the OCT3 is composed of a sequence of A-scans. The macular thickness map scan protocol uses 6 radial scans per individual. In addition, we were able to manually measure the central foveal thickness from the raw data and compare this value with the computer output. This may reflect the difference in approach between the manual method and the automatic method of the OCT3 mapping software.

The software automatically determined the mean and standard deviation thickness for the center point where all 6 scans intersected, whereas we manually located the minimum point on each separate radial scan and averaged those values. If the OCT scans were not perfectly centered on the patient's fixation point for all 6 scans, the point of intersection would not correspond to the center exactly Figure 4.

This may give falsely elevated values. Given that the awake human eye is in constant motion, the minimum point for each radial scan will virtually never converge at the center, despite faster OCT3 scanning speeds.

Because the central point is the smallest area of measurement, it will be most affected by tiny eye movements, followed by the central foveal zone.

As a result, the standard deviation for central foveal thickness is the largest. Consequently, foveal thickness may be a more practical and reliable indicator than central foveal thickness for changes in the macula. We believe future OCT studies should report foveal thickness, in addition to central foveal thickness, in the evaluation of the efficacy of different therapies for macular edema. Recently, Brown et al 27 directly compared the clinical gold standard for the detection of macular edema contact lens biomicroscopy with the OCT3 for the detection of diabetic foveal edema.

Our findings do not agree with their assessment. We use 2 SDs to define the cutoffs for the upper and lower levels of normal foveal thickness. Such outlying values can occur and do arise in nearly all experimental data. Patients with subclinical macular thickening or thinning, and other risk factors, may require more frequent follow-up visits.

Further OCT studies are needed to investigate whether diabetic patients with subclinical thickening are at higher risk for developing diabetic retinopathy. Although it has been suspected that macular thickness might decline slightly with age, no statistically significant relationship could be found from this study.

These findings are consistent with studies by Hee et al 6 and Sanchez-Tocino et al. Future studies with larger sample sizes and a more even distribution of men and women may provide more useful information regarding differences by age, sex, and race.

In conclusion, normative values for macular thickness in a healthy population were obtained using commercially available OCT3 mapping software. March 30, ; final revision received March 10, ; accepted March 10, Cystoid macular edema in pseudophakia. Macular thickening and visual acuity: Retinal thickness analysis for quantitative assessment of diabetic macular edema.

Optical coherence tomography of the human retina. Imaging of macular diseases with optical coherence tomography.

Quantitative assessment of macular edema with optical coherence tomography. Topography of macular edema with optical coherence tomography. Reproducibility of retinal thickness measurements in healthy and diabetic eyes using optical coherence tomography. Comparison of foveal thickness measured with the retinal thickness analyzer and optical coherence tomography. Retinal thickness study with optical coherence tomography in patients with diabetes. Macular thickness measured by optical coherence tomography OCT in diabetic patients.

Reproducibility of nerve fiber thickness, macular thickness, and optic nerve head measurements using StratusOCT. Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics. Detection of diabetic foveal edema. Duker, MD ; Tony H.

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Looking Aloft: A Closer Look at Critical Thickness

We identified the nasal quadrant as the thickest region within the central 3-mm diameter. This is consistent with the anatomical relationship of the converging of nerve fibers with the optic disc.

Most of the OCT studies 6 , 8 , 11 - 15 , 17 - 20 in the literature report central foveal thickness only. Investigators have shown that central foveal thickness is significantly correlated with best-corrected visual acuity in healthy and diabetic eyes. However, foveal thickness may be more indicative of changes in the macula than central foveal thickness for several reasons. Foveal thickness is determined from many more data points than central foveal thickness. For example, each radial scan on the OCT3 is composed of a sequence of A-scans.

The macular thickness map scan protocol uses 6 radial scans per individual. In addition, we were able to manually measure the central foveal thickness from the raw data and compare this value with the computer output. This may reflect the difference in approach between the manual method and the automatic method of the OCT3 mapping software. The software automatically determined the mean and standard deviation thickness for the center point where all 6 scans intersected, whereas we manually located the minimum point on each separate radial scan and averaged those values.

If the OCT scans were not perfectly centered on the patient's fixation point for all 6 scans, the point of intersection would not correspond to the center exactly Figure 4. This may give falsely elevated values. Given that the awake human eye is in constant motion, the minimum point for each radial scan will virtually never converge at the center, despite faster OCT3 scanning speeds. Because the central point is the smallest area of measurement, it will be most affected by tiny eye movements, followed by the central foveal zone.

As a result, the standard deviation for central foveal thickness is the largest. Consequently, foveal thickness may be a more practical and reliable indicator than central foveal thickness for changes in the macula. We believe future OCT studies should report foveal thickness, in addition to central foveal thickness, in the evaluation of the efficacy of different therapies for macular edema.

Recently, Brown et al 27 directly compared the clinical gold standard for the detection of macular edema contact lens biomicroscopy with the OCT3 for the detection of diabetic foveal edema. Our findings do not agree with their assessment. We use 2 SDs to define the cutoffs for the upper and lower levels of normal foveal thickness.

Such outlying values can occur and do arise in nearly all experimental data. Patients with subclinical macular thickening or thinning, and other risk factors, may require more frequent follow-up visits.

Further OCT studies are needed to investigate whether diabetic patients with subclinical thickening are at higher risk for developing diabetic retinopathy. Although it has been suspected that macular thickness might decline slightly with age, no statistically significant relationship could be found from this study.

These findings are consistent with studies by Hee et al 6 and Sanchez-Tocino et al. Future studies with larger sample sizes and a more even distribution of men and women may provide more useful information regarding differences by age, sex, and race.

In conclusion, normative values for macular thickness in a healthy population were obtained using commercially available OCT3 mapping software. March 30, ; final revision received March 10, ; accepted March 10, Cystoid macular edema in pseudophakia. Macular thickening and visual acuity: Retinal thickness analysis for quantitative assessment of diabetic macular edema. Optical coherence tomography of the human retina.

Imaging of macular diseases with optical coherence tomography. Quantitative assessment of macular edema with optical coherence tomography. Topography of macular edema with optical coherence tomography. Reproducibility of retinal thickness measurements in healthy and diabetic eyes using optical coherence tomography. Comparison of foveal thickness measured with the retinal thickness analyzer and optical coherence tomography. Retinal thickness study with optical coherence tomography in patients with diabetes.

Macular thickness measured by optical coherence tomography OCT in diabetic patients. Reproducibility of nerve fiber thickness, macular thickness, and optic nerve head measurements using StratusOCT. Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics.

Detection of diabetic foveal edema. Duker, MD ; Tony H. Ko, PhD ; et al James G. Fujimoto, PhD ; Joel S. Sign in to access your subscriptions Sign in to your personal account. Create a free personal account to download free article PDFs, sign up for alerts, and more. Purchase access Subscribe to the journal. Create a free personal account to access your subscriptions, sign up for alerts, and more. Purchase access Subscribe to JN Learning for one year.

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This tells us that snow can fall even when the temperature is above freezing at the surface. We see this quite often, actually, and usually the snow that falls is very wet snow. Frozen snowflakes falling from above need time as they fall to melt, so if the layer above freezing is relatively shallow, the snowflakes simply don't have time to fully melt before they hit the ground.

The mean temperature in the layer should be cooler than degrees Celsius. This represents a temperature on the upper bound of the so-called "dendritic growth zone". It turns out that the most vigorous production of snowflakes tends to occur where there are temperatures between to degrees Celsius the exact numbers will vary depending on what study you look at or who you ask. Therefore, it would make sense that we need to have a layer that is at least that cold to be confident in seeing snowflakes if snow is forming.

The mean temperatures never get above freezing except in the lowest layer. This implies that if we ever see the temperature on our profile get above freezing except for in a very near-surface layer, but even then A small layer above freezing may not be enough to fully melt the snow crystals. However, a relatively deep layer above freezing will start pulling the mean values in layers spanning that particular layer closer to the freezing point.

This will in turn warm the mean temperatures in those layers beyond these "critical" values. I believe this implies that critical thickness values may be more representative in atmospheres where the lower part of the troposphere i. It's an excellent review of how accurate critical thickness values are based on a statistical analysis. He also confirms a tendency for the values to be more applicable in a stable environment.

So, remember--critical thickness plots are fun tools that can help provide an initial guess at checking precipitation type.

It's always best to check multiple critical thickness values for different layers to get a clearer picture of what's going on. And, we can see from the simple calculations above what these critical thickness values can tell us about a typical snow vs a typical rain environment. There's a lot more analysis that could be done, but this is just a flavor of what critical thickness implies.

Remember last time I mentioned how we would want to see a buildup of really cold arctic air on our side of the globe if we were to have an "arctic outbreak" here later this week?

Here is the hemispheric plot of mb heights or, in proxy form, temperature from 48 hours ago:. We can see that the coldest air represented by the lowest mb heights was just about centered over the North Pole two days ago.

Now look at this morning's plot:. The center of the cold air has shifted off the pole! Not only that, but it has shifted toward the North American side.

Could this be the beginning of our arctic outbreak air? Remember this air has a long way to go before it gets down here, and interactions with the land can warm the air considerably. Though this weekend's snow cover over the upper midwest won't do anything to help warm the air mass, if the snow sticks around Posted by Luke Madaus at 3: Newer Post Older Post Home. Fig 3 -- Northern Hemispheric plot of mb heights shaded and mean sea-level pressure contoured from 12Z, Nov.

From the HOOT website.

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