Agreement, repeatability, and reproducibility of quantitative retinal layer assessment using swept-source and spectral-domain optical coherence tomography in eyes with retinal diseases

Optical coherence tomography (OCT) has revolutionized the clinical practice of ophthalmology. It is a noninvasive imaging technique that provides high-resolution, cross-sectional images of the retina, retinal nerve fiber layer and the optic nerve head. This review discusses the present applications of the commercially available spectral-domain OCT (SD-OCT) systems in the diagnosis and management of retinal diseases, with particular emphasis on choroidal imaging. Future directions of OCT technology and their potential clinical uses are discussed. Analysis of the choroidal thickness in healthy eyes and disease states such as age-related macular degeneration, central serous chorioretinopathy, diabetic retinopathy and inherited retinal dystrophies has been successfully achieved using SD-OCT devices with software improvements. Future OCT innovations such as longer-wavelength OCT systems including the swept-source technology, along with Doppler OCT and en-face imaging, may improve the detection of subtle microstructural changes in chorioretinal diseases by improving imaging of the choroid. Advances in OCT technology provide for better understanding of pathogenesis, improved monitoring of progression and assistance in quantifying response to treatment modalities in diseases of the posterior segment of the eye. Further improvements in both hardware and software technologies should further advance the clinician's ability to assess and manage chorioretinal diseases.

Seventy percent of the blood flow to the eye goes to the choroid, a structure that is vitally important to the function of the retina. The in vivo structure of the choroid in health and disease is incompletely visualized with traditional imaging modalities, including indocyanine green angiography, ultrasonography, and spectral domain optical coherence tomography (OCT). Use of new OCT modalities, including enhanced depth imaging OCT, image averaging, and swept-source OCT, have led to increased visualization of the choroidal anatomy. The correlation of these new anatomical findings with other imaging modalities results increases understanding of many eye diseases and recognises of new ones. The status of the choroid appears to be a crucial determinant in the pathogenesis of diseases such as age-related choroidal atrophy, myopic chorioretinal atrophy, central serous chorioretinopathy, chorioretinal inflammatory diseases, and tumors. Extension of these imaging techniques has provided insights into abnormalities of the sclera and optic nerve. Future developments will include blood flow information, 3D rendering of various ocular structures, and the ability to evaluate changes in 3D structural information over time (4D imaging). Copyright © 2013 Elsevier Inc. All rights reserved.

In three dimensional optic disc tomography a reference plane is required to calculate optic disc rim or cup values. The position of the reference plane often depends on the retinal thickness at the temporal disc margin. Originally it was assumed that the retinal thickness at the temporal disc margin is independent of age. The aim of the study was to check this hypothesis using optical coherence tomography, and additionally to determine the reproducibility of OCT measurements in this area. 100 eyes of 100 healthy volunteers were included in this study. Three OCT scans were performed on each eye. The scans were aligned vertically and placed at the temporal edge of the optic disc. For each eye, the thickness of the whole retina as well as the thickness of the retinal nerve fibre layer were calculated together with their coefficients of variation. Thereafter retinal thickness and nerve fibre layer thickness were correlated with age. The mean retinal thickness was 249 (SD 22) micro m. The mean nerve fibre layer thickness was 109 (22) micro m. The mean coefficients of variation were 3.5% (total retinal thickness) and 8.0% (nerve fibre layer thickness). Both the total retinal thickness and the nerve fibre layer thickness were significantly correlated with age (total retina: y = 269.5 - 0.53 x x; R(2) = 0.133; p = 0.0002, nerve fibre layer: y = 126.8 - 0.44 x x; R(2) = 0.094; p<0.0019. Using OCT scans the total retinal thickness can be calculated with high reproducibility (coefficient of variation = 3.5%). The reproducibility of nerve fibre layer thickness measurements is clearly lower (coefficient of variation = 8.0%). Both the total retinal thickness and the nerve fibre layer thickness significantly decrease with age. This influence of the age related decrease in RNFL/retinal thickness on the reference plane, however, is negligible.