Reliability for Nerve Fiber Layer Reflectance Using Spectral Domain Optical Coherence Tomography

TL;DR

This study assesses the reliability of nerve fiber layer reflectance measurements using spectral domain OCT, comparing normalization methods and evaluating repeatability and diagnostic accuracy in healthy and glaucoma eyes.

Contribution

It introduces and compares various normalization techniques for NFL reflectance in spectral domain OCT and evaluates their repeatability and diagnostic performance.

Findings

NFL reflectance normalized by Post-NFL-Bright showed the best diagnostic accuracy.

Normalization by PPEC Max and Post-NFL-Bright had the lowest dependence on attenuation.

All metrics demonstrated similar diagnostic accuracy, with Post-NFL-Bright slightly better.

Abstract

Purpose: Reliability for Nerve Fiber Layer Reflectance Using Spectral Domain Optical Coherence Tomography (OCT) Methods: The study utilized OCT to scan participants with a cubic 6x6 mm disc scan. NFL reflectance were normalized by the average of bands below NFL and summarized. We selected several reference bands, including the pigment epithelium complex (PPEC), the band between NFL and Bruch's membrane (Post-NFL), and the top 50% of pixels with higher values were selected from the Post-NFL band by Post-NFL-Bright. Especially, we also included NFL attenuation coefficient (AC), which was equivalent to NFL reflectance normalized by all pixels below NFL. An experiment was designed to test the NFL reflectance against different levels of attenuation using neutral density filter (NDF). We also evaluated the within-visit and between-visit repeatability using a clinical dataset with normal and glaucoma eyes. Results: The experiment enrolled 20 healthy participants. The clinical dataset selected 22 normal and 55 glaucoma eyes with at least two visits form functional and structural OCT (FSOCT) study. The experiment showed that NFL reflectance normalized PPEC Max and Post-NFL-Bright had lowest dependence, slope=-0.77 and -1.34 dB/optical density on NDF levels, respectively. The clinical data showed that the NFL reflectance metrics normalized by Post-NFL-Bright or Post-NFL-Mean metrics had a trend of better repeatability and reproducibility than others, but the trend was not significant. All metrics demonstrated similar diagnostic accuracy (0.82-0.87), but Post-NFL-Bright provide the best result. Conclusions: The NFL reflectance normalized by the maximum in PPEC had less dependence of the global attenuation followed by Post-NFL-Bright, PPEC/Mean, Post-NFL-Mean and NFL/AC. But NFL reflectance normalized by Post-NFL-Bright had better result in two datasets.