Detection of Glaucoma Deterioration in the Macular Region With Optical Coherence Tomography
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
Macular imaging with optical coherence tomography (OCT) measures the most critical retinal ganglion cells (RGC) in the human eye. The goal of this perspective is to review the challenges to detection of glaucoma progression with macular OCT imaging and propose ways to enhance its performance.
DESIGN
Perspective with review of relevant literature.
METHODS
Review of challenges and issues related to detection of change on macular OCT images in glaucoma eyes.
SETTING
NA.
PATIENT OR STUDY POPULATION
NA.
INTERVENTION OR OBSERVATION PROCEDURE(S)
NA.
MAIN OUTCOME MEASURE
Confounding factors affecting detection of change on macular OCT images.
RESULTS
The main challenges to detection of structural progression in the macula include the magnitude of and the variable amount of test-retest variability among patients, the confounding effect of aging, lack of a reliable and easy-to-measure functional outcome or external standard, confounding effect of macular conditions including myopia, and the measurement floor of macular structural outcomes. Potential solutions to these challenges include controlling head tilt or torsion during imaging, estimating within-eye variability for individual patients, improved data visualization, use of artificial intelligence methods, and implementation of statistical approaches suitable for multidimensional longitudinal data.
CONCLUSIONS
Macular OCT imaging is a crucial structural imaging modality for assessing the central RGCs. Addressing the current shortcomings in acquisition and analysis of macular volume scans can enhance its utility for measuring the health of central RGCs and hence assist clinicians with timely institution of appropriate treatment.
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Additional Info
Disclosure statements are available on the authors' profiles:
Detection of Glaucoma Deterioration in the Macular Region With Optical Coherence Tomography: Challenges and Solutions
Am J Ophthalmol 2020 Sep 17;[EPub Ahead of Print], K Nouri-Mahdavi, RE WeissFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The authors point out that, although the use of OCT images in the macular region can aid the detection of structural deterioration in glaucoma, this isn't as straightforward as we'd like to think. Part of the problem is "noise" in the image due to head position variability or changes in the quality of the ocular surface or other structural challenges. The authors offer potential solutions, two of which are immediately useful for the clinician: 1) controlling larger changes in head tilt and turning at every imaging session to decrease between-visit variability for OCT measurements; and 2) repeat imaging of a given eye during the initial one or two visits, which could provide a good estimate of test–retest variability in thickness measurements. If repeat imaging shows consistent variability, the conclusions drawn from the imaging results must be tempered accordingly.