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Updated: Jul 14, 2025

Retinal Vascular Reactivity as Assessed by Optical Coherence Tomography Angiography
Published on: March 26, 2020
The OSCAR-MP Consensus Criteria for Quality Assessment of Retinal Optical Coherence Tomography Angiography
Rebecca Wicklein1, Charmaine Yam1, Christina Noll1
1From the Department of Neurology (R.W., C.N., L.A., N.B., E.F.R., E.W., B.H., B.K.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Neuroinflammation (C.Y., O.C., A.P., A.T.T.), Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London; Neurosciences Institute (C.Y.), Cleveland Clinic London, United Kingdom; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany; Experimental and Clinical Research Center (F.C.O., H.Z., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.Z.), Berlin; Department of Neurology (P.A., M.R.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine University Düsseldorf; Department of Neurology (P.A.), Maria Hilf Clinics, Mönchengladbach; Department of Ophthalmology (C.B., N.F.), Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Airport Munich Eye Clinic MVZ (N.F.), Germany; Department of Ophthalmology (J.P.), University of Basel, Switzerland; Institute of Clinical Neuroimmunology (J.H., J.A.G.), LMU Hospital, Ludwig-Maximilians-Universität München, Munich; Department of Ophthalmology (C.M.), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurology (E.S.V., P.A.C., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology (O.A.-L.), Cedars-Sinai Medical Center, Los Angeles, CA; Servicio de Neurología (S.C., A.V.-J.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Neurology with Institute of Translational Neurology (J.K., H.W.), University Hospital Münster, Germany; Department of Neurology (J.L.P.), First Medical Faculty, Charles University and General University Hospital in Prague, Czech Republic; National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC) (O.C.), United Kingdom; Ophthalmology Department (E.G.-M.), Miguel Servet University Hospital, Aragones Institute of Health Sciences, Zaragoza, Spain; Department of Neurology (V.K.), University Hospital Zurich, Switzerland; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P., A.T.T.), University College London, United Kingdom; and Department of Neurology (A.P.), Amsterdam UMC, Vrije Universiteit Amsterdam, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Netherlands.
This study developed the OSCAR-MP criteria for standardized quality control of optical coherence tomography angiography (OCTA) scans. The new criteria significantly improved interrater agreement for assessing OCTA image quality in international multicenter studies.
Area of Science:
- Ophthalmology
- Neurology
- Medical Imaging
Background:
- Optical coherence tomography angiography (OCTA) is a crucial noninvasive imaging technique for retinal vasculature assessment.
- OCTA is increasingly utilized in ophthalmologic, neuro-ophthalmologic, and neurologic disease diagnosis.
- Currently, validated consensus criteria for OCTA quality control (QC) are lacking.
Purpose of the Study:
- To develop standardized, easy-to-apply quality control (QC) criteria for OCTA imaging.
- To establish criteria through literature review, interrater agreement assessment, and refinement.
- To validate the developed QC criteria in an international, multicenter study.
Main Methods:
- Conducted an extensive literature review to identify OCTA artifacts and quality aspects.
- Developed the OSCAR-MP (Obvious problems, Signal strength, Centration, Algorithm failure, Retinal pathology, Motion artifacts, Projection artifacts) criteria.
- Evaluated interrater agreement, identified disagreement reasons, and revised criteria with a scoring guide and training set.
- Validated the refined criteria in an international, interdisciplinary, multicenter study.
Main Results:
- Identified 7 key aspects affecting OCTA quality: OSCAR-MP.
- Initial application of OSCAR-MP criteria showed substantial interrater agreement (κ = 0.67).
- Projection artifacts were a primary source of disagreement; defining a region of interest (ROI) was crucial.
- After training and using a scoring guide, interrater agreement for rejecting poor-quality OCTA images reached almost perfect levels (κ = 0.92).
Conclusions:
- Proposed a 3-step approach for standardized OCTA quality control: define ROI, assess artifacts using OSCAR-MP, and evaluate quality within the ROI.
- The OSCAR-MP criteria demonstrated high interrater agreement in an international multicenter setting.
- OSCAR-MP is a promising QC protocol for future clinical trials and research involving OCTA.

