Assessing the role of cross‐linked sodium hyaluronate in improving the quality of circumpapillary OCT scans

Abstract

AbstractPurposeAssessment of cross‐linked sodium hyaluronate (XLHA) in improving circumpapillary OCT scan quality and segmentation accuracyMethodsCircumpapillary OCT scans (Heidelberg Spectralis) of prospectively recruited glaucoma clinic patients were assessed. Patients were included if suboptimal image quality was suspected, based on live preview images. Exclusion criteria included severe loss of media clarity due to corneal opacification or dense cataract, adverse reaction to any constituents of the investigative eyedrop, contact lens use, eyedrop use in the preceding two hours, significant imaging artefact, or scanning and segmentation failure. Prior to repeat scanning, within‐patient eyes were randomised to receive topical application of XLHA (VisuXL) or blinking alone as a control group. The objective primary outcome measure was the mean proprietary image quality indicator (QI). Subjectively, masked clinician assessment of image preference was assessed. Global circumpapillary RNFL thickness and the improvement of segmentation errors were secondary outcomes.ResultsSixty‐seven patients (134 eyes) were eligible for analysis with a mean age (±SD) of 69.7 ± 14.4 years, of whom 57% were male and 43% female. Mean baseline QI in the XLHA group was 23.0 ± 4.95, and 23.3 ± 5.04 in the control eyes (p = 0.76). The mean change in QI was +0.28 ± 3.93 in the XLHA eyes, and +0.34 ± 4.01 in the control eyes (p = 0.93). No significant effect on RNFL thickness (p = 0.82), subjective image preference (p = 0.73) or the extent of segmentation errors (p = 0.46) was seen. Post‐hoc analysis revealed baseline QI as a predictor of repeat scan improvement across all groups, with a baseline QI less than 24.5 associated with improvement on repeat scanning (OR 4.49, 95% CI 2.06 – 9.59).ConclusionsRepeat scanning was beneficial with baseline QI below 24.5; however, no evidence was found to support the use of XLHA over blinking to improve repeat OCT scan quality.