Optical Coherence Tomography: Clinicopathologic Correlations - The 2016 Gordon K. Klintworth Lecture.

BACKGROUND/AIMS: Spectral domain optical coherence tomography (SD-OCT) has become a mainstay of ophthalmic practice that has revolutionized the assessment and treatment of a variety of ocular disorders. Studies that directly correlate SD-OCT and histopathology are necessary to demonstrate the actual nature of the retinal pathology responsible for the images that resemble histologic sections, but are generated by mathematical algorithms.
METHODS: Careful correlative light microscopy was performed on a small number of eyes undergoing enucleation for intraocular tumors that had pertinent findings imaged by SD-OCT. Expeditious processing and a fixation technique that prevented retinal detachment minimized tissue distortion and sectioning artifact.
RESULTS: The retinal layers disclosed by SD-OCT images do not correspond directly to light microscopy. Photoreceptor ellipsoids can persist in foveal detachments without a distinct ellipsoid band in corresponding SD-OCT images. Lipidized histiocytes can appear as bright hyperreflective spots, and clumps of subretinal macrophages as "shaggy photoreceptors" overlying choroidal tumors.
CONCLUSION: The meaningful interpretation of SD-OCT's striking visual imagery requires a firm foundation in ocular histology and pathology. The accuracy of interpretation can be improved by correlative studies that directly compare OCT and histopathology.