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Pappelis K, Jansonius NM. Retinal Vessel Caliber Measurement Bias in Fundus Images in the Presence of the Central Light Reflex. Transl Vis Sci Technol 2023; 12:16. [PMID: 37450282 PMCID: PMC10353742 DOI: 10.1167/tvst.12.7.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose To investigate the agreement between a fundus camera and a scanning laser ophthalmoscope in retinal vessel caliber measurements and to identify whether the presence of the central light reflex (CLR) explains potential discrepancies. Methods For this cross-sectional study, we obtained fundus camera and scanning laser ophthalmoscope images from 85 eyes of 85 healthy individuals (aged 50-65 years) with different blood pressure status. We measured the central retinal artery equivalent (CRAE) and central retinal artery vein equivalent (CRVE) with the Knudtson-Parr-Hubbard algorithm and assessed the CLR using a semiautomatic grading method. We used Bland-Altman plots, 95% limits of agreement, and the two-way mixed effects intraclass correlation coefficient for consistency [ICC(3,1)] to describe interdevice agreement. We used multivariable regression to identify factors associated with differences in between-device measurements. Results The between-device difference in CRAE (9.5 µm; 95% confidence interval, 8.0-11.1 µm) was larger than the between-device difference in CRVE (2.9 µm; 95% confidence interval, 1.3-4.5 µm), with the fundus camera yielding higher measurements (both P < 0.001). The 95% fundus camera-scanning laser ophthalmoscope limits of agreement were -4.8 to 23.9 µm for CRAE and -12.0 to 17.8 µm for CRVE. The corresponding ICCs(3,1) were 0.89 (95% confidence interval, 0.83-0.92) and 0.91 (95% confidence interval, 0.86-0.94). The between-device CRAE difference was positively associated with the presence of a CLR (P = 0.002). Conclusions Fundus cameras and scanning laser ophthalmoscopes yield correlated but not interchangeable caliber measurements. The CLR induces bias in arteriolar caliber in fundus camera images, compared with scanning laser ophthalmoscope images. Translational Relevance Refined measurements could yield better estimates of the association between retinal vessel caliber and ophthalmic or systemic disease.
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Affiliation(s)
- Konstantinos Pappelis
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Graduate School of Medical Sciences, Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, the Netherlands
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Graduate School of Medical Sciences, Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, the Netherlands
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Heikka T, Jansonius NM. Influence of signal‐to‐noise ratio, glaucoma stage and segmentation algorithm on
OCT
usability for quantifying layer thicknesses in the peripapillary retina. Acta Ophthalmol 2022; 101:251-260. [PMID: 36331147 DOI: 10.1111/aos.15279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE OCT can be used for glaucoma assessment, but its usefulness may depend on image quality, disease stage and segmentation algorithm. We aimed to determine how layer thicknesses as assessed with different algorithms depend on image quality and disease stage, how reproducible the algorithms are, and if the algorithms (dis)agree. METHODS Optic disc OCT data (Canon OCT-HS100) from 20 healthy subjects and 28 early, 29 moderate, and 23 severe glaucoma patients were assessed with four different algorithms (CANON, IOWA, FWHM, DOCTRAP). We measured retinal nerve fibre layer thickness (RNFLT) and total retinal thickness (TRT) along the 1.7-mm-radius OCT measurement circle centred at the optic disc. In healthy subjects, image quality was degraded with neutral density filters (0.3-0.9 optical density [OD]); three scans were made to assess repeatability. Results were analysed with ANOVA with Bonferroni corrected t-tests for post hoc analysis and with intraclass correlation coefficient (ICC) analysis. RESULTS For all algorithms, RNFLT was more sensitive to image quality than TRT. Both RNFLT and TRT showed differences between healthy and glaucoma (all algorithms p < 0.001 for both RNFLT and TRT) and between early and moderate glaucoma (RNFLT: p = 0.001 to p = 0.09; TRT: p < 0.001 to p = 0.03); neither was able to discriminate between moderate and severe glaucoma (p = 0.08 to p = 1.0). Generally, repeatability was excellent (ICC >0.75); agreement between algorithms varied from moderate to excellent. CONCLUSIONS OCT becomes less informative with glaucoma progression, irrespective of the algorithm. For good-quality scans, RNFLT and TRT perform similarly; TRT may be advantageous with poor image quality.
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Affiliation(s)
- Tuomas Heikka
- Department of Ophthalmology, University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - Nomdo M. Jansonius
- Department of Ophthalmology, University of Groningen University Medical Center Groningen Groningen The Netherlands
- Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences) University of Groningen Groningen The Netherlands
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Rapid Objective Testing of Visual Function Matched to the ETDRS Grid and Its Diagnostic Power in Age-Related Macular Degeneration. OPHTHALMOLOGY SCIENCE 2022; 2:100143. [PMID: 36249701 PMCID: PMC9559873 DOI: 10.1016/j.xops.2022.100143] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/17/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
Abstract
Purpose To study the power of an 80-second multifocal pupillographic objective perimetry (mfPOP) test tailored to the ETDRS grid to diagnose age-related macular degeneration (AMD) by Age-Related Eye Disease Study (AREDS) severity grade. Design Evaluation of a diagnostic technology. Methods We compared diagnostic power of acuity, ETDRS grid retinal thickness data, new 80-second M18 mfPOP test, and two wider-field 6-minute mfPOP tests (Macular-P131, Widefield-P129). The M18 stimuli match the size and shape of bifurcated ETDRS grid regions, allowing easy structure–function comparisons. M18, P129, and P131 stimuli test both eyes concurrently. We recruited 34 patients with early-stage AMD with a mean ± standard deviation (SD) age of 72.6 ± 7.06 years. The M18 and P129 plus P131 stimuli had 26 and 51 control participants, respectively with mean ± SD ages of 73.1 ± 8.17 years and 72.1 ± 5.83 years, respectively. Multifocal pupillographic objective perimetry testing used the Food and Drug Administration-cleared Objective FIELD Analyzer (OFA; Konan Medical USA). Main Outcome Measures Percentage area under the receiver operator characteristic curve (AUC) and Hedge’s g effect size. Results Acuity and OCT ETDRS grid thickness and volume produced reasonable diagnostic power (percentage AUC) for AREDS grade 4 eyes at 83.9 ± 9.98% and 90.2 ± 6.32% (mean ± standard error), respectively, but not for eyes with less severe disease. By contrast, M18 stimuli produced percentage AUCs from 72.8 ± 6.65% (AREDS grade 2) to 92.9 ± 3.93% (AREDS grade 4), and 82.9 ± 3.71% for all eyes. Hedge’s g effect sizes ranged from 0.84 to 2.32 (large to huge). Percentage AUC for P131 stimuli performed similarly and for P129 performed somewhat less well. Conclusions The rapid and objective M18 test provided diagnostic power comparable with that of wider-field 6-minute mfPOP tests. Unlike acuity or OCT ETDRS grid data, OFA tests produced reasonable diagnostic power in AREDS grade 1 to 3 eyes.
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Montesano G, Ometto G, Higgins BE, Iester C, Balaskas K, Tufail A, Chakravarthy U, Hogg RE, Crabb DP. Structure-Function Analysis in Macular Drusen With Mesopic and Scotopic Microperimetry. Transl Vis Sci Technol 2021; 9:43. [PMID: 33442497 PMCID: PMC7774115 DOI: 10.1167/tvst.9.13.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To investigate the structure–function relationship in eyes with drusen with mesopic and scotopic microperimetry. Methods We analyzed structural and functional data from 43 eyes with drusen. Functional data were acquired with mesopic and scotopic two-color (red and cyan) microperimetry. Normative values were calculated using data from 56 healthy eyes. Structural measurements were green autofluorescence and dense macular optical coherence tomography scans. The latter were used to calculate the retinal pigment epithelium elevation (RPE-E) and the photoreceptor reflectivity ratio (PRR). The pointwise structure–function relationship was measured with linear mixed models having the log-transformed structural parameters as predictors and the sensitivity loss (SL, deviation from normal) as the response variable. Results In the univariable analysis, the structural predictors were all significantly correlated (P < 0.05) with the SL in the mesopic and scotopic tests. In a multivariable model, mesopic microperimetry yielded the best structure–function relationship. All predictors were significant (P < 0.05), but the predictive power was weak (best R2 = 0.09). The relationship was improved when analyzing locations with abnormal RPE-E (best R2 = 0.18). Conclusions Mesopic microperimetry shows better structure–function relationship compared to scotopic microperimetry; the relationship is weak, likely due to the early functional damage and the small number of tested locations affected by drusen. The relationship is stronger when locations with drusen are isolated for the mesopic and scotopic cyan test. Translational Relevance These results could be useful to devise integrated structure–function methods to detect disease progression in intermediate age-related macular degeneration.
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Affiliation(s)
- Giovanni Montesano
- City, University of London-Optometry and Visual Sciences, London, UK.,NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Giovanni Ometto
- City, University of London-Optometry and Visual Sciences, London, UK.,NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Bethany E Higgins
- City, University of London-Optometry and Visual Sciences, London, UK
| | - Costanza Iester
- City, University of London-Optometry and Visual Sciences, London, UK
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Usha Chakravarthy
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - David P Crabb
- City, University of London-Optometry and Visual Sciences, London, UK
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Heikka T, Cense B, Jansonius NM. Retinal layer thicknesses retrieved with different segmentation algorithms from optical coherence tomography scans acquired under different signal-to-noise ratio conditions. BIOMEDICAL OPTICS EXPRESS 2020; 11:7079-7095. [PMID: 33408981 PMCID: PMC7747907 DOI: 10.1364/boe.399949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 05/13/2023]
Abstract
Glaucomatous damage can be quantified by measuring the thickness of different retinal layers. However, poor image quality may hamper the accuracy of the layer thickness measurement. We determined the effect of poor image quality (low signal-to-noise ratio) on the different layer thicknesses and compared different segmentation algorithms regarding their robustness against this degrading effect. For this purpose, we performed OCT measurements in the macular area of healthy subjects and degraded the image quality by employing neutral density filters. We also analysed OCT scans from glaucoma patients with different disease severity. The algorithms used were: The Canon HS-100's built-in algorithm, DOCTRAP, IOWA, and FWHM, an approach we developed. We showed that the four algorithms used were all susceptible to noise at a varying degree, depending on the retinal layer assessed, and the results between different algorithms were not interchangeable. The algorithms also differed in their ability to differentiate between young healthy eyes and older glaucoma eyes and failed to accurately separate different glaucoma stages from each other.
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Affiliation(s)
- Tuomas Heikka
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barry Cense
- Department of Mechanical Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Optical+Biomedical Engineering Laboratory, Department of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley, WA, Australia
| | - Nomdo M. Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Heikka T, Ometto G, Montesano G, Rowe S, Jansonius NM, Crabb DP. Testing a phantom eye under various signal-to-noise ratio conditions using eleven different OCT devices. BIOMEDICAL OPTICS EXPRESS 2020; 11:1306-1315. [PMID: 32206411 PMCID: PMC7075602 DOI: 10.1364/boe.383103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 05/05/2023]
Abstract
We compared eleven OCT devices in their ability to quantify retinal layer thicknesses under different signal-strength conditions, using a commercially available phantom eye. We analyzed a medium-intensity 50 µm layer in an identical manner for all devices, using the provided log-scale images and a reconstructed linear-scale tissue reflectivity metric. Thickness measurements were highly comparable when the data were analyzed in an identical manner. With optimal signal strength, the thickness of the 50 µm layer was overestimated by a mean of 4.3 µm in the log-scale images and of 2.7 µm in the linear-scale images.
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Affiliation(s)
- Tuomas Heikka
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Contributed equally
| | - Giovanni Ometto
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
- Moorfields Eye Hospital, London, UK
- Contributed equally
| | - Giovanni Montesano
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
- Moorfields Eye Hospital, London, UK
| | - Scott Rowe
- Rowe Technical Design, Inc. Dana Point, CA 92629, USA
| | - Nomdo M. Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David P. Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
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Impact of surface micromorphology and demineralization severity on enamel loss measurements by cross-polarization optical coherence tomography. J Dent 2019; 81:52-58. [DOI: 10.1016/j.jdent.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/21/2018] [Accepted: 12/17/2018] [Indexed: 11/23/2022] Open
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Qiu K, Wang G, Zhang R, Lu X, Zhang M, Jansonius NM. Influence of optic disc-fovea distance on macular thickness measurements with OCT in healthy myopic eyes. Sci Rep 2018; 8:5233. [PMID: 29588514 PMCID: PMC5869586 DOI: 10.1038/s41598-018-23479-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/29/2018] [Indexed: 02/07/2023] Open
Abstract
Assessment of macular thickness is important in the evaluation of various eye diseases. This study aimed to determine the influence of the optic disc-fovea distance (DFD) on macular thickness in myopic eyes. We determined the DFD and the macular thickness in 138 eyes from 138 healthy myopic subjects using the Cirrus HD-OCT. Correlation analysis and multiple linear regression were performed to determine the influence of DFD, axial length, disc area, and β-PPA on macular thickness. To further remove the confounding effect of ocular magnification on the DFD and OCT scan area, a subgroup analysis was performed in eyes with a limited axial length range (24-25 mm). DFD was significantly correlated with both regional (central, inner, and outer ETDRS subfields) and overall average macular thickness at a Bonferroni corrected P value of 0.004 (r ranging from -0.27 to -0.47), except for the temporal outer (r = -0.15, P = 0.089) and inferior outer (r = -0.22, P = 0.011) macular thickness. In the multivariable analysis, DFD was significantly associated with the average inner and outer macular thickness, the central subfield thickness, and the overall macular thickness (all P < 0.001), independent of ocular magnification and other covariates. Our findings indicate that eyes with a greater DFD have a lower macular thickness.
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Affiliation(s)
- Kunliang Qiu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, The People's Republic of China.,Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geng Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, The People's Republic of China
| | - Riping Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, The People's Republic of China
| | - Xuehui Lu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, The People's Republic of China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, The People's Republic of China.
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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