Dawn Myers

Quality issues in interpretation of optical coherence tomograms in macular diseases.

Purpose: To analyze the scan characteristics associated with poor-quality Stratus optical coherence tomograms submitted to a reading center for multicenter clinical trials. Methods: Data from evaluation of 6,741 fast macular thickness map reports from trials involving age-related macular degeneration (AMD), diabetic macular edema, and retinal vein occlusion were analyzed. Optical coherence tomograms with an erroneous centerpoint thickness needing manual remeasurement (MR) were categorized as being of poor quality. The frequency of MR and the artifacts associated were analyzed by disease type, underlying retinal morphology, and severity of retinal thickening. Results: MR was performed in 2,027 (30%) optical coherence tomograms. AMD had the highest frequency of MR (54.9%), followed by retinal vein occlusion (23.9%) and diabetic macular edema (16.3%). Boundary line errors were the most common artifact across all disease types (61.3% of scans requiring MR) and increased with increasing retinal thickness. Decentration artifact was seen in 15.4% of scans requiring MR. The median absolute difference between machine and manually measured centerpoint thickness assessed in a subset of 84 scans was 75.5 &mgr;m. Conclusion: Artifacts causing erroneous reported centerpoint thickness are common. Identifying clues that indicate suboptimal quality of optical coherence tomography (OCT) images are important to avoid erroneous interpretation of OCT data in clinical trials.

Optical Coherence Tomography Evaluation in the Multicenter Uveitis Steroid Treatment (MUST) Trial

Purpose: To describe the evaluation of optical coherence tomography (OCT) scans in the Muliticenter Uveitis Steroid Treatment (MUST) trial and report baseline OCT features of enrolled participants. Methods: Time-domain OCTs acquired by certified photographers using a standardized scan protocol were evaluated at a reading center. Accuracy of retinal thickness data was confirmed with quality evaluation, and caliper measurement of centerpoint thickness (CPT) was performed when retinal thickness data were unreliable. Morphological evaluation included cysts, subretinal fluid, epiretinal membranes (ERMs), and vitreomacular traction. Results: Of the 453 OCTs evaluated, automated retinal thickness was accurate in 69.5% of scans, caliper measurement was performed in 26%, and 4% were ungradable. Intraclass correlation was.98 for reproducibility of caliper measurement. Macular edema (centerpoint thickness ≥ 240 μm) was present in 36%. Cysts were present in 36.6% of scans and ERMs in 27.8%, predominantly central. Intergrader agreement ranged from 78 to 82% for morphological features. Conclusion: Retinal thickness data can be retrieved in a majority of OCT scans in clinical trial submissions for uveitis studies. Small cysts and ERMs involving the center are common in intermediate and posterior/panuveitis requiring systemic corticosteroid therapy.

Quantitative analysis of the Stratus optical coherence tomography fast macular thickness map reports

The cross sectional optical coherence tomography images have an important role in evaluating retinal diseases. The reports generated by the Stratus fast macular thickness scan protocol are useful for both clinical and research purposes. The centerpoint thickness is an important outcome measure for many therapeutic trials related to macular disease. The data is susceptible to artifacts such as decentration and boundary line errors and could be potentially erroneous. An understanding of how the data is generated is essential before utilizing the data. This article describes the interpretation of the fast macular thickness map report, assessment of the quality of an optical coherence tomography image and identification of the artifacts that could influence the numeric data.