16 CHEN Comparison of Different OCT Systems

Comparison of Different
OCT Systems
Teresa C. Chen, MD
Associate Professor of Ophthalmology, Harvard Medical School
Glaucoma Service, Massachusetts Eye and Ear Infirmary
• I have the following financial interests or relationships to disclose:
– Department of Defense: Grant Support
– Harvard Foundation Grant (Fidelity Charitable Fund): Grant Support
Outline
 Purpose  Review the literature on the use of SD‐OCT
to help diagnose glaucoma
 Methods  2006 to 2018
 All commercially available SD‐OCT machines
 Results  RNFL, optic nerve, macula
 not lamina
 Conclusions  no OCTA
Outline
 Purpose
 Methods  PubMed and Cochrane Library Databases
 February 2006 to April 2018
 Results
 Conclusions
Outline
 Purpose
 Results
 Conclusions
Outline
 Purpose
 Results Lin SC, Singh K, Jampel HD, Hodapp EA,
 Conclusions Smith SD, Francis BA, Dueker DK, Fechtner
RD, Samples JS, Schuman JS, Minckler DS.
Optic Nerve Head and RNFL Analysis.
Ophthalmology 2007;114:1937‐1949.
Outline
 Purpose
 Results Lin SC, Singh K, Jampel HD, Hodapp EA,
 Conclusions Smith SD, Francis BA, Dueker DK, Fechtner
RD, Samples JS, Schuman JS, Minckler DS.
Optic Nerve Head and RNFL Analysis.
Ophthalmology 2007;114:1937‐1949.
Outline
 Purpose
 Results Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K,
 Conclusions Radhakrishnan S, Takusagawa H, Chen PP.
Spectral Domain OCT: Helping the Clinician
Diagnose Glaucoma. Ophthalmology
2018;125:1817‐1827.
How Time Domain OCT Works

Reference Mirror
SLD Light
Source
Huang D, Swanson EA, Beam

Lin CP, Schuman JS, Splitter
Stinson WG, Chang W,
Hee MR, Flotte T,
Gregory K, Puliafito CA,
Fujimoto JG. Optical
Coherence Tomography.
Science, 1991. Photo Detector A-line
How Spectral Domain OCT Works
Reference Mirror
SLD Light
Source
Beam
Splitter
Spectrometer
Fourier transform
Johannes de Boer PhD (MGH)

“Ultra High Speed Optical Coherence Tomography” Video-Rate SD-OCT
White BR, Pierce MC, Nassif N, Cense B, Park BH,
Chen TC, de Boer JF…Imaging Using Ultra-High-
Speed Spectral Domain Optical Doppler
Tomography. Optics Express 2003; 11 (25): 3490-7.
American Glaucoma Society

Sarasota, Florida, 2004
3D SDOCT
Spectral(3D = Video-Rate)
Domain OCT - 2003
 imaging the eye
for the first time
in 3D (video-rate)
wide field!
 in real time
 White BR, Pierce MC, Nassif N, Cense B, Park BH, Chen TC, de Boer JF…Imaging Using Ultra-High-Speed Spectral
Domain Optical Doppler Tomography. Optics Express 2003; 11 (25): 3490-7.
 Nassif N, Cense B, Park BH, Yun SH, Chen TC, Bouma BE, Tearney GJ, de Boer JF. In vivo Human Retinal Imaging
by Ultrahigh-Speed Spectral Domain OCT. Opt Lett 2004;29(5):480-482.
 Nassif N, Cense B, Park BH, Pierce M, Yun SH, Bouma BE, Tearney GJ, Chen TC, de Boer JF. In vivo High-resolution
Video-Rate Spectral Domain OCT of the Human Retina and Optic Nerve. Opt Express 2004;12(3):367-376.
 Cense B, Nassif N, Chen TC, Pierce MC, Yun SH, Park BH, Bouma BE, Tearney GJ, de Boer JF. Ultrahigh-resolution
High-speed Retinal Imaging Using Spectral Domain OCT. Opt Express 2004;12(11):2435-2447.
708 articles
Inclusion criteria:
- SD-OCT was the technology
Outline
- RNFL, optic nerve, macula
- original research
- SD-OCT & glaucoma diagnosis
- adult subjects
- at least 125 patients
Exclusion criteria:
 Purpose -
-
reproducibility
progression
- level III evidence
2018;125:1817‐1827.
708 articles
Inclusion criteria:
- original research
Outline
- adult subjects
Exclusion criteria:
 Purpose -
-
reproducibility
progression
2018;125:1817‐1827.
708 articles
Inclusion criteria:
- original research
Outline
- adult subjects
Exclusion criteria:
 Purpose -
-
reproducibility
progression
2018;125:1817‐1827.
708 articles
Inclusion criteria:
- original research
Outline
- adult subjects
Exclusion criteria:
 Purpose -
-
reproducibility
progression
Inclusion & exclusion criteria yielded:
- 2 level I articles 2018;125:1817‐1827.
- 57 level II articles
Outline
Many different SD‐OCT machines
 Purpose
 Methods
 Results
 Conclusions
Many SD-OCT machines
• Cirrus HD-OCT (Carl Zeiss Meditec, Inc,
Dublin, California)
RTVue
• RTVue (Optovue, Inc, Fremont, California) Spectralis
• Spectralis SD-OCT (Heidelberg Engineering Bioptigen

GmbH, Heidelberg, Germany)
Cirrus
• 3D-OCT (Topcon Medical Systems, Inc,
SOCT
Paramus, New Jersey) Copernicus
Spectral OCT SLO
• Bioptigen Envisu SD-OCT (Bioptigen, Inc, Topcon
time
Research Triangle Park, North Carolina) 3D OCT
domain
OCT
• SOCT Copernicus HR (Optopol Technology,
SA, Zawiercie, Poland)

Dublin, California)
RTVue

Cirrus
SOCT
Spectral OCT SLO
Topcon
time
3D OCT
domain
OCT
Dublin, California)
RTVue

Cirrus
SOCT
Spectral OCT SLO
SDOCT machines appear to Topcon
time
3D OCT
have similar clinical domain
OCT
diagnostic abilities1-4
1. Akashi et al. IOVS 2013;54(7):4478-4484.

2. Akashi et al. IOVS 2013;54(9):6025-6032.
3. Leite et al. Ophthalmology
2011:118(7):1334-1339.
4. Lee, et al. Optom Vis Sci 2011:88(6):751-
758.

Dublin, California)
RTVue

Cirrus
SOCT
Spectral OCT SLO
RNFL thickness values Topcon
time
3D OCT
between machines are not domain
OCT
interchangeable1
1. Lee, et al. Optom Vis Sci 2011;88(6):751-

758.
2. Seibold, et al. Am J Ophthalmol
2010;150(6):807-814.
Artifacts in OCTmachines
Many SD-OCT Imaging
RNFL values are not interchangeable for different SDOCT machines…
Stratus Cirrus Spectralis
110.1 ± 12.8 98.7 ± 10.9 106.6 ± 12.8
RTVue
112.8± 13.2
Comparison of RNFL Thickness in Normal Eyes Using TDOCT and SDOCT.

Leonard Seibold, Naresh Mandava, Malik Kahook. Am J Ophthalmol 2010.
40 normals

RNFL “thinning” due to different SDOCT machines…
Stratus Cirrus Spectralis
∼ 104 microns ∼ 97 microns ∼ 105 microns
2009 2013 2014

different signal strength range
SDOCT Machine Scan Quality Index

Cirrus HD-OCT Signal Strength > 6
(max. 10)
RTVue Signal Strength Index (SSI) ≥ 30
(max. 100)
3D-OCT Image quality > 45

(max. 160)
Spectralis SD-OCT Quality (Q) > 15
(max. 40)
Effect of Corneal Drying on Optical Coherence
Tomography. Daniel Stein, Gadi Wollstein, Hiroshi
Ishikawa, Ellen Hertzmark, Robert Noecker, Joel
Schuman. Ophthalmology 2006; 113: 985-991.
Artifacts in OCTmachines
Many SD-OCT Imaging
different normative databases
Outline
 Purpose
Similar diagnostic data
 Methods
Different machines…
 Results
RNFL values not interchangeable
 Conclusions signal strength ranges
normative databases
software
SD-OCT Software Differences

RNFL optic nerve macula
most commonly used
Table 1.
3.4mm to 3.46 mm diameter
scan circle

most commonly used
Table 1.
3.4mm to 3.46 mm diameter
scan circle
● Spectralis Glaucoma Module Premium Edition (GMPE)
FDA approved in 2016
● RNFL scan protocol:
● 12°/14°/16° arc
● centered over BMO
● 3.5 mm, 4.1 mm, and 4.65 mm*
* Gmeiner et al. IOVS 2016;57(9):575‐584.

● Spectralis Glaucoma Module Premium Edition (GMPE)
FDA approved in 2016
● RNFL scan protocol:
● 12°/14°/16° arc
● 3.5 mm, 4.1 mm, and 4.65 mm*
Table 1.
reference plane vs. reference
plane independent

Software 2D optic nerve 3D
old way new way
● reference plane dependent parameters ● reference plane independent parameters
o Cirrus ‐ 200 microns above RPE ○ Spectralis – BMO‐MRW
o RTVue – 150 microns above RPE
o 3D OCT – 120 microns above RPE
AGS
2004
optic nerve
old way new way
o Cirrus ‐ 200 microns above RPE Chen TC, Zeng A, Sun W, Mujat M, de Boer JF. Spectral Domain Optical
Coherence Tomography in Glaucoma. International Ophthalmology
o RTVue – 150 microns above RPE Clinics 2008 Fall; 48 (4): 29‐45.
Chen TC. Trans Am Oph Soc 2009;107:254‐81.

optic nerve
old way new way
o Cirrus ‐ 200 microns above RPE …better than reference plane parameters
o RTVue – 150 microns above RPE Chauhan et al. Ophthalmology 2013.
Tsikata et al. IOVS 2016.
REFERENCE PLANE INDEPENDENT PARAMETERS
minimum circumpapillary band (MCB) MCB (3 eyes)
area
Elschnig’s ring (60 raster lines)
(Povazay, JBO 2007)
minimum distance band (MDB) MDB (16 eyes)
area and thickness
RPE/BM complex (193 raster lines)
(Chen, Int Oph Clinics 2008
Chen, Trans Am Oph Soc 2009)
BMO‐MRW BMO‐MRW (155 patients)
area and width
BMO (24 radial lines)
(Chauhan, Ophthalmol 2013)
reference plane independent neuroretinal rim parameter

Spectral Domain OCT
Spectral Domain OCT

Spectral Domain OCT
optic nerve macula
NFL: Nerve fiber layer (ganglion cells axons)

GCL: Ganglion Cell Layer (ganglion cells bodies)
IPL: Inner Plexiform Layer (ganglion cells dendrites)
Retina: total retinal thickness
RTVue 3D OCT
GCC: Ganglion Cell Complex = NFL + GCL + IPL GCC
GCIPL
NFL
Cirrus GCA: Ganglion Cell Analysis Spectralis
GCC = NFL + GCL + IPL Total retina thickness
GCIPL = GCL + IPL
diagram from Akashi et al. IOVS 2013

Spectralis Glaucoma Module Premium Edition (GMPE)
GMPE FDA approved in 2016
Posterior Pole Asymmetry Analysis (PPAA)
● 8 X 8 array or superpixel 3°X3°
● 30°X25° volume scan
● 61 horizontal Bscans (120 microns apart)
Miraftabi et al TVST 2016
ganglion cell thickness maps
“Measuring GCL does not provide
any advantage for detection of
progression with current SD‐OCT
technology”
Miraftabi, Amini, Morales, Henry, Yu, Afifi, Coleman,
Caprioli, Nouri‐Mahdavi. IOVS 2016.
Outline
 Purpose
Similar diagnostic data
 Methods
Different machines…
 Results
RNFL values not interchangeable
 Conclusions signal strength ranges
normative databases
software
Outline
 Purpose
 Methods
 Results similar across machines
 Conclusions
Outline
Cirrus
 Purpose RTVue
Spectralis
 Methods 3D OCT
 location
 Conclusions  severe disease
 signal strength
Outline
Cirrus
 Purpose RTVue
Spectralis
 Methods 3D OCT
Accuracy of a test is quantified by AUROC:
 Conclusions AUROC = 1 is a perfect test
AUROC = 0.5 uninformative test
Excellent test (AUROC 0.90 – 1.0)
Good test (AUROC 0.80 – 0.90)
Fair test (AUROC 0.70 – 0.80)
Poor test (AUROC 0.60 – 0.70)
Cirrus and Glaucoma

Cirrus
26 articles studied Cirrus RNFL thickness:
global or average RNFL can distinguish normal from glaucoma patients
AUROC 0.677 – 0.969 (poor to excellent)
inferior and superior quadrants best
inferior quadrant AUROC 0.686 – 0.963 (poor to excellent)
superior quadrant AUROC 0.601 – 0.944 (poor to excellent)
better diagnostic ability for worse disease severity
pre‐perimetric glaucoma AUROC 0.752 – 0.860 (fair to good)
advanced glaucoma AUROC 0.936 – 0.981 (excellent)
Cirrus
Studies comparing Cirrus SD‐OCT versus Stratus TD‐OCT RNFL thickness:
Cirrus SD‐OCT same or better AUROC curves
Cirrus SD‐OCT had better resolution (i.e. 5 versus 10 microns)
Cirrus SD‐OCT had faster acquisition speeds
Cirrus SD‐OCT had better signal strength
poor signal strength (1.0% of Cirrus versus 23% of Stratus scans)
Cirrus SD‐OCT had less measurement variability
COV (< 6.4% for Cirrus and < 12.8% for Stratus)
Cirrus has added advantage of RNFL thickness deviation maps
size, shape, depth, location, disc margin distance
Cirrus
8 articles studied Cirrus disc parameters:
Rim area
Disc area
Average cup‐to‐disc ratio
Vertical cup‐to‐disc ratio
Cup volume
Cirrus
Rim area AUROC 0.655 – 0.960 (poor to excellent)
Disc area
Vertical cup‐to‐disc ratio AUROC 0.400 – 0.962 (uninformative to excellent)
Cup volume
Cirrus
Rim area AUROC 0.655 – 0.960 (poor to excellent)
Disc area
Vertical cup‐to‐disc ratio AUROC 0.400 – 0.962 (uninformative to excellent)
Cup volume
advanced glaucoma ‐ rim area AUROC 0.937 (excellent)
advanced glaucoma – vertical cup‐to‐disc ratio AUROC 0.911‐0.941 (excellent)
Cirrus
14 articles studied Cirrus macular parameters  best parameters were…
Minimum GCIPL AUROC 0.702 – 0.980 (fair to excellent)
Inferior temporal GCIPL AUROC 0.752 – 0.970 (fair to excellent)
Average GCIPL AUROC 0.703 – 0.960 (fair to excellent)
Inferior GCIPL thickness AUROC 0.702 – 0.950 (fair to excellent)
Superior temporal GCIPL thickness AUROC 0.652 – 0.932 (poor to excellent)
Average GCC AUROC 0.901 – 0.945 (excellent)
Inferior temporal GCC AUROC 0.922 (excellent)
Superior temporal GCC AUROC 0.910 (excellent)
Inferior GCC AUROC 0.904 – 0.908 (excellent)
Cirrus
13 articles studied Cirrus combined parameters:
Most studies suggest that best macular, RNFL, and disc parameters are similar
One study suggested that macular inferior temporal GCIPL was better than
inferior RNFL for discriminating myopic glaucoma from myopia alone
(0.752 vs. 0.686 p = 0.036)
RTVue and Glaucoma

RTVue
19 articles studied RTVue RNFL thickness:
average RNFL best for distinguishing normal from glaucoma patients
AUROC 0.828 – 0.977 (good to excellent)
inferior and superior quadrants next best
inferior quadrant AUROC 0.823 – 0.982 (good to excellent)
superior quadrant AUROC 0.805 – 0.944 (good to excellent)
RTVue
19 articles studied RTVue RNFL thickness:
pre‐perimetric glaucoma AUROC 0.720 – 0.820 (fair to good)
advanced glaucoma AUROC 0.936 – 0.977 (excellent)
better diagnostic data with improved signal strength index (SSI)
SSI ≥ 30 AUROC 0.678 – 0.890 (fair to good)
SSI ≥ 70 AUROC 0.962 – 0.994 (excellent)
RTVue
8 articles studied RTVue disc parameters:
Cup area
Disc area
Rim area
Rim volume
Nerve head volume
Cup volume
Cup disc area ratio
Horizontal cup‐to‐disc ratio
Vertical cup‐to‐disc ratio
RTVue
Cup area
Disc area
Inferior Rim area AUROC 0.720 – 0.960 (fair to excellent)
Rim volume
Nerve head volume
Cup volume
Cup disc area ratio
Vertical cup‐to‐disc ratio AUROC 0.621 – 0.970 (poor to excellent)
RTVue
Cup area
Disc area
Inferior Rim area AUROC 0.720 – 0.960 (fair to excellent)
Rim volume
Nerve head volume
Cup volume
Cup disc area ratio
Vertical cup‐to‐disc ratio AUROC 0.621 – 0.970 (poor to excellent)
RTVue
articles studied RTVue disc parameters:
rim area diagnostic data increased as disease severity increased
rim area has better diagnostic data for perimetric glaucoma with improved SSI
rim area (SSI ≥ 30) AUROC 0.651 – 0.747 (poor to fair)
rim area (SSI ≥ 70) AUROC 0.873 – 0.922 (good to excellent)
RTVue
19 articles studied RTVue macular parameters:
average GCC thickness best for distinguishing normal from glaucoma patients
AUROC 0.642 – 0.957 (poor to excellent)
inferior GCC thickness next best
AUROC 0.743 – 0.949 (fair to excellent)
RTVue
GCC thickness with better diagnostic ability for worse disease severity
pre‐perimetric glaucoma AUROC 0.720 – 0.780 (fair)
advanced glaucoma AUROC 0.916 (excellent)
better diagnostic data for perimetric glaucoma with improved SSI
average GCC thickness (SSI ≤ 30) AUROC 0.726 – 0.873 (fair to good)
average GCC thickness (SSI ≤ 70) AUROC 0.886 – 0.959 (good to excellent)
RTVue
Suggested that macular parameters provide better diagnostic data vs. RNFL thickness
i.e. AUROC does not decrease with high myopia
RNFL thickness  AUROC 0.939 vs. 0.827 (excellent versus good)
GCC thickness AUROC 0.933 vs. 0.935 (excellent)
RTVue
8 articles studies compared RNFL vs. disc vs. macular parameters:
Most studies (6 of 8) suggest that best RNFL, disc, and macular parameters are similar
Spectralis and Glaucoma
Spectralis
● RNFL thickness scan
● most common scan
● 12° arc
● 3.45 mm circle for typical axial length
● with tracking
● GMPE scan protocol:
● 12°/14°/16° arc
● 3.5 mm, 4.1 mm, and 4.65 mm*
Spectralis
12 articles studied Spectralis RNFL parameters  best parameters were…
Global RNFL thickness AUROC 0.880 – 0.978 (good to excellent)

Inferior RNFL thickness AUROC 0.850 – 0.958 (good to excellent)
Superior RNFL thickness AUROC 0.880 – 0.936 (good to excellent)
Temporal‐inferior RNFL thickness AUROC 0.855 – 0.959 (good to excellent)
Temporal‐superior RNFL thickness AUROC 0.803 – 0.951 (good to excellent)
Spectralis
BMO‐MRW (24 radial line scan) AUROC 0.929 – 0.960 (excellent)
Unclear if BMO‐MRW better than RNFL thickness
Spectralis
MDB (high‐density 193 raster scan)
MDB better than RNFL thickness, especially…
nasal region
temporal region
inferonasal region
superonasal region
2 studies suggest that BMO‐MRW and MDB thickness
better than rim area and thickness
Spectralis
inferior macular retina thickness best
AUROC 0.858 (good)
Topcon 3D OCT and Glaucoma
3D OCT-1000 or 3D OCT-2000
4 articles studied 3D OCT‐1000 or 3D OCT‐2000 parameters:
Best RNFL thickness parameters for distinguishing normal from glaucoma patients
average or global RNFL AUROC 0.890 – 0.974 (good to excellent)
inferior RNFL AUROC 0.909 – 0.964 (excellent)
superior RNFL AUROC 0.826 – 0.909 (good to excellent)
Best macular parameters
average GC/IPL AUROC 0.830 – 0.954 (good to excellent)
average GCC AUROC 0.872 – 0.968 (good to excellent)
inferior GC/IPL AUROC 0.856 – 0.954 (good to excellent)
inferior GCC AUROC 0.888 – 0.969 (good to excellent)
Outline
 SD‐OCT important tool for glaucoma
 Purpose  SD‐OCT > TD‐OCT
 resolution
 Methods  acquisition speed
 scan quality (signal strength)
 Results  inter‐test variability
 RNFL thickness maps
 Different SD‐OCT machines have similar
 Conclusions abilities to distinguish between normal &
glaucoma patients
 Values between machines are not
interchangeable
Outline
 Purpose  Better AUROC values for…
 greater disease severity
 Methods  better signal strength
 Results  Diagnosis
(RNFL ~ macula ~ disc)
 Conclusions  maybe macula for myopes
 Combining parameters improves
diagnostic performance
Outline
 Most important parameters …
 Purpose 1) RNFL thickness
2) Macula
 Methods • GCC
• GC/IPL
3) Disc
 Results • rim area
• vertical cup‐disc ratio
 Conclusions
 Most important regions …
 average
 inferior & superior
 inferior temporal & superior temporal
SDOCT has a lot of great information…

OCT Diseases
that should always be correlated with clinical data
THANKS
Harvard Foundation Grant (Fidelity Charitable Fund)
National Institutes of Health - RO1 EY14975-01
Harvard Catalyst
American Glaucoma Society Mid-Career Award
Massachusetts Lions Eye Research Fund, Inc.
Department of Defense SBIR
Massachusetts General Hospital Massachusetts Eye and Ear Infirmary
and VU University • Kayoung Yi, MD, PhD
• Johannes de Boer, PhD • Edem Tsikata, PhD
• B. Hyle Park, PhD • Alice Vercellin Verticchio, MD
• John B. Miller, MD
• Mircea Mujat, PhD
• Iryna Falkenstein, MD
• Vivek Srinivasan, PhD
• Linda Yi-Chieh Poon, MD
• Barry Cense, PhD
• Stacey Brauner, MD
• Gary Tearney, PhD • Ziad Khoueir, MD
• Brett Bouma, PhD • Derrick T. Lin, MD
• Mark Pierce, PhD • Daniel Deschler, MD
• Wei Sun, BS • Peter A.D. Rubin, MD
• Vivek Srinivasan, PhD • Mark Latina, MD
• Ben Vakoc, PhD • Joan W. Miller, MD
Outline
 Purpose
 Methods
 Results
 Conclusions
Limitations of Time Domain OCT
Pictures from Carl Zeiss Meditec, Inc
Video Rate Spectral Domain OCT
pictures courtesy Mary Beth Cunnane, MD

2D 3D
Video Rate Spectral Domain OCT
OCT Terminology
1D 2D 3D
A-scan B-scan C-mode
(A-line) (frame)
Software 2D  3D
best disc parameters: best disc parameters:

global rim area MDB
2D inferior rim area

vertical cup-to-disc ratio
3D
● Shieh et al. AJO 2016.
● Tsikata et al. IOVS 2016.
● Fan et al. Journal of Glaucoma 2017.
Software 2D  3D

global rim area MDB

3D
Software 2D  3D

global rim area MDB

3D BMO-MRW
Software 2D  3D

global rim area MDB

3D BMO-MRW
rim volume
area
(Povazay, JBO 2007)
area and thickness
rim width ‐ RW RW (9 monkeys)

area and width
(Strouthidis, IOVS 2011)
area
(Povazay, JBO 2007)
area and thickness

area and width
area
(Povazay, JBO 2007)
area and thickness

area and width
area
(Povazay, JBO 2007)
minimum distance band (MDB) MDB (16 eyes) disc photos

area and thickness HVF

area and width
area
(Povazay, JBO 2007)
area and thickness

area and width

16 CHEN Comparison of Different OCT Systems

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16 CHEN Comparison of Different OCT Systems

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Comparison of Different

How Time Domain OCT Works

Huang D, Swanson EA, Beam

Johannes de Boer PhD (MGH)

American Glaucoma Society

• Spectralis SD-OCT (Heidelberg Engineering Bioptigen

Many SD-OCT machines

• Spectralis SD-OCT (Heidelberg Engineering Bioptigen

• Spectralis SD-OCT (Heidelberg Engineering Bioptigen

1. Akashi et al. IOVS 2013;54(7):4478-4484.

Many SD-OCT machines

• Spectralis SD-OCT (Heidelberg Engineering Bioptigen

1. Lee, et al. Optom Vis Sci 2011;88(6):751-

110.1 ± 12.8 98.7 ± 10.9 106.6 ± 12.8

Comparison of RNFL Thickness in Normal Eyes Using TDOCT and SDOCT.

Many SD-OCT machines

∼ 104 microns ∼ 97 microns ∼ 105 microns

2009 2013 2014

SDOCT Machine Scan Quality Index

3D-OCT Image quality > 45

SD-OCT Software Differences

SD-OCT Software Differences

SD-OCT Software Differences

SD-OCT Software Differences

SD-OCT Software Differences

reference plane independent neuroretinal rim parameter

Spectral Domain OCT

NFL: Nerve fiber layer (ganglion cells axons)

diagram from Akashi et al. IOVS 2013

Cirrus and Glaucoma

Studies comparing Cirrus SD‐OCT versus Stratus TD‐OCT RNFL thickness:

RTVue and Glaucoma

rim area diagnostic data increased as disease severity increased

12 articles studied Spectralis RNFL parameters  best parameters were…

Global RNFL thickness AUROC 0.880 – 0.978 (good to excellent)

SDOCT has a lot of great information…

Pictures from Carl Zeiss Meditec, Inc

Video Rate Spectral Domain OCT

pictures courtesy Mary Beth Cunnane, MD

best disc parameters: best disc parameters:

2D inferior rim area

best disc parameters: best disc parameters:

2D inferior rim area

best disc parameters: best disc parameters:

2D inferior rim area

best disc parameters: best disc parameters:

2D inferior rim area

rim width ‐ RW RW (9 monkeys)

rim width ‐ RW RW (9 monkeys)

rim width ‐ RW RW (9 monkeys)

minimum distance band (MDB) MDB (16 eyes) disc photos

rim width ‐ RW RW (9 monkeys)

rim width ‐ RW RW (9 monkeys)

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