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Evidence-Based Criteria for Determining Peripapillary OCT Reliability.

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  • 1Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.

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Optical coherence tomography (OCT) signal strength (SS) and artifacts significantly impact retinal nerve fiber layer (RNFL) measurement reliability, especially in severe glaucoma. Guidelines are proposed to help interpret OCT scan results.

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Glaucoma Research

Background:

  • Optical coherence tomography (OCT) is crucial for diagnosing and monitoring glaucoma by measuring retinal nerve fiber layer (RNFL) thickness.
  • OCT measurement reliability can be affected by signal strength (SS) and image artifacts.
  • Understanding these factors is essential for accurate glaucoma assessment.

Purpose of the Study:

  • To evaluate how OCT signal strength (SS) and artifacts influence the reliability of RNFL thickness measurements.
  • To determine if glaucoma severity affects the relationship between SS, artifacts, and RNFL measurement reliability.

Main Methods:

  • A retrospective, longitudinal cohort study analyzed 2,992 OCT scans from 474 eyes of 241 glaucoma patients.
  • Multilevel linear models were used to estimate true RNFL thickness and calculate reliability (ΔRNFL) based on SS and artifact presence.
  • The models incorporated demographic and clinical data, with splines and interaction terms to assess SS and artifact effects, including quadrant-specific impacts.

Main Results:

  • Decreasing SS from 10 to 3 had a modest impact on RNFL measurement reliability.
  • SS below 3 significantly reduced OCT reliability, with a more pronounced effect in severe glaucoma.
  • Image artifacts substantially decreased reliability independently of SS, affecting only the quadrant with the artifact.

Conclusions:

  • OCT signal strength below 3 critically impacts RNFL measurement reliability, especially in advanced glaucoma.
  • Image artifacts introduce significant unreliability in affected quadrants, irrespective of signal strength.
  • Evidence-based guidelines are proposed to aid clinicians in interpreting OCT scan reliability.