Performance Of Optical Coherence Tomography Research Articles

Prediction of OCT images of short-term response to anti-VEGF treatment for diabetic macular edema using different generative adversarial networks.

This study sought to assess the predictive performance of optical coherence tomography (OCT) images for the response of diabetic macular edema (DME) patients to anti-vascular endothelial growth factor (VEGF) therapy generated from baseline images using generative adversarial networks (GANs). Patient information, including clinical and imaging data, was obtained from inpatients at the Ophthalmology Department of Qilu Hospital. 715 and 103 pairs of pre-and post-treatment OCT images of DME patients were included in the training and validation sets, respectively. The post-treatment OCT images were used to assess the validity of the generated images. Six different GAN models (CycleGAN, PairGAN, Pix2pixHD, RegGAN, SPADE, UNIT) were applied to predict the efficacy of anti-VEGF treatment by generating OCT images. Independent screening and evaluation experiments were conducted to validate the quality and comparability of images generated by different GAN models. OCT images generated f GAN models exhibited high comparability to the real images, especially for edema absorption. RegGAN exhibited the highest prediction accuracy over the CycleGAN, PairGAN, Pix2pixHD, SPADE, and UNIT models. Further analyses were conducted based on the RegGAN. Most post-therapeutic OCT images (95/103) were difficult to differentiate from the real OCT images by retinal specialists. A mean absolute error of 26.74±21.28μm was observed for central macular thickness (CMT) between the synthetic and real OCT images. Different generative adversarial networks have different prognostic efficacy for DME, and RegGAN yielded the best performance in our study. Different GAN models yielded good accuracy in predicting the OCT-based response to anti-VEGF treatment at one month. Overall, the application of GAN models can assist clinicians in prognosis prediction of patients with DME to design better treatment strategies and follow-up schedules.

Morphometric Assessment for Functional Evaluation of Coronary Stenosis with Optical Coherence Tomography and the Optical Flow Ratio in a Vessel with Single Stenosis.

Objectives: The study aimed to evaluate the diagnostic performance of optical coherence tomography (OCT) in identifying functionally significant coronary stenosis in a vessel with single stenosis. Background: The OCT-based morphofunctional computational method for deriving the optical flow ratio (OFR) has diagnostic value, as it can identify the functional severity of coronary stenosis, but the ability of the OFR to aid the OCT in determining coronary stenosis hemodynamics in single-stenosis lesion remains unclear. Methods: 74 vessels with single stenosis were studied in 69 patients; all cases were performed through OCT and quantitative flow ratio (QFR), and OCT images were used to perform OFR. Results: Among vessels with single stenosis, OFR showed a good correlation with QFR (r = 0.86; p < 0.001). Taking QFR as the standard, the vessel-level diagnosis accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of OFR were 90% (95% CI: 81 to 96), 94% (95% CI: 77 to 99), 88% (95% CI: 74 to 96), 85% (95% CI: 68 to 94) and 95% (95% CI: 82 to 99), respectively. Among vessels with OFR/QFR concordance, both the minimum lumen area (MLA) and minimum lumen diameter (MLD) showed excellent diagnostic efficiency (MLA: area under the curve (AUC) = 0.92, 95% CI: 0.85 to 0.98, p < 0.001; MLD: AUC = 0.93, 95% CI: 0.86 to 0.98, p < 0.001) in determining the functional significance of coronary stenosis in a single stenosis lesion, and the best cutoff values were 1.55 mm2 and 1.40 mm. Conclusions: OFR has a good correlation with QFR. OCT-measured MLA and MLD have excellent diagnostic efficiency in identifying the hemodynamic significance of coronary stenosis in a vessel with single stenosis.

Diagnostic Performance of Optical Coherence Tomography and Nonspecialist Gonioscopy to Detect Angle Closure.

AimTo compare the usefulness of gonioscopy performed by general ophthalmologists (GO) and anterior segment optical coherence tomography (AS-OCT) in detecting angle closure in patients with a shallow anterior chamber.MethodsForty-four patients with a shallow anterior chamber (defined by a ratio of peripheral anterior chamber depth to peripheral corneal thickness lower than 1/2) were included in this cross-sectional study. Gonioscopy was performed in all subjects by two glaucoma experts (GE1 and GE2) and one GO. Anterior segment imaging was performed using Visante® OCT (Carl Zeiss Meditec Inc.). Agreement between examiners was assessed with first-order agreement coefficients (AC1). Diagnostic accuracies of GO gonioscopy and AS-OCT were evaluated using sensitivity, specificity, and area under the receiver operating characteristic (AROC) curves.ResultsFor static gonioscopy, the agreement between GE1 and GE2 was substantial (AC1 = 0.65), and that between GE1 and GO was moderate (AC1 = 0.50). For indentation gonioscopy, the agreement between GE1 and GE2 was slightly lower (AC1 = 0.55); however, the agreement between GE1 and GO showed a larger reduction (AC1 = 0.12). GO's gonioscopy presented a low specificity (25%) and the AROC to angle closure detection was lower than AS-OCT (0.56–0.73). Combined information of GO gonioscopy and AS-OCT improved specificity (85.7%) and AROC (0.77) of angle closure evaluation.ConclusionAgreement between GO and glaucoma experts was moderate for static gonioscopy and slight for indentation gonioscopy. AS-OCT performed better than GO gonioscopy in detecting angle closure in patients with a shallow anterior chamber. The addition of AS-OCT to clinical information in patients with GO positive gonioscopy improved the specificity and AROC of gonioscopy test.How to cite this articleEsporcatte BLB, Vessani RM, Melo Jr LAS, et al. Diagnostic Performance of Optical Coherence Tomography and Nonspecialist Gonioscopy to Detect Angle Closure. J Curr Glaucoma Pract 2022;16(1):53–58.

Detection of Early Glaucomatous Damage: Performance of Summary Statistics From Optical Coherence Tomography and Perimetry.

PurposeTo evaluate the diagnostic performance of optical coherence tomography (OCT) and visual field (VF) summary statistics (metrics) that are available in OCT and VF reports.MethodsOCT disc and macular scans and 24-2 and 10-2 VFs were obtained from 56 healthy control (HC) eyes/participants and 61 eyes/patients with 24-2 mean deviation of better than –6 dB. All metrics were obtained from OCT radial, circle, and posterior pole cube scans and 24-2 and 10-2 VFs. Their diagnostic performances were evaluated, in isolation and in combinations. For specificity, the 56 HC eyes were used. For sensitivity, 40 of the 61 patient eyes were deemed likely glaucomatous based on an automated topographic method that evaluates structure–function (S–F) agreement. Any 1 of these 40 eyes not judged as abnormal by any given metric was considered a false negative.ResultsAll single OCT and VF metrics misclassified HCs as glaucomatous and missed likely glaucomatous eyes. The best performing single metric was the temporal inferior thickness of the 3.5-mm circle scan, with 96% specificity and 83% sensitivity. Combinations of OCT–OCT and OCT–VF metrics markedly improved specificity. A newly proposed metric that evaluates structure–structure (S–S) agreement at a hemifield level had the highest accuracy. This S–S metric had 98% specificity and 80% sensitivity.ConclusionsOCT and VF metrics, single or in combinations, have only moderate sensitivity for eyes with early glaucoma.Translational RelevanceOCT and VF metrics combinations evaluating S–S or S–F agreement can be highly specific, which is an important implication for clinical and research purposes.

A multi-regression framework to improve diagnostic ability of optical coherence tomography retinal biomarkers to discriminate mild cognitive impairment and Alzheimer\u2019s disease

BackgroundDiagnostic performance of optical coherence tomography (OCT) to detect Alzheimer’s disease (AD) and mild cognitive impairment (MCI) remains limited. We assessed whether compensating the circumpapillary retinal nerve fiber layer (cpRNFL) thickness for multiple demographic and anatomical factors as well as the combination of macular layers improves the detection of MCI and AD.MethodsThis cross-sectional study of 62 AD (n = 92 eyes), 108 MCI (n = 158 eyes), and 55 cognitively normal control (n = 86 eyes) participants. Macular ganglion cell complex (mGCC) thickness was extracted. Circumpapillary retinal nerve fiber layer (cpRNFL) measurement was compensated for several ocular factors. Thickness measurements and their corresponding areas under the receiver operating characteristic curves (AUCs) were compared between the groups. The main outcome measure was OCT thickness measurements.ResultsParticipants with MCI/AD showed significantly thinner measured and compensated cpRNFL, mGCC, and altered retinal vessel density (p < 0.05). Compensated RNFL outperformed measured RNFL for discrimination of MCI/AD (AUC = 0.74 vs 0.69; p = 0.026). Combining macular and compensated cpRNFL parameters provided the best detection of MCI/AD (AUC = 0.80 vs 0.69; p < 0.001).Conclusions and relevanceAccounting for interindividual variations of ocular anatomical features in cpRNFL measurements and incorporating macular information may improve the identification of high-risk individuals with early cognitive impairment.

Complete Coronary Stent Removal After Optical Coherence Tomography Performance 8 Months Later for Device Entrapment: A Scary Challenge.

We describe an uncommon and potentially life-threatening complication during stent assessment by optical coherence tomography (OCT) with entrapment and complete stent removal. Possible mechanisms for OCT-catheter entrapment include malapposed stent struts, catheter deformation, and loss of guidewire position. In this case, the OCT catheter was advanced over the guidewire, which was probably passed through a proximal malapposed stent strut. Tips to avoid potential complications during OCT performance are provided.

Imaging-Based Uveitis Surveillance in Juvenile Idiopathic Arthritis: Feasibility, Acceptability, and Diagnostic Performance.

Children with juvenile idiopathic arthritis (JIA) need regular examinations for uveitis to avoid visual morbidity from the most common extraarticular manifestation of disease. This study was undertaken to investigate the feasibility, acceptability, and performance of optical coherence tomography (OCT) imaging-based diagnosis of uveitis. This observational cross-sectional study included children with and those without uveitis. The children underwent routine clinical examinations and anterior segment OCT scanning of intraocular inflammatory cells. Acceptability of image acquisition was assessed using a visual analog scale and length of time needed to acquire images. Interobserver and intraobserver variability of manual counting of acquired images (Bland-Altman limits of agreement), correlation between imaging and routine assessment, and sensitivity and specificity of anterior segment OCT detection of active inflammation were assessed. Of the 26 children ages 3-15 years (median age 8 years) who underwent imaging, 12 had active inflammation. All patients rated the acceptability of image acquisition as at least 8.5 on a scale of 0-10. Time taken to acquire images ranged from 1.5 minutes to 22 minutes (median time 8 minutes). There was good positive correlation between clinical assessment and image-based cell quantification (R2 = 0.63, P = 0.002). Sensitivity of anterior segment OCT manual image cell count for diagnosis of active inflammation was 92% (95% confidence interval [95% CI] 62-99%), specificity was 86% (95% CI 58-98%), and negative predictive value (ruling out uveitis) was 92% (95% CI 65-99%). Non-contact, high-resolution imaging for JIA uveitis surveillance is feasible, acceptable to patients, and holds the promise of transforming pediatric practice. Further work is needed to determine the analytic and clinical validity of anterior segment OCT quantification of active inflammation, and the clinical utility and cost-effectiveness of imaging-based disease monitoring.

Statistical evaluation of reader variability in assessing the diagnostic performance of optical coherence tomography.

.Significance: Optical coherence tomography (OCT) is widely used as a potential diagnostic tool for a variety of diseases including various types of cancer. However, sensitivity and specificity analyses of OCT in different cancers yield results varying from 11% to 100%. Hence, there is a need for more detailed statistical analysis of blinded reader studies.Aim: Extensive statistical analysis is performed on results from a blinded study involving OCT of breast tumor margins to assess the impact of reader variability on sensitivity and specificity.Approach: Five readers with varying levels of experience reading OCT images assessed 50 OCT images of breast tumor margins collected using an intraoperative OCT system. Statistical modeling and analysis was performed using the R language to analyze reader experience and variability.Results: Statistical analysis showed that the readers’ prior experience with OCT images was directly related to the probability of the readers’ assessment agreeing with histology. Additionally, results from readers with prior experience specific to OCT in breast cancer had a higher probability of agreement with histology compared to readers with experience with OCT in other (noncancer) diseases.Conclusions: The results from this study demonstrate the potential impact of reader training and experience in the assessment of sensitivity and specificity. They also demonstrate even greater potential improvement in diagnostic performance by combining results from multiple readers. These preliminary findings suggest valuable directions for further study.

Editors' note: Optical coherence tomography for diagnosing optic neuritis: Are we there yet?

In the editorial “Optical coherence tomography for diagnosing optic neuritis: Are we there yet?,” Drs. Saidha and Naismith discussed the potential application of optical coherence tomography (OCT) in providing objective support for previous optic neuritis (ON) and in highlighting the research article by Drs. Xu et al. entitled “Optical coherence tomography is highly sensitive in detecting prior optic neuritis.” In a reader response, Dr. Avasarala highlights several potential issues hindering the use of OCT in this context, including the cost of OCT hardware, continually changing algorithms for retinal segmentation, and the paucity of data on OCT's performance relative to pattern shift visual evoked responses (VEPs), a relatively older test. He also notes that an earlier publication by Naismith et al. found that OCT was less sensitive than VEP in detecting subclinical previous ON. Replying to these comments, Drs. Saidha and Naismith note that this previous study used older third-generation time domain OCT and that current fourth-generation spectral domain OCT has a much higher resolution. They cite the excellent reliability and reproducibility of key OCT measures and note that they provide useful information about the global multiple sclerosis disease process. They also argue that OCT and VEP are better viewed as complementary measures of structure and function, respectively. This is especially true because VEP has its limitations too, including distinguishing inner retinal processes from optic nerve ones. Drs. Saidha and Naismith also speculate that the use of OCT in diagnosing acute ON may also become more apparent, given the frequent thickening of the retinal nerve fiber layer during acute ON. As OCT technology continues to evolve, its clinical applications are likely to be further clarified and expanded in the coming years. In the editorial “Optical coherence tomography for diagnosing optic neuritis: Are we there yet?,” Drs. Saidha and Naismith discussed the potential application of optical coherence tomography (OCT) in providing objective support for previous optic neuritis (ON) and in highlighting the research article by Drs. Xu et al. entitled “Optical coherence tomography is highly sensitive in detecting prior optic neuritis.” In a reader response, Dr. Avasarala highlights several potential issues hindering the use of OCT in this context, including the cost of OCT hardware, continually changing algorithms for retinal segmentation, and the paucity of data on OCT's performance relative to pattern shift visual evoked responses (VEPs), a relatively older test. He also notes that an earlier publication by Naismith et al. found that OCT was less sensitive than VEP in detecting subclinical previous ON. Replying to these comments, Drs. Saidha and Naismith note that this previous study used older third-generation time domain OCT and that current fourth-generation spectral domain OCT has a much higher resolution. They cite the excellent reliability and reproducibility of key OCT measures and note that they provide useful information about the global multiple sclerosis disease process. They also argue that OCT and VEP are better viewed as complementary measures of structure and function, respectively. This is especially true because VEP has its limitations too, including distinguishing inner retinal processes from optic nerve ones. Drs. Saidha and Naismith also speculate that the use of OCT in diagnosing acute ON may also become more apparent, given the frequent thickening of the retinal nerve fiber layer during acute ON. As OCT technology continues to evolve, its clinical applications are likely to be further clarified and expanded in the coming years.

107Diagnostic accuracy of optical coherence tomography for the identification of in-stent fibroatheroma following stent implantation: an ex-vivo histological validation study

Abstract Background Previous histopathological studies have demonstrated that new atherosclerotic formation within the neointima, called neoatherosclerosis, is one of the most important mechanisms leading to both very late in-stent restenosis and stent thrombosis after stent implantation. Therefore, to distinguish lipid-containing atherosclerotic neointima from other tissues using intracoronary imaging modalities is clinically important to prevent late stent failures. Purpose This study evaluated the diagnostic performance of optical coherence tomography (OCT) for the detection of “in-stent fibroatheroma” following stent implantation by comparing cross-sections of the model with the corresponding histological images. Methods Fifty stented coronary arteries from the 31 autopsy hearts were imaged by OCT. Coronary arterial histopathological specimens, all of which included more than 30% of %neointimal hyperplasia, were compared with the corresponding OCT cross-sections. Histological in-stent fibroatheroma was defined as neointima containing large necrotic core and inflammatory cells. OCT-derived in-stent fibroatheroma comprised a low-intensity tissue containing a poorly delineated region with invisible stent strut behind low signal intensity. Results A total of 122 OCT cross-sections were compared with histological images. OCT examination revealed that 24 images (20%) contained low-intensity tissue inside the neointima. Of those, 5 images, in which stent strut behind low signal intensity was invisible, were diagnosed as OCT-derived in-stent fibroatheroma (4%) (Figure A). By histological analysis, only 4 images were classified as in-stent fibroatheroma (3%) (Figure B). With histology as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for OCT-derived in-stent fibroatheroma were 100%, 99%, 80%, 100%, and 99%, respectively. The only histological finding underlying the false-positive-diagnosis of OCT-derived in-stent fibroatheroma was foam cells accumulation without necrotic core on the neointimal surface (Figure C and D). Most tissue that showed low-intensity tissue with visible stent strut by OCT contained proteoglycan matrix and organized thrombus in the absence of an underlying necrotic core. Coregistration of OCT with histology Conclusion This study showed the potential capability of OCT based on the visualization of stent struts behind low-intensity regions for discriminating in-stent fibroatheroma from other neointimal tissues following stent implantation.

Multispectral cross-polarization reflectance measurements suggest high contrast of demineralization on tooth surfaces at wavelengths beyond 1300nm due to reduced light scattering in sound enamel.

The enamel scattering coefficient decreases markedly with increasing wavelength from the visible to the near-infrared (NIR). However, beyond 1300nm, the scattering coefficient is difficult to measure, and it is not known whether light scattering continues to decrease significantly at longer wavelengths. It is hypothesized that water absorption is a major contributor to the contrast between sound and demineralized enamel beyond 1300nm since deeply penetrating photons in sound enamel are likely absorbed by water. Reflectance images of demineralization on tooth surfaces were acquired at wavelengths near 1450, 1860, 1880, and 1950nm. The magnitude of water absorption is similar at 1450 and 1880nm but varies markedly between 1860, 1880, and 1950nm. Multispectral comparisons of lesion contrast provide insight into the mechanism responsible for higher contrast at longer NIR wavelengths. The highest contrast was at 1950nm; however, the markedly higher contrast at 1880 compared to 1450nm and similar contrast between 1860 and 1880nm suggests that the enamel scattering coefficient continues to decrease beyond 1300nm, and that reduced light scattering in sound enamel is most responsible for the higher lesion contrast at longer NIR wavelengths. This has important implications for the choice of wavelengths for caries detection and diagnostic devices, including the performance of optical coherence tomography beyond 1300nm.

The relationship between optical coherence tomography performance and visual acuity of acute retinal necrosis

Objective: To analyze the relationship between optical coherence tomography(OCT) performance and visual acuity of patients with acute retinal necrosis (ARN). Methods: Retrospective analysis was performed on the patients diagnosed with ARN at the ophthalmology department of Peking union hospital during October 2011 and May 2016. Fourteen patients (15 eyes), 9 males and 5 females, whose anterior and posterior inflammation disappeared and the retinal necrosis lesion in the fundus of the eye subsided were included. The mean age was (41.6±12.2) years. All patients underwent careful examinations including best corrected visual acuity (BCVA), slit-lamp microscope, indirect ophthalmoscope, color fundus picture, fundus fluorescein angiography (FFA) and OCT (results of their last consultations). Results: BCVA: 8 eyes were increased, 2 eyes were unchanged and 5 eyes were decreased at the last visit; light perception (LP) 1 eye, finger count (FC) 1 eye, 3 eyes of 0.01 to 0.1, 6 eyes of 0.15 to 0.25. The inflammatory reaction in the anterior segment of 14 eyes disappeared, while the inflammatory reaction of the remaining 1 eye was relieved. The fundus lesions of all 15 eyes disappeared. According to OCT results: five eyes (5/15) exhibited normal macula area, among the 5 eyes, 4 eyes are of 0.15 to 0.25 visual acuity, and 1 eye is of 0.5 visual acuity;macular epiretinal membrane is present in three eyes (3/15), of which the visual acuity is 0.02, 0.25 and 0.3 respectively macula edema is present in three eyes (3/15), among the 3 eyes, 1 eye (visual acuity of 0.01)showed thickening of neurosensory retina, cystoid change of fovea and several fluid dark areas, the other 2 eyes (visual acuity of 0.02 and 0.5 respectively) showed small diffuse fluid dark area in the neurosensory retina;atrophy of neurosensory retina and absence of IS/OS was found in four eyes (4/15), among the 4 eyes, the visual acuity of 3 is below 0.01, and the other 1 eye is of 0.08 visual acuity. Conclusions: The OCT performance of stationary phase of ARN tends to be positively correlated with the visual acuity of patients. The prognosis of visual acuity of the patients whose OCT results showed atrophy of neurosensory retina and absence of IS/OS is poor. (Chin J Ophthalmol, 2018, 54: 369-374).

High-speed OCT light sources and systems [Invited

Imaging speed is one of the most important parameters that define the performance of optical coherence tomography (OCT) systems. During the last two decades, OCT speed has increased by over three orders of magnitude. New developments in wavelength-swept lasers have repeatedly been crucial for this development. In this review, we discuss the historical evolution and current state of the art of high-speed OCT systems, with focus on wavelength swept light sources and swept source OCT systems.

Neural Network Analysis of Different Segmentation Strategies of Nerve Fiber Layer Assessment for Glaucoma Diagnosis.

To compare the diagnostic performance of different segmentations of the nerve fiber layer (NFL) thickness measurements using an artificial neural network and to define the optimal number of sectors with best diagnostic ability for glaucoma diagnosis. A total of 117 glaucoma patients and 123 normal subjects were included in the study. NFL thickness measurements were performed using the Spectralis-OCT (Heidelberg Engineering) to obtain the NFL thickness average; measurements from 2 semicircles, 4 quadrants, and 6, 8, 12, 16, 24, 32, and 64 sectors; and 768 uniformly divided locations around the peripapillary NFL. An artificial neural network evaluation was performed to compare the influence of sector analysis on the diagnostic performance of optical coherence tomography. Receiver operating characteristic curves were used to compare the diagnostic ability of the different segmentation analyses. The 6 sectors divided by the horizontal division of the nasal and temporal quadrants were better than the 6 sectors divided by the vertical line through the superior and inferior quadrants [areas under curve, 0.778; 95% confidence interval (CI), 0.720-0.829 and 0.814; 95% CI, 0.759-0.861, respectively]. In the case of quadrants, clock quadrants (area under curve 0.770; 95% CI, 0.712-0.822) were better than the ISNT (inferior-superior-nasal-temporal) quadrants (area under curve, 0.770; 95% CI, 0.712-0.822; P=0.003). The first segmentation strategy that improved the diagnostic value of 4 ISNT quadrants was the 12-sector analysis (area under curve, 0.845; 95% CI, 0.793-0.889; P=0.001). The 2 best candidate strategies for the OCT report were the 12-sector analysis and the 4 planimetric quadrant (alternatively, the 4 clock quadrants) analysis.

Detection and proportion of very early dental caries in independent living older adults.

Dental caries is an important healthcare challenge in adults over 65 years of age. Integration of oral health screening into non-dental primary care practice may improve access to preventive dental care for vulnerable populations such as the elderly. Such integration would require easy, fast, and accurate early caries detection tools. Primary goal of this study was to evaluate the diagnostic performance of optical coherence tomography (OCT) imaging for detecting very early caries in the elderly living in community-based settings. The International Caries Detection and Assessment System (ICDAS) served as gold standard. Secondary goal of this study was to provide baseline prevalence data of very early caries lesions in independent living adults aged 65+ years. Seventy-two subjects were recruited from three sites in Southern California: a retirement community, a senior health fair, and a convalescent hospital. Clinical examination was performed using the ICDAS visual criteria and this was followed by OCT imaging. The two-dimensional OCT images (B-scan) were analyzed with simple software. Locations with a log of back-scattered light intensity (BSLI) below 2.9 were scored as sound, and areas equaling or exceeding 2.9 BSLI were considered carious. Diagnostic performance of OCT imaging was compared with ICDAS score. OCT-based diagnosis demonstrated very good sensitivity (95.1%) and good specificity (85.8%). 54.7% of dentate subjects had at least one tooth with very early coronal caries. Early coronal decay is prevalent in the unrestored pits and fissures of coronal surfaces of teeth in independent living adults aged 65+ years. Though OCT imaging coupled with a simple diagnostic algorithm can accurately detect areas of very early caries in community-based settings, existing devices are expensive and not well-suited for use by non-dental health care providers. Simple, inexpensive, fast, and accurate tools for early caries detection by field health care providers working in non-traditional settings are urgently needed to support inter-professional dental health management.

Optical coherence tomography for the diagnosis of neovascular age-related macular degeneration: a systematic review.

The purpose is to study the diagnostic performance of optical coherence tomography (OCT) and alternative diagnostic tests for neovascular age-related macular degeneration (nAMD). Methods employed are as follows:systematic review and meta-analysis; OCT including time-domain (TD-OCT) and the most recently developed spectral domain (SD-OCT); comparator tests: visual acuity, clinical evaluation (slit lamp), Amsler chart, colour fundus photographs, infra-red reflectance, red-free images/blue reflectance, fundus autofluorescence imaging (FAF), indocyanine green angiography (ICGA), preferential hyperacuity perimetry (PHP), and microperimetry; reference standard: fundus fluorescein angiography. Databases searched included MEDLINE, MEDLINE In Process, EMBASE, Biosis, SCI, the Cochrane Library, DARE, MEDION, and HTA database. Last literature searches: March 2013. Risk of bias assessed using QUADAS-2. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic (HSROC) curves. Twenty-two studies (2 abstracts and 20 articles) enrolling 2124 participants were identified, reporting TD-OCT (12 studies), SD-OCT (1 study), ICGA (8 studies), PHP (3 studies), Amsler grid, colour fundus photography and FAF (1 study each). Most studies were considered to have a high risk of bias in the patient selection (55%, 11/20), and flow and timing (40%, 8/20) domains. In a meta-analysis of TD-OCT studies, sensitivity and specificity (95% CI) were 88% (46-98%) and 78% (64-88%), respectively. There was insufficient information to undertake meta-analysis for other tests. TD-OCT is a sensitive test for detecting nAMD, although specificity was only moderate. Data on SD-OCT are sparse. Diagnosis of nAMD should not rely solely on OCT.

Detection of Early Glaucoma With Optical Coherence Tomography (StratusOCT)

To evaluate the performance of optical coherence tomography (StratusOCT) for discriminating eyes with early glaucoma from normal eyes. Thirty eyes with established early glaucomatous visual field defects (EGVF group), 30 eyes with evidence of early glaucomatous optic neuropathy with normal standard achromatic perimetry [early glaucoma by disc (EGD)], and 33 age-matched normal eyes with good quality StratusOCT nerve fiber layer (NFL) images were enrolled. Average NFL thickness and NFL thickness at quadrants and sectors, areas under receiver operator characteristic curves, and sensitivities at 80% and 90% specificity were evaluated. The average (+/-SD) mean deviation in the EGVF group was -3.4 (+/-1.7) dB. Receiver operator characteristic curves showed areas under the curve (AUC) for NFL thickness in the superior quadrant (AUC=0.75+/-0.07) and in the inferior quadrant (AUC=0.94+/-0.03) to be the best StratusOCT parameters for discrimination of normal controls from EGD and EGVF eyes, respectively. The best parameter for detection of EGD eyes at 80% and 90% specificities was NFL thickness at superior quadrant (51% and 36% sensitivities, respectively). The best parameter for detection of EGVF eyes at 80% and 90% specificities was NFL thickness in the inferior quadrant (90% and 87% sensitivities, respectively). Optical coherence tomography (StratusOCT) showed good sensitivity and specificity in a group of glaucoma patients with early visual field loss. In patients with normal visual fields in whom the optic disc appeared glaucomatous to glaucoma specialists, half were confirmed to have StratusOCT findings consistent with damage from glaucoma.

Optic Disk and Nerve Fiber Layer Imaging to Detect Glaucoma

To compare optic disk and retinal nerve fiber layer (RNFL) imaging methods to discriminate eyes with early glaucoma from normal eyes. Retrospective, cross-sectional study. In a tertiary care academic glaucoma center, 92 eyes of 92 subjects (46 with early perimetric open-angle glaucoma and 46 controls) were studied. Diagnostic performance of optical coherence tomography (StratusOCT; Carl Zeiss Meditec, Dublin, California, USA), scanning laser polarimetry (GDx VCC; Laser Diagnostic Technologies, San Diego, California, USA), confocal laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] III; Heidelberg Engineering GmbH, Heidelberg, Germany), and qualitative assessment of stereoscopic optic disk photographs were compared. Outcome measures were areas under receiver operator characteristic curves (AUCs) and sensitivities at fixed specificities. Classification and regression tree (CART) analysis was used to evaluate combinations of quantitative parameters. The average (+/- standard deviation) visual field mean deviation for glaucomatous eyes was -4.0 +/- 2.5 dB (decibels). Parameters with largest AUCs (+/- standard error) were: average RNFL thickness for StratusOCT (0.96 +/- 0.02), nerve fiber indicator for GDx VCC (0.92 +/- 0.03), Frederick S. Mikelberg (FSM) discriminant function for HRT III (0.91 +/- 0.03), and 0.97 +/- 0.02 for disk photograph evaluation. At 95% specificity, sensitivity of disk photograph evaluation (90%) was greater than GDx VCC (P = .05) and HRT III (P = .002) results, but not significantly different than those of StratusOCT (P > .05). The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area with CART produced a sensitivity of 91% and specificity of 96%. StratusOCT, GDx VCC, and HRT III performed as well as, but not better than, qualitative evaluation of optic disk stereophotographs for detection of early perimetric glaucoma. The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area ratio provided a high diagnostic precision.

Identifying early glaucoma with optical coherence tomography

PurposeTo evaluate performance of optical coherence tomography (OCT) for detection of early glaucoma. DesignObservational case-control study. MethodsSetting: University-based tertiary care center. Study Population: One eye from 50 normals, 42 glaucoma suspects, and 59 early glaucoma patients meeting the following criteria: visual field (VF) mean deviation ≥−6.00 dB, age ≥40 years, spherical refractive error ≤5 diopters, astigmatism ≤3 diopters, and visual acuity ≥20/30. Observation Procedure: Early glaucoma by VF (EGVF) was described as repeatable abnormal achromatic VFs based on predefined criteria. Glaucoma suspects (GS) were defined as presence of glaucomatous disk appearance with normal achromatic VFs. Outcome Measures: Average nerve fiber layer thickness (NFLT) and NFLT in each of four quadrants and 12 clock-hour sectors. Receiver operating characteristic curves and sensitivity and specificity were used to assess the performance of OCT. ResultsAverage NFLT was 128.4 ± 15.4, 102.0 ± 25.4, and 86.5 ± 31.5 μm in normal, GS, and EGVF eyes, respectively. Normal eyes were different from both glaucoma groups (P < .001); NFLT in the superior quadrant and at the 11 o'clock position had the highest area under the receiver operating characteristic curve (.840 and .933) in the GS and EGVF groups (P = .03). The sensitivity of the OCT for detection of glaucoma was 71% and 85% for the GS and EGVF groups with specificity fixed at 90%. ConclusionThe OCT discriminates well between eyes with early perimetric glaucoma and normal eyes. However, its performance is less adequate in eyes with suspicious disk and normal VFs.