Comparison of Different OCT Systems
Teresa C. Chen, MDAssociate Professor of Ophthalmology, Harvard Medical School
Glaucoma Service, Massachusetts Eye and Ear Infirmary
• I have the following financial interests or relationships to disclose:
– Department of Defense: Grant Support
– Harvard Foundation Grant (Fidelity Charitable Fund): Grant Support
Outline
Purpose
Methods
Results
Conclusions
Review the literature on the use of SD‐OCT to help diagnose glaucoma 2006 to 2018
All commercially available SD‐OCT machines RNFL, optic nerve, macula
not lamina no OCTA
Outline
Purpose
Methods
Results
Conclusions
PubMed and Cochrane Library Databases February 2006 to April 2018
Outline
Purpose
Methods
Results
Conclusions
PubMed and Cochrane Library Databases February 2006 to April 2018
Outline
Purpose
Methods
Results
Conclusions
PubMed and Cochrane Library Databases February 2006 to April 2018
Lin SC, Singh K, Jampel HD, Hodapp EA, Smith SD, Francis BA, Dueker DK, FechtnerRD, Samples JS, Schuman JS, Minckler DS. Optic Nerve Head and RNFL Analysis. Ophthalmology 2007;114:1937‐1949.
Purpose
Methods
Results
Conclusions
PubMed and Cochrane Library Databases February 2006 to April 2018
Outline
Lin SC, Singh K, Jampel HD, Hodapp EA, Smith SD, Francis BA, Dueker DK, FechtnerRD, Samples JS, Schuman JS, Minckler DS. Optic Nerve Head and RNFL Analysis. Ophthalmology 2007;114:1937‐1949.
Purpose
Methods
Results
Conclusions
PubMed and Cochrane Library Databases February 2006 to April 2018
Outline
Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K, Radhakrishnan S, Takusagawa H, Chen PP. Spectral Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018;125:1817‐1827.
SLD Light Source
Reference Mirror
Photo Detector A-line
Beam Splitter
How Time Domain OCT Works
Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, Hee MR, Flotte T, Gregory K, Puliafito CA, Fujimoto JG. Optical Coherence Tomography. Science, 1991.
SLD Light Source
Reference Mirror
Spectrometer
Beam Splitter
Fourier transform
How Spectral Domain OCT Works
American Glaucoma Society
Sarasota, Florida, 2004
“Ultra High Speed Optical Coherence Tomography” Video-Rate SD-OCT
White BR, Pierce MC, Nassif N, Cense B, Park BH, Chen TC, de Boer JF…Imaging Using Ultra-High-Speed Spectral Domain Optical Doppler Tomography. Optics Express 2003; 11 (25): 3490-7.
Johannes de Boer PhD (MGH)
White BR, Pierce MC, Nassif N, Cense B, Park BH, Chen TC, de Boer JF…Imaging Using Ultra-High-Speed Spectral Domain Optical Doppler Tomography. Optics Express 2003; 11 (25): 3490-7.
Nassif N, Cense B, Park BH, Yun SH, Chen TC, Bouma BE, Tearney GJ, de Boer JF. In vivo Human Retinal Imaging by Ultrahigh-Speed Spectral Domain OCT. Opt Lett 2004;29(5):480-482.
Nassif N, Cense B, Park BH, Pierce M, Yun SH, Bouma BE, Tearney GJ, Chen TC, de Boer JF. In vivo High-resolution Video-Rate Spectral Domain OCT of the Human Retina and Optic Nerve. Opt Express 2004;12(3):367-376.
Cense B, Nassif N, Chen TC, Pierce MC, Yun SH, Park BH, Bouma BE, Tearney GJ, de Boer JF. Ultrahigh-resolution High-speed Retinal Imaging Using Spectral Domain OCT. Opt Express 2004;12(11):2435-2447.
3D Spectral Domain OCT - 2003 imaging the eye
for the first time in 3D (video-rate)
in real time
SDOCT (3D = Video-Rate)
wide field!
Purpose
Methods
Results
Conclusions
PubMed and Cochrane Library Databases February 2006 to April 2018
Outline
708 articlesInclusion criteria:- SD-OCT was the technology - RNFL, optic nerve, macula- original research- SD-OCT & glaucoma diagnosis- adult subjects- at least 125 patientsExclusion criteria:- reproducibility- progression- level III evidence
Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K, Radhakrishnan S, Takusagawa H, Chen PP. Spectral Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018;125:1817‐1827.
Outline
Purpose
Methods
Results
Conclusions
PubMed and Cochrane Library Databases February 2006 to April 2018
708 articlesInclusion criteria:- original research- SD-OCT was the technology - RNFL, optic nerve, macula- SD-OCT & glaucoma diagnosis- adult subjects- at least 125 patientsExclusion criteria:- reproducibility- progression- level III evidence
Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K, Radhakrishnan S, Takusagawa H, Chen PP. Spectral Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018;125:1817‐1827.
Outline
Purpose
Methods
Results
Conclusions
PubMed and Cochrane Library Databases February 2006 to April 2018
708 articlesInclusion criteria:- original research- SD-OCT was the technology - RNFL, optic nerve, macula- SD-OCT & glaucoma diagnosis- adult subjects- at least 125 patientsExclusion criteria:- reproducibility- progression- level III evidence
Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K, Radhakrishnan S, Takusagawa H, Chen PP. Spectral Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018;125:1817‐1827.
Outline
Purpose
Methods
Results
Conclusions
PubMed and Cochrane Library Databases February 2006 to April 2018
Inclusion & exclusion criteria yielded:- 2 level I articles- 57 level II articles
708 articlesInclusion criteria:- original research- SD-OCT was the technology - RNFL, optic nerve, macula- SD-OCT & glaucoma diagnosis- adult subjects- at least 125 patientsExclusion criteria:- reproducibility- progression- level III evidence
Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K, Radhakrishnan S, Takusagawa H, Chen PP. Spectral Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018;125:1817‐1827.
Outline
Purpose
Methods
Results
Conclusions
Many different SD‐OCT machines
Spectralis
Spectral OCT SLO
SOCT Copernicus
Bioptigen
RTVue
Cirrus
Topcon3D OCT
time domain
OCT
• Cirrus HD-OCT (Carl Zeiss Meditec, Inc, Dublin, California)
• RTVue (Optovue, Inc, Fremont, California)
• Spectralis SD-OCT (Heidelberg Engineering GmbH, Heidelberg, Germany)
• 3D-OCT (Topcon Medical Systems, Inc, Paramus, New Jersey)
• Bioptigen Envisu SD-OCT (Bioptigen, Inc, Research Triangle Park, North Carolina)
• SOCT Copernicus HR (Optopol Technology, SA, Zawiercie, Poland)
Many SD-OCT machines
Spectralis
Spectral OCT SLO
SOCT Copernicus
Bioptigen
RTVue
Cirrus
Topcon3D OCT
Many SD-OCT machines
• Cirrus HD-OCT (Carl Zeiss Meditec, Inc, Dublin, California)
• RTVue (Optovue, Inc, Fremont, California)
• Spectralis SD-OCT (Heidelberg Engineering GmbH, Heidelberg, Germany)
• 3D-OCT (Topcon Medical Systems, Inc, Paramus, New Jersey)
time domain
OCT
Spectralis
Spectral OCT SLO
SOCT Copernicus
Bioptigen
RTVue
Cirrus
Topcon3D OCT
SDOCT machines appear to have similar clinical diagnostic abilities1-4
1. Akashi et al. IOVS 2013;54(7):4478-4484.2. Akashi et al. IOVS 2013;54(9):6025-6032.3. Leite et al. Ophthalmology
2011:118(7):1334-1339.4. Lee, et al. Optom Vis Sci 2011:88(6):751-
758.
• Cirrus HD-OCT (Carl Zeiss Meditec, Inc, Dublin, California)
• RTVue (Optovue, Inc, Fremont, California)
• Spectralis SD-OCT (Heidelberg Engineering GmbH, Heidelberg, Germany)
• 3D-OCT (Topcon Medical Systems, Inc, Paramus, New Jersey)
Many SD-OCT machines
time domain
OCT
Spectralis
Spectral OCT SLO
SOCT Copernicus
Bioptigen
RTVue
Cirrus
Topcon3D OCT
RNFL thickness values between machines are not interchangeable1
1. Lee, et al. Optom Vis Sci 2011;88(6):751-758.
2. Seibold, et al. Am J Ophthalmol2010;150(6):807-814.
• Cirrus HD-OCT (Carl Zeiss Meditec, Inc, Dublin, California)
• RTVue (Optovue, Inc, Fremont, California)
• Spectralis SD-OCT (Heidelberg Engineering GmbH, Heidelberg, Germany)
• 3D-OCT (Topcon Medical Systems, Inc, Paramus, New Jersey)
Many SD-OCT machines
time domain
OCT
Stratus Cirrus Spectralis
Artifacts in OCT Imaging
110.1 ± 12.8 98.7 ± 10.9 106.6 ± 12.8
RTVue
112.8± 13.2
Comparison of RNFL Thickness in Normal Eyes Using TDOCT and SDOCT. Leonard Seibold, Naresh Mandava, Malik Kahook. Am J Ophthalmol 2010.
40 normals
RNFL values are not interchangeable for different SDOCT machines…
Many SD-OCT machines
RNFL “thinning” due to different SDOCT machines…
Stratus Cirrus Spectralis
2009 2013 2014
∼ 104 microns ∼ 97 microns ∼ 105 microns
Many SD-OCT machines
different signal strength range
SDOCT Machine Scan Quality Index
Cirrus HD-OCT Signal Strength > 6 (max. 10)
RTVue Signal Strength Index (SSI) ≥ 30 (max. 100)
3D-OCT Image quality > 45 (max. 160)
Spectralis SD-OCT Quality (Q) > 15 (max. 40)
Many SD-OCT machines
Effect of Corneal Drying on Optical Coherence Tomography. Daniel Stein, Gadi Wollstein, Hiroshi Ishikawa, Ellen Hertzmark, Robert Noecker, Joel Schuman. Ophthalmology 2006; 113: 985-991.
Artifacts in OCT ImagingMany SD-OCT machinesdifferent normative databases
Outline
Purpose
Methods
Results
Conclusions
Similar diagnostic data
Different machines…
RNFL values not interchangeablesignal strength rangesnormative databasessoftware
Many different SD‐OCT machines
RNFL optic nerve macula
SD-OCT Software Differences
RNFL optic nerve macula
most commonly used
Table 1.3.4mm to 3.46 mm diameter scan circle
SD-OCT Software Differences
RNFL optic nerve macula
most commonly used
Table 1.3.4mm to 3.46 mm diameter scan circle
SD-OCT Software Differences
● Spectralis Glaucoma Module Premium Edition (GMPE)FDA approved in 2016
● RNFL scan protocol:● 12°/14°/16° arc● centered over BMO● 3.5 mm, 4.1 mm, and 4.65 mm*
* Gmeiner et al. IOVS 2016;57(9):575‐584.
RNFL optic nerve macula
SD-OCT Software Differences
● Spectralis Glaucoma Module Premium Edition (GMPE)FDA approved in 2016
● RNFL scan protocol:● 12°/14°/16° arc● centered over BMO● 3.5 mm, 4.1 mm, and 4.65 mm*
* Gmeiner et al. IOVS 2016;57(9):575‐584.
RNFL optic nerve macula
SD-OCT Software Differences
RNFL optic nerve macula
Table 1.reference plane vs. reference plane independent
SD-OCT Software Differences
● reference plane independent parameters○ Spectralis – BMO‐MRW
old way new way
AGS 2004
Software 2D 3D
● reference plane dependent parameterso Cirrus ‐ 200 microns above RPE
o RTVue – 150 microns above RPE
o 3D OCT – 120 microns above RPE
SD-OCT Software Differencesoptic nerve
● reference plane independent parameters
Chen TC, Zeng A, Sun W, Mujat M, de Boer JF. Spectral Domain Optical Coherence Tomography in Glaucoma. International Ophthalmology Clinics 2008 Fall; 48 (4): 29‐45.
Chen TC. Trans Am Oph Soc 2009;107:254‐81.
old way new way● reference plane dependent parameterso Cirrus ‐ 200 microns above RPE
o RTVue – 150 microns above RPE
o 3D OCT – 120 microns above RPE
SD-OCT Software Differencesoptic nerve
● reference plane independent parameters
…better than reference plane parametersChauhan et al. Ophthalmology 2013.Tsikata et al. IOVS 2016.
old way new way● reference plane dependent parameterso Cirrus ‐ 200 microns above RPE
o RTVue – 150 microns above RPE
o 3D OCT – 120 microns above RPE
SD-OCT Software Differencesoptic nerve
minimum distance band (MDB)
BMO‐MRW
minimum circumpapillary band (MCB)
MDB (16 eyes)area and thicknessRPE/BM complex (193 raster lines)(Chen, Int Oph Clinics 2008Chen, Trans Am Oph Soc 2009)
MCB (3 eyes)areaElschnig’s ring (60 raster lines)(Povazay, JBO 2007)
BMO‐MRW (155 patients)area and widthBMO (24 radial lines)(Chauhan, Ophthalmol 2013)
REFERENCE PLANE INDEPENDENT PARAMETERS
reference plane independent neuroretinal rim parameter
RNFL
Spectral Domain OCToptic nerve macula
RNFL
Spectral Domain OCToptic nerve macula
3D OCTGCCGCIPLNFLSpectralisTotal retina thickness
NFL: Nerve fiber layer (ganglion cells axons)GCL: Ganglion Cell Layer (ganglion cells bodies)IPL: Inner Plexiform Layer (ganglion cells dendrites)Retina: total retinal thickness
RTVueGCC: Ganglion Cell Complex = NFL + GCL + IPL
Cirrus GCA: Ganglion Cell AnalysisGCC = NFL + GCL + IPLGCIPL = GCL + IPL
Spectral Domain OCToptic nerve macula
diagram from Akashi et al. IOVS 2013
Spectralis Glaucoma Module Premium Edition (GMPE)GMPE FDA approved in 2016
Posterior Pole Asymmetry Analysis (PPAA)● 8 X 8 array or superpixel 3°X3°● 30°X25° volume scan● 61 horizontal Bscans (120 microns apart)
Miraftabi et al TVST 2016
ganglion cell thickness maps
Miraftabi, Amini, Morales, Henry, Yu, Afifi, Coleman, Caprioli, Nouri‐Mahdavi. IOVS 2016.
“Measuring GCL does not provide any advantage for detection of progression with current SD‐OCT technology”
Outline
Purpose
Methods
Results
Conclusions
Similar diagnostic data
Different machines…
RNFL values not interchangeablesignal strength rangesnormative databasessoftware
Many different SD‐OCT machines
Outline
Purpose
Methods
Results
Conclusions
similar across machines
Outline
Purpose
Methods
Results
Conclusions
similar across machines location severe disease signal strength
Cirrus
RTVueSpectralis3D OCT
Outline
Purpose
Methods
Results
Conclusions Accuracy of a test is quantified by AUROC:
AUROC = 1 is a perfect testAUROC = 0.5 uninformative test
Excellent test (AUROC 0.90 – 1.0)Good test (AUROC 0.80 – 0.90)Fair test (AUROC 0.70 – 0.80)Poor test (AUROC 0.60 – 0.70)
similar across machines
Cirrus
RTVueSpectralis3D OCT
Cirrus and Glaucoma
RNFL optic nerve macula
Cirrus
global or average RNFL can distinguish normal from glaucoma patientsAUROC 0.677 – 0.969 (poor to excellent)
inferior and superior quadrants bestinferior quadrant AUROC 0.686 – 0.963 (poor to excellent)superior quadrant AUROC 0.601 – 0.944 (poor to excellent)
better diagnostic ability for worse disease severitypre‐perimetric glaucoma AUROC 0.752 – 0.860 (fair to good)advanced glaucoma AUROC 0.936 – 0.981 (excellent)
26 articles studied Cirrus RNFL thickness:
RNFL optic nerve macula
Cirrus
Cirrus SD‐OCT same or better AUROC curves Cirrus SD‐OCT had better resolution (i.e. 5 versus 10 microns)Cirrus SD‐OCT had faster acquisition speedsCirrus SD‐OCT had better signal strength
poor signal strength (1.0% of Cirrus versus 23% of Stratus scans)Cirrus SD‐OCT had less measurement variability
COV (< 6.4% for Cirrus and < 12.8% for Stratus)Cirrus has added advantage of RNFL thickness deviation maps
size, shape, depth, location, disc margin distance
Studies comparing Cirrus SD‐OCT versus Stratus TD‐OCT RNFL thickness:
RNFL optic nerve macula
Cirrus
8 articles studied Cirrus disc parameters:
Rim areaDisc areaAverage cup‐to‐disc ratioVertical cup‐to‐disc ratio Cup volume
RNFL optic nerve macula
Cirrus
8 articles studied Cirrus disc parameters:
Rim area AUROC 0.655 – 0.960 (poor to excellent)Disc areaAverage cup‐to‐disc ratioVertical cup‐to‐disc ratio AUROC 0.400 – 0.962 (uninformative to excellent)Cup volume
RNFL optic nerve macula
Cirrus
8 articles studied Cirrus disc parameters:
Rim area AUROC 0.655 – 0.960 (poor to excellent)Disc areaAverage cup‐to‐disc ratioVertical cup‐to‐disc ratio AUROC 0.400 – 0.962 (uninformative to excellent)Cup volume
better diagnostic ability for worse disease severityadvanced glaucoma ‐ rim area AUROC 0.937 (excellent)advanced glaucoma – vertical cup‐to‐disc ratio AUROC 0.911‐0.941 (excellent)
RNFL optic nerve macula
Cirrus
14 articles studied Cirrus macular parameters best parameters were…
Minimum GCIPL AUROC 0.702 – 0.980 (fair to excellent)Inferior temporal GCIPL AUROC 0.752 – 0.970 (fair to excellent)Average GCIPL AUROC 0.703 – 0.960 (fair to excellent)Inferior GCIPL thickness AUROC 0.702 – 0.950 (fair to excellent)Superior temporal GCIPL thickness AUROC 0.652 – 0.932 (poor to excellent)Average GCC AUROC 0.901 – 0.945 (excellent)Inferior temporal GCC AUROC 0.922 (excellent)Superior temporal GCC AUROC 0.910 (excellent)Inferior GCC AUROC 0.904 – 0.908 (excellent)
macula
Cirrus
13 articles studied Cirrus combined parameters:
Most studies suggest that best macular, RNFL, and disc parameters are similar
One study suggested that macular inferior temporal GCIPL was better than inferior RNFL for discriminating myopic glaucoma from myopia alone
(0.752 vs. 0.686 p = 0.036)
optic nerveRNFL
RTVue and Glaucoma
RNFL optic nerve macula
RTVue
19 articles studied RTVue RNFL thickness:
average RNFL best for distinguishing normal from glaucoma patientsAUROC 0.828 – 0.977 (good to excellent)
inferior and superior quadrants next bestinferior quadrant AUROC 0.823 – 0.982 (good to excellent)superior quadrant AUROC 0.805 – 0.944 (good to excellent)
RNFL optic nerve macula
RTVue
19 articles studied RTVue RNFL thickness:
better diagnostic ability for worse disease severitypre‐perimetric glaucoma AUROC 0.720 – 0.820 (fair to good)advanced glaucoma AUROC 0.936 – 0.977 (excellent)
better diagnostic data with improved signal strength index (SSI)SSI ≥ 30 AUROC 0.678 – 0.890 (fair to good)SSI ≥ 70 AUROC 0.962 – 0.994 (excellent)
RNFL optic nerve macula
RTVue
Cup area Disc areaRim areaRim volumeNerve head volumeCup volumeCup disc area ratioHorizontal cup‐to‐disc ratioVertical cup‐to‐disc ratio
8 articles studied RTVue disc parameters:
RNFL optic nerve macula
RTVue
Cup area Disc areaRim area AUROC 0.720 – 0.960 (fair to excellent)Rim volumeNerve head volumeCup volumeCup disc area ratioHorizontal cup‐to‐disc ratioVertical cup‐to‐disc ratio AUROC 0.621 – 0.970 (poor to excellent)
8 articles studied RTVue disc parameters:
Inferior
RNFL optic nerve macula
RTVue
Cup area Disc areaRim area AUROC 0.720 – 0.960 (fair to excellent)Rim volumeNerve head volumeCup volumeCup disc area ratioHorizontal cup‐to‐disc ratioVertical cup‐to‐disc ratio AUROC 0.621 – 0.970 (poor to excellent)
8 articles studied RTVue disc parameters:
Inferior
RNFL optic nerve macula
RTVue
articles studied RTVue disc parameters:
rim area diagnostic data increased as disease severity increased
rim area has better diagnostic data for perimetric glaucoma with improved SSIrim area (SSI ≥ 30) AUROC 0.651 – 0.747 (poor to fair)rim area (SSI ≥ 70) AUROC 0.873 – 0.922 (good to excellent)
RNFL optic nerve macula
RTVue
19 articles studied RTVue macular parameters:
average GCC thickness best for distinguishing normal from glaucoma patientsAUROC 0.642 – 0.957 (poor to excellent)
inferior GCC thickness next bestAUROC 0.743 – 0.949 (fair to excellent)
RNFL optic nerve macula
RTVue
19 articles studied RTVue macular parameters:
GCC thickness with better diagnostic ability for worse disease severitypre‐perimetric glaucoma AUROC 0.720 – 0.780 (fair)advanced glaucoma AUROC 0.916 (excellent)
better diagnostic data for perimetric glaucoma with improved SSIaverage GCC thickness (SSI ≤ 30) AUROC 0.726 – 0.873 (fair to good)average GCC thickness (SSI ≤ 70) AUROC 0.886 – 0.959 (good to excellent)
RNFL optic nerve macula
RTVue
2 articles studied RTVue macular parameters:
Suggested that macular parameters provide better diagnostic data vs. RNFL thicknessi.e. AUROC does not decrease with high myopiaRNFL thickness AUROC 0.939 vs. 0.827 (excellent versus good)GCC thickness AUROC 0.933 vs. 0.935 (excellent)
macula
8 articles studies compared RNFL vs. disc vs. macular parameters:
Most studies (6 of 8) suggest that best RNFL, disc, and macular parameters are similar
optic nerveRNFL
RTVue
Spectralis and Glaucoma
RNFL optic nerve macula
Spectralis
● RNFL thickness scan● most common scan● 12° arc● 3.45 mm circle for typical axial length● with tracking
● GMPE scan protocol:● 12°/14°/16° arc● centered over BMO● 3.5 mm, 4.1 mm, and 4.65 mm*
* Gmeiner et al. IOVS 2016;57(9):575‐584.
RNFL optic nerve macula
Spectralis
Global RNFL thickness AUROC 0.880 – 0.978 (good to excellent)Inferior RNFL thickness AUROC 0.850 – 0.958 (good to excellent)Superior RNFL thickness AUROC 0.880 – 0.936 (good to excellent)Temporal‐inferior RNFL thickness AUROC 0.855 – 0.959 (good to excellent)Temporal‐superior RNFL thickness AUROC 0.803 – 0.951 (good to excellent)
12 articles studied Spectralis RNFL parameters best parameters were…
RNFL optic nerve macula
Spectralis
BMO‐MRW (24 radial line scan) AUROC 0.929 – 0.960 (excellent)
Unclear if BMO‐MRW better than RNFL thickness
RNFL optic nerve macula
Spectralis
MDB (high‐density 193 raster scan)
MDB better than RNFL thickness, especially…nasal regiontemporal regioninferonasal regionsuperonasal region
2 studies suggest that BMO‐MRW and MDB thicknessbetter than rim area and thickness
RNFL optic nerve macula
Spectralis
inferior macular retina thickness bestAUROC 0.858 (good)
Topcon 3D OCT and Glaucoma
RNFL macula
3D OCT-1000 or 3D OCT-2000optic nerve
4 articles studied 3D OCT‐1000 or 3D OCT‐2000 parameters:
Best RNFL thickness parameters for distinguishing normal from glaucoma patientsaverage or global RNFL AUROC 0.890 – 0.974 (good to excellent)inferior RNFL AUROC 0.909 – 0.964 (excellent)superior RNFL AUROC 0.826 – 0.909 (good to excellent)
Best macular parametersaverage GC/IPL AUROC 0.830 – 0.954 (good to excellent)average GCC AUROC 0.872 – 0.968 (good to excellent)inferior GC/IPL AUROC 0.856 – 0.954 (good to excellent)inferior GCC AUROC 0.888 – 0.969 (good to excellent)
Outline
Purpose
Methods
Results
Conclusions
SD‐OCT important tool for glaucoma SD‐OCT > TD‐OCT
resolution acquisition speed scan quality (signal strength) inter‐test variability RNFL thickness maps
Different SD‐OCT machines have similar abilities to distinguish between normal & glaucoma patients
Values between machines are not interchangeable
Outline
Purpose
Methods
Results
Conclusions
Better AUROC values for… greater disease severity better signal strength
Diagnosis(RNFL ~ macula ~ disc) maybe macula for myopes
Combining parameters improves diagnostic performance
Outline
Purpose
Methods
Results
Conclusions
Most important parameters …1) RNFL thickness2) Macula
• GCC • GC/IPL
3) Disc• rim area• vertical cup‐disc ratio
Most important regions … average inferior & superior inferior temporal & superior temporal
OCT Diseasesthat should always be correlated with clinical dataSDOCT has a lot of great information…
Harvard Foundation Grant (Fidelity Charitable Fund)National Institutes of Health - RO1 EY14975-01
Harvard CatalystAmerican Glaucoma Society Mid-Career AwardMassachusetts Lions Eye Research Fund, Inc.
Department of Defense SBIR
Massachusetts General Hospital
and VU University• Johannes de Boer, PhD
• B. Hyle Park, PhD
• Mircea Mujat, PhD
• Vivek Srinivasan, PhD
• Barry Cense, PhD
• Gary Tearney, PhD
• Brett Bouma, PhD
• Mark Pierce, PhD
• Wei Sun, BS
• Vivek Srinivasan, PhD
• Ben Vakoc, PhD
Massachusetts Eye and Ear Infirmary• Kayoung Yi, MD, PhD• Edem Tsikata, PhD• Alice Vercellin Verticchio, MD• John B. Miller, MD• Iryna Falkenstein, MD• Linda Yi-Chieh Poon, MD• Stacey Brauner, MD• Ziad Khoueir, MD• Derrick T. Lin, MD• Daniel Deschler, MD• Peter A.D. Rubin, MD• Mark Latina, MD• Joan W. Miller, MD
THANKS
Outline
Purpose
Methods
Results
Conclusions
Pictures from Carl Zeiss Meditec, Inc
Limitations of Time Domain OCT
Video Rate Spectral Domain OCT
2D 3Dpictures courtesy Mary Beth Cunnane, MD
OCT Terminology
(A-line) (frame)C-mode
Video Rate Spectral Domain OCT
B-scan
2D 3D1DA-scan
● Shieh et al. AJO 2016.● Tsikata et al. IOVS 2016.● Fan et al. Journal of Glaucoma 2017.
2D 3Dbest disc parameters:global rim areainferior rim areavertical cup-to-disc ratio
best disc parameters:MDB
Software 2D 3D
2D 3Dbest disc parameters:global rim areainferior rim areavertical cup-to-disc ratio
best disc parameters:MDB
● Shieh et al. AJO 2016.● Tsikata et al. IOVS 2016.● Fan et al. Journal of Glaucoma 2017.
Software 2D 3D
2D 3Dbest disc parameters:global rim areainferior rim areavertical cup-to-disc ratio
best disc parameters:MDBBMO-MRW
● Shieh et al. AJO 2016.● Tsikata et al. IOVS 2016.● Fan et al. Journal of Glaucoma 2017.
Software 2D 3D
2D 3Dbest disc parameters:global rim areainferior rim areavertical cup-to-disc ratio
best disc parameters:MDBBMO-MRWrim volume
● Shieh et al. AJO 2016.● Tsikata et al. IOVS 2016.● Fan et al. Journal of Glaucoma 2017.
Software 2D 3D
minimum distance band (MDB)
rim width ‐ RW
minimum circumpapillary band (MCB)
MDB (16 eyes)area and thicknessRPE/BM complex (193 raster lines)(Chen, Int Oph Clinics 2008Chen, Trans Am Oph Soc 2009)
MCB (3 eyes)areaElschnig’s ring (60 raster lines)(Povazay, JBO 2007)
RW (9 monkeys)area and widthBMO (80 radial lines)(Strouthidis, IOVS 2011)
REFERENCE PLANE INDEPENDENT PARAMETERS
minimum distance band (MDB)
rim width ‐ RW
minimum circumpapillary band (MCB)
MDB (16 eyes)area and thicknessRPE/BM complex (193 raster lines)(Chen, Int Oph Clinics 2008Chen, Trans Am Oph Soc 2009)
MCB (3 eyes)areaElschnig’s ring (60 raster lines)(Povazay, JBO 2007)
RW (9 monkeys)area and widthBMO (80 radial lines)(Strouthidis, IOVS 2011)
REFERENCE PLANE INDEPENDENT PARAMETERS
minimum distance band (MDB)
rim width ‐ RW
minimum circumpapillary band (MCB)
MDB (16 eyes)area and thicknessRPE/BM complex (193 raster lines)(Chen, Int Oph Clinics 2008Chen, Trans Am Oph Soc 2009)
MCB (3 eyes)areaElschnig’s ring (60 raster lines)(Povazay, JBO 2007)
RW (9 monkeys)area and widthBMO (80 radial lines)(Strouthidis, IOVS 2011)
REFERENCE PLANE INDEPENDENT PARAMETERS
minimum distance band (MDB)
rim width ‐ RW
minimum circumpapillary band (MCB)
MDB (16 eyes)area and thicknessRPE/BM complex (193 raster lines)(Chen, Int Oph Clinics 2008Chen, Trans Am Oph Soc 2009)
MCB (3 eyes)areaElschnig’s ring (60 raster lines)(Povazay, JBO 2007)
RW (9 monkeys)area and widthBMO (80 radial lines)(Strouthidis, IOVS 2011)
REFERENCE PLANE INDEPENDENT PARAMETERS
disc photos
HVF
minimum distance band (MDB)
rim width ‐ RW
minimum circumpapillary band (MCB)
MDB (16 eyes)area and thicknessRPE/BM complex (193 raster lines)(Chen, Int Oph Clinics 2008Chen, Trans Am Oph Soc 2009)
MCB (3 eyes)areaElschnig’s ring (60 raster lines)(Povazay, JBO 2007)
RW (9 monkeys)area and widthBMO (80 radial lines)(Strouthidis, IOVS 2011)
REFERENCE PLANE INDEPENDENT PARAMETERS