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      Artifact Rates for 2D Retinal Nerve Fiber Layer Thickness Versus 3D Retinal Nerve Fiber Layer Volume

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          Abstract

          Purpose

          To compare artifact rates in two-dimensional (2D) versus three-dimensional (3D) retinal nerve fiber layer (RNFL) scans using Spectralis optical coherence tomography (OCT)

          Methods

          Thirteen artifact types in 2D and 3D RNFL scans were identified in 106 glaucomatous eyes and 95 normal eyes. Artifact rates were calculated per B-scan and per eye. In 3D volume scans, artifacts were counted only for the 97 B-scans used to calculate RNFL parameters for the 2.5–3.5-mm annulus. 3D RNFL measurements were calculated twice, once before and again after deletion of B-scans with artifacts and subsequent automated interpolation.

          Results

          For 2D scans, artifacts were present in 58.5% of B-scans (62 of 106) in glaucomatous eyes. For 3D scans, a mean of 35.4% of B-scans (34.3 of 97 B-scans per volume scan) contained an artifact in 106 glaucomatous eyes. For 3D data of glaucoma patients, mean global RNFL thickness values were similar before and after interpolation (77.0 ± 11.6 µm vs. 75.1 ± 11.2 µm, respectively; P = 0.23). Fewer clinically significant artifacts were noted in 3D RNFL scans, where only 7.5% of glaucomatous eyes (8 of 106) and 0% of normal eyes (0 of 95) had artifacts, compared to 2D RNFL scans, where 58.5% of glaucomatous eyes (62 of 106) and 14.7% of normal eyes (14 of 95) had artifacts.

          Conclusions

          Compared to 2D RNFL scans, 3D RNFL volume scans less often require manual correction to obtain accurate measurements.

          Translational Relevance

          3D RNFL volume scans have fewer clinically significant artifacts compared to 2D RNFL thickness scans.

          Related collections

          Most cited references23

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          Optic nerve damage in human glaucoma. III. Quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic neuropathy, papilledema, and toxic neuropathy.

          The number and distribution of human optic nerve axons were compared with clinical measurements available the same eyes, including visual acuity, disc appearance, and visual field studies. Definite loss of axons occurs prior to reproducible visual field defects in some patients suspected of having glaucoma. In glaucoma, the superior and inferior poles of the nerve lose nerve fibers at a selectively greater rate, leading to an hourglass-shaped atrophy. Cavernous degeneration of the retrobulbar optic nerve is rarely observed in chronic glaucoma. The pattern of atrophy in examples of toxic amblyopia, ischemic optic neuropathy and chronic papilledema differ from that of glaucoma, suggesting different mechanisms of damage in these conditions.
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            Spectral domain optical coherence tomography: ultra-high speed, ultra-high resolution ophthalmic imaging.

            To introduce a new ophthalmic optical coherence tomography technology that allows unprecedented simultaneous ultra-high speed and ultra-high resolution. Using a superluminescent diode source, a clinically viable ultra-high speed, ultra-high resolution spectral domain optical coherence tomography system was developed. In vivo images of the retina, the optic nerve head, and retinal blood flow were obtained at an ultra-high speed of 34.1 microseconds (ms) per A-scan, which is 73 times faster than commercially available optical coherence tomography instruments. Single images (B-scans) consisting of 1000 A-scans were acquired in 34.1 ms, allowing video rate imaging at 29 frames per second with an axial resolution of 6 mum. Using a different source in a slightly slower configuration, single images consisting of 500 A-scans were acquired in 34 ms, allowing imaging at 29 frames per second at an axial resolution of 3.5 microm, which is 3 times better than commercially available optical coherence tomography instruments. The amount of energy directed into the eye in both cases, 600 microW, is less than that of the Stratus OCT3 and is safe for intrabeam viewing for up to 8 hours at the same retinal location. Spectral domain optical coherence tomography technology enables ophthalmic imaging with unprecedented simultaneous ultra-high speed and ultra-high resolution.
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              Artifacts in spectral-domain optical coherence tomography measurements in glaucoma.

              IMPORTANCE Spectral-domain optical coherence tomography (SD-OCT) has an integral role in the diagnosis and treatment of glaucoma. Understanding the types of artifacts commonly seen in the imaging of patients being evaluated for glaucoma will help physicians better implement these data in the care of patients. OBJECTIVES To determine the frequency and distribution of SD-OCT imaging artifacts in patients being evaluated for glaucoma and to provide examples of common artifacts. DESIGN, SETTING, AND PARTICIPANTS A retrospective cross-sectional study design was used to examine SD-OCT images (using Spectralis SD-OCT) of 277 consecutive patients who had a diagnosis of glaucoma of any stage or had suspected glaucoma. Retinal nerve fiber layer (RNFL) and macular thickness scans were included. For each scan, the final printout and the source images that generated the final printout were examined. If present, artifacts were classified as evident on the final printout or not and were categorized as to the primary source of the artifact (eg, ocular pathologic features or technician errors). Examples of common artifacts are provided. MAIN OUTCOMES AND MEASURES The presence of imaging artifacts. RESULTS In 277 consecutive patients, 131 macular thickness scans were obtained, and 277 RNFL scans were obtained. Of the macular thickness scans, 37 (28.2%; 95% CI, 20.8%-36.1%) had imaging artifacts. Six of these artifacts were not obvious on the final printout. Of the RNFL scans, 55 (19.9%; 95% CI, 15.2%-24.6%) contained artifacts. Seven of these artifacts were not evident on the final printout. The most common cause of artifacts for macular thickness and RNFL scans was ocular pathologic features, primarily the presence of an epiretinal membrane. CONCLUSIONS AND RELEVANCE It is likely that SD-OCT-related imaging artifacts occur in 15.2% to 36.1% of scans obtained in patients being evaluated for glaucoma. Some of these artifacts may not be evident on the final printout. Physicians should be alert to the possibility of artifacts, particularly in patients with ocular pathologic features such as an epiretinal membrane.
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                Author and article information

                Journal
                Transl Vis Sci Technol
                Transl Vis Sci Technol
                tvst
                tvst
                TVST
                Translational Vision Science & Technology
                The Association for Research in Vision and Ophthalmology
                2164-2591
                12 February 2020
                February 2020
                : 9
                : 3
                : 12
                Affiliations
                [1 ] Harvard Medical School, Department of Ophthalmology , Boston, MA, USA
                [2 ] Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Glaucoma Service , Boston, MA, USA
                [3 ] Beirut Eye and ENT Specialist Hospital, Saint-Joseph University Medical School , Beirut, Lebanon
                [4 ] Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine , Kaohsiung, Taiwan
                [5 ] Wellman Center for Photomedicine, Massachusetts General Hospital , Boston, MA, USA
                [6 ] Institute for Medical Engineering and Science, Massachusetts Institute of Technology , Cambridge, MA, USA
                [7 ] Harvard Medical School, Division of Health Sciences and Technology , Cambridge, MA, USA
                [8 ] LaserLaB Amsterdam, Department of Physics and Astronomy, Vrije Universiteit , Amsterdam, The Netherlands
                [9 ] Department of Ophthalmology, Amsterdam UMC , Amsterdam, The Netherlands
                Author notes
                Correspondence: Teresa C. Chen, Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Glaucoma Service , 243 Charles St, Boston, MA 02114, USA. e-mail: teresa_chen@ 123456meei.harvard.edu
                Article
                TVST-19-1839
                10.1167/tvst.9.3.12
                7351591
                32714638
                7233bd6a-ab17-4cef-a32b-a193b6a75b42
                Copyright 2020 The Authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 24 November 2019
                : 18 August 2019
                Page count
                Pages: 10
                Categories
                Article
                Custom metadata
                corrected-proof
                PAP

                optical coherence tomography,glaucoma,rnfl artifacts

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