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Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 25 May 2026 | Viewed by 12084

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Dr. Jose Ignacio Fernandez-Vigo

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1. Department of Ophthalmology, Hospital Clínico San Carlos, 28040 Madrid, Spain
2. Centro Internacional de Oftalmología Avanzada, 28010 Madrid, Spain
3. Department of Ophthalmology, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
Interests: optical coherence tomography; OCT; retinal diseases; vitreoretinal surgery; macular degeneration; glaucoma; retinal imaging; ophthalmology
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Special Issue Information

Dear Colleagues,

It is my pleasure to invite you to contribute to this Special Issue entitled “Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition”. This is a new volume, and we published 11 papers in the first volume. For more details, please visit the following link: https://www.mdpi.com/journal/jcm/special_issues/C92CVM3742

The continuous development of optical coherence tomography (OCT) in the field of ophthalmology has revolutionized clinical practice. In the beginning, it was developed for ophthalmology with the aim of evaluating the posterior segment, mainly the macula and the optic nerve. Shortly after, it was employed for the assessment of the anterior segment, expanding its usefulness and resulting in focused study of the cornea, anterior chamber, and iridocorneal angle. Through OCT, it is now possible to examine structures that were previously difficult to assess, such as the choroid, vitreous, lens, extraocular muscles, or ciliary muscle.

Recently, intraoperative OCT, en face OCT, and wide-field OCT have been developed, offering new insights into surgical maneuvers and a variety of diseases. Moreover, analysis of the changes after surgery in different ophthalmological subspecialties, including the retina, the cornea, and glaucoma, has become more accurate with the progress in OCT.

This Special Issue aims to present selected original research papers and review articles that discuss the current state of the art, address existing knowledge gaps, and present the clinical utility of such advances in OCT, focusing on their clinical impacts on the management of different ophthalmological diseases.

Dr. Jose Ignacio Fernandez-Vigo
Guest Editor

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Keywords

optical coherence tomography
ophthalmology
intraoperative OCT
en face OCT
wide-field OCT
retinal diseases
glaucoma
cornea
strabismus
cataract

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Published Papers (8 papers)

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Research

Jump to: Review, Other

14 pages, 4320 KB

Open AccessArticle

Retinal Microvascular Features Assessed by Optical Coherence Tomography Angiography in Attention Deficit Hyperactivity Disorder

by Carmen Miquel-Lopez, Jose Javier Garcia-Medina, Antonio Eusebio Lopez-Hernandez, Diego Garcia-Ayuso, Javier Martinez-Soria, Camila Yane-Gauffin, Maria de los Reyes Retamero-Sanchez, Javier Hernandez-Olivares and Monica Del-Rio-Vellosillo

J. Clin. Med. 2026, 15(7), 2669; https://doi.org/10.3390/jcm15072669 - 1 Apr 2026

Viewed by 453

Abstract

Background: Attention deficit hyperactivity disorder (ADHD) lacks objective biomarkers that may complement clinical diagnosis. Optical coherence tomography angiography (OCTA) enables non-invasive quantitative assessment of retinal microvasculature and has emerged as a potential tool to explore neurovascular features associated with neurodevelopmental disorders. The aim of this study was to comparatively evaluate macular and peripapillary OCTA parameters in individuals with ADHD and neurotypical controls. Methods: This comparative case–control study involved 200 eyes (100 from 50 patients with ADHD and 100 from 50 neurotypical controls) belonging to the same well-characterized cohort previously evaluated using structural optical coherence tomography (OCT). Macular and peripapillary OCTA scans were obtained, and quantitative parameters related to vessel density, perfusion density, and peripapillary flow metrics of the superficial retinal capillary plexus were analyzed separately for right and left eyes. Group comparisons were performed using independent-samples t-tests and analysis of covariance adjusted for age, sex, and axial length, with correction for multiple comparisons. Results: After adjustment for age, sex, and axial length, no OCTA parameter showed statistically significant between-group differences after correction for multiple comparisons. Across parameters, mean differences were small and did not provide statistical evidence of an effect under the prespecified analytical framework. Conclusions: Superficial OCTA-derived microvascular parameters did not demonstrate robust between-group differences in ADHD in this cohort. These results suggest that when restricted to the superficial capillary plexus, OCTA metrics are unlikely to serve as standalone biomarkers for ADHD. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

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14 pages, 1157 KB

Open AccessArticle

Fibrin Glue Versus Absorbable Sutures for Conjunctival Closure in Pediatric Strabismus Surgery: A Comparative Study of Clinical Outcomes and AS-OCT Findings

by Ahmet Yusuf Goktas and Dilara Pirhan

J. Clin. Med. 2026, 15(4), 1531; https://doi.org/10.3390/jcm15041531 - 15 Feb 2026

Viewed by 509

Abstract

Background/Objectives: Conjunctival closure may influence early postoperative comfort and wound healing after pediatric strabismus surgery. We compared fibrin glue with absorbable sutures using anterior segment optical coherence tomography (AS-OCT)-based conjunctival thickness, serial clinical scores, ocular-surface screening, and operative time. Methods: We retrospectively reviewed 82 children (5–15 years) who underwent bilateral medial rectus recession. The conjunctiva was closed with 8-0 polyglactin 910 (Vicryl) (suture group, n = 40) or fibrin glue (fibrin group, n = 42) according to routine practice; right eyes were analyzed. Conjunctival thickness was measured by AS-OCT preoperatively and at week 6. The comfort questionnaire (CQ) score and inflammation score (IS) were recorded on postoperative day 1 and weeks 1, 2, and 6. Total operative time and closure time were obtained from surgical video recordings. Ocular Surface Disease Index-6 (OSDI-6) and non-invasive keratographic break-up time (NIKBUT) were assessed preoperatively and at week 6 in cooperative children (n = 62). Results: Conjunctival thickness increased in both groups and was slightly higher at week 6 with sutures (p < 0.001), with a slightly greater percentage increase (p = 0.001). CQ and IS were worse with sutures through week 2 (all p < 0.05) and converged by week 6 (both p > 0.05). Fibrin glue shortened total operative time (32.75 vs. 35.46 min; p < 0.05) and closure time (3.90 vs. 5.35 min; p < 0.001). In the ocular-surface subset, OSDI-6 and NIKBUT did not differ between groups at week 6. No infections or granulomas occurred; two early conjunctival wound gaps occurred in the fibrin group and one resolved with topical management, while the other met the dehiscence definition (≥2 mm) and required re-suturing, and both healed without sequelae. Conclusions: In pediatric strabismus surgery, fibrin glue demonstrated better early comfort with a modest difference in conjunctival thickness at week 6 along with slightly shorter operative time while clinical scores converged by week 6, and ocular-surface screening outcomes were similar. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

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12 pages, 1720 KB

Open AccessArticle

Study on Factors Affecting Toric Intraocular Lens Rotation Using Intraoperative OCT—Factors Influencing IOL Deployment and Proximity to Posterior Capsule After Insertion

by Kei Ichikawa, Seiji Tokiwa, Yoshiki Tanaka, Hiroto Toda, Yukihito Kato, Yukihiro Sakai, Kazuo Ichikawa and Naoki Yamamoto

J. Clin. Med. 2025, 14(18), 6599; https://doi.org/10.3390/jcm14186599 - 19 Sep 2025

Viewed by 1215

Abstract

Background/Objectives: Cataract surgery often reveals preexisting corneal astigmatism, which can be corrected using a toric intraocular lens (T-IOL). However, postoperative T-IOL rotation may compromise correction. We investigated T-IOL rotation, focusing on deployment time and proximity to the posterior capsule (PC), using intraoperative optical coherence tomography (iOCT). Methods: Six different T-IOL models were inserted into acrylic simulated lens capsule models under different tacking durations (5 s, 30 s, and 60 s) and temperature conditions (23 °C, 28 °C, and 32 °C). The selection criteria for porcine lenses for examination required that they match human lens dimensions, typical of those used to train cataract surgeons. T-IOL misalignment due to vibration was assessed. Additionally, the impact of temporary intraocular pressure (IOP) reduction on T-IOL proximity to the PC was measured using iOCT in porcine eyes. Results: Tacking time and temperature independently affected T-IOL deployment, with shorter tacking durations and higher temperatures leading to faster deployment. Among lenses tested under identical tacking time and temperature conditions, iSert Micro Toric Aspheric 1-Piece IOL (355T3) had the slowest expansion time, while Avansee™ Preload 1-Piece Toric (YP-T3) had the fastest. Porcine eyes with a corneal white-to-white major axis < 16.0 mm fell within the 95% confidence interval for matching human lens size. Temporarily reducing IOP during surgery improved T-IOL adhesion to the PC, reducing both the occurrence and degree (from 14.0° to nearly 0°) of postoperative rotation. Conclusions: Optimal T-IOL deployment, temporary IOP reduction during surgery, and enhanced adhesion to the PC can reduce the risk and degree of T-IOL rotation. Intraoperative iOCT aids in monitoring T-IOL positioning, which is essential to prevent rotation. Accumulated fluid between the T-IOL and PC may contribute to rotation, which requires further investigation. These findings provide practical strategies for enhancing T-IOL stability and improving the effectiveness of astigmatism correction in cataract surgery. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

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14 pages, 1704 KB

Open AccessFeature PaperArticle

Retinal Thinning in Attention Deficit Hyperactivity Disorder (ADHD): Structural Changes Detected by Spectral-Domain OCT

by Carmen Miquel-Lopez, Jose Javier Garcia-Medina, A. Eusebio Lopez-Hernandez, Diego Garcia-Ayuso, Maravillas De-Paco-Matallana, Javier Hernandez-Olivares, Maria Dolores Pinazo-Duran and Monica Del-Rio-Vellosillo

J. Clin. Med. 2025, 14(16), 5723; https://doi.org/10.3390/jcm14165723 - 13 Aug 2025

Cited by 3 | Viewed by 1416

Abstract

Background/Objectives: Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. As the retina is an extension of the central nervous system, retinal imaging may provide insights into the ADHD pathophysiology. The objective of this work was to evaluate structural retinal alterations using optical coherence tomography (OCT) in ADHD patients compared to neurotypical controls. Methods: A case–control study involving 200 eyes (100 from 50 patients with ADHD and 100 from 50 controls) was conducted by comparing the thicknesses of the macular region (total retina, inner and outer retinal layers, ganglion cell layer plus inner plexiform layer [GCIPL], and macular retinal nerve fiber layer [mRNFL]), the peripapillary region (pRNFL), and the optic nerve head (ONH) parameters. Areas under the curve (AUCs) were calculated to evaluate diagnostic performance. Right and left eyes were analyzed separately. Results: Patients with ADHD showed a significant reduction in total and outer retinal thickness across several macular sectors in both eyes. No significant differences were observed in mRNFL, GCIPL, inner retina, pRNFL, or ONH parameters between groups. AUC values derived from ROC analysis indicate moderate diagnostic performance for total and outer retinal thickness in the macular region. Conclusions: ADHD is associated with retinal thinning in the macula (total and outer retinal thickness) in both eyes, suggesting the potential of OCT-based biomarkers for this condition. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

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14 pages, 774 KB

Open AccessArticle

First Clinical Evidence Linking Smoking to Increased Postoperative Macular and Retinal Nerve Fiber Layer Thickness in Cataract Surgery Patients: A Prospective Cohort Study

by Darko Batistic, Sandro Glumac, Jozefina Josipa Dukic, Filip Rada, Josip Vrdoljak, Jaksa Batistic, Braco Boskovic, Maja Mizdrak and Ante Kreso

J. Clin. Med. 2025, 14(12), 4131; https://doi.org/10.3390/jcm14124131 - 11 Jun 2025

Cited by 1 | Viewed by 1639

Abstract

Background: Postoperative macular edema may limit visual recovery following cataract surgery. Although smoking is recognized as a risk factor for ocular inflammation, its impact on early postoperative macular morphology following cataract surgery has not been investigated. Methods: This prospective cohort study enrolled 88 elderly patients undergoing elective cataract surgery in a single university teaching hospital. The patients were divided into long-term smokers and lifelong non-smokers. Spectral-domain optical coherence tomography (OCT) was used to assess the central subfoveal thickness (CST), cube volume (CV), cube average thickness (CAT), retinal nerve fiber layer (RNFL), and cup-to-disk ratio (CDR) preoperatively and on the 1st, 7th, and 14th postoperative days (PODs). The phacoemulsification time and cumulative dissipated energy were recorded. Linear mixed-effects models were used to assess group-by-time interactions, and multivariable regression, adjusted for baseline covariates, was employed for analyses. Results: Eighty patients were included in the final analysis. Smokers had significantly thinner baseline CST than non-smokers. Both groups showed early postoperative CST increases, but only smokers exhibited sustained and significantly greater increases in CV and CAT on POD 14 (CV Δ +0.30 mm³ vs. +0.04 mm³; p = 0.026; CAT Δ +6.5 µm vs. +1.2 µm; p = 0.037). The RNFL and CDR changes did not differ significantly at earlier timepoints. However, smokers showed a notably greater RNFL thickening on POD 14 (Δ +4.2 µm; p = 0.001). Smoking status remained the strongest independent predictor of these changes (p < 0.001), while phacoemulsification parameters showed no significant interaction effects. Conclusions: Cigarette consumption independently predicts pronounced postoperative macular and RNFL thickening after uncomplicated elective cataract surgery. These transient structural changes could complicate early glaucoma assessment and should be considered when interpreting postoperative OCT findings in smokers. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

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Review

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23 pages, 2023 KB

Open AccessReview

Enhanced Imaging of Ocular Surface Lesions

by Wisam O. Najdawi, William R. Herskowitz, Diego E. Alba, Omar Badla, Pragat J. Muthu, Anat Galor and Carol L. Karp

J. Clin. Med. 2026, 15(1), 289; https://doi.org/10.3390/jcm15010289 - 30 Dec 2025

Viewed by 893

Abstract

Ocular surface lesions represent a diverse group of pathologies which may be challenging to diagnose clinically. Anterior segment imaging—including anterior segment optical coherence tomography (AS-OCT), optical coherence tomography angiography (OCTA), ultrasound biomicroscopy (UBM), and in vivo confocal microscopy (IVCM)—provides valuable adjunct information for the diagnosis, management, and monitoring of these lesions. The present review aims to provide an update on the principles, current clinical applications, advantages, limitations, and recent advancements in the imaging modalities used for the evaluation of ocular surface lesions. Notable recent advancements include the application of artificial intelligence in the interpretation of AS-OCT, intraoperative use of AS-OCT, the development of three-dimensional UBM, and expanded applications of each modality for a variety of ocular surface lesions. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

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20 pages, 3863 KB

Open AccessReview

The Clinical Usefulness of Evaluating the Lens and Intraocular Lenses Using Optical Coherence Tomography: An Updated Literature Review

by José Ignacio Fernández-Vigo, Lucía De-Pablo-Gómez-de-Liaño, Ignacio Almorín-Fernández-Vigo, Beatriz De-Pablo-Gómez-de-Liaño, Ana Macarro-Merino, Julián García-Feijóo and José Ángel Fernández-Vigo

J. Clin. Med. 2024, 13(23), 7070; https://doi.org/10.3390/jcm13237070 - 22 Nov 2024

Cited by 1 | Viewed by 4639

Abstract

The Lens Dysfunction Syndrome includes two widespread ocular disorders: presbyopia and cataract. Understanding its etiology, onset, progression, impact, prevention, and treatment remains a significant scientific challenge. The lens is a fundamental structure of the ocular dioptric system that allows for focus adjustment or accommodation to view objects at different distances. Its opacification, primarily related to aging, leads to the development of cataracts. Traditionally, lens alterations have been diagnosed using a slit lamp and later with devices based on the Scheimpflug camera. However, both methods have significant limitations. In recent years, optical coherence tomography (OCT) has become a valuable tool for assessing the lens and pseudophakic intraocular lenses (IOLs) in clinical practice, providing a highly detailed non-invasive evaluation of these structures. Its clinical utility has been described in assessing the shape, location or position, and size of the lens, as well as in determining the degree and type of cataract and its various components. Regarding pseudophakic IOLs, OCT allows for the accurate assessment of their position and centering, as well as for detecting possible complications, including the presence of glistening or IOL opacification. Furthermore, OCT enables the evaluation of the posterior capsule and its associated pathologies, including late capsular distension syndrome. This review highlights the key applications of OCT in the assessment of the lens and pseudophakic IOLs. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

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Other

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19 pages, 3368 KB

Open AccessSystematic Review

Longitudinal Observation by Optical Coherence Tomography in Patients Treated with Ethambutol: A Systematic Review and Meta-Analysis

by Rui Luo, Jin Ma and Yong Zhong

J. Clin. Med. 2026, 15(3), 1230; https://doi.org/10.3390/jcm15031230 - 4 Feb 2026

Viewed by 490

Abstract

Background: The retinal changes caused by ethambutol are not clear in patients with the administration of ethambutol and without ethambutol-induced optic neuropathy (EON). The aim of this systematic review is to estimate the changes in retinal nerve fiber layer (RNFL) and ganglion cell layer and inner plexiform layer (GCIPL) thicknesses measured by optical coherence tomography (OCT) in patients with mycobacterial infection treated with ethambutol and not suffering from EON. Methods: A systematic review of articles was conducted by searching PubMed, Embase, and Web of Science until November 2025. Additional studies were identified by the review of references. Search terms included OCT and ethambutol. Longitudinal observational studies using an OCT device to measure RNFL and GCIPL thicknesses before and after the administration of ethambutol in patients with mycobacterial infection without ocular diseases were included. The extraction of data in studies was performed by two researchers using data extraction sheets. The meta-analysis was conducted using the random-effect model. Results: In total, 14 studies (n = 1138) were eligible for the systematic review. Meta-analysis combining RNFL measured after the longest duration of ethambutol administration showed no significant decrease compared to RNFL before treatment. However, there were significant decreases in RNFL thickness in male-dominant studies, studies conducted in Turkey and India, and studies conducted by the Cirrus OCT device. In addition, the decreases in RNFL thickness were correlated with the duration of ethambutol administration in male-dominant studies. Only two studies reported the thickness changes in GCIPL, and the study with a higher male proportion showed significant decreases in GCIPL thickness. Conclusions: Ethambutol does not cause a significant RNFL decrease generally in mycobacterial infection patients; however, it may lead to decreased RNFL thickness in male patients and patients in some regions, even though they do not suffer from EON. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

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