Comparison of Different OCT Systems Teresa C. Chen, MD Associate - - PDF document
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
Teresa C. Chen, MD
Associate Professor of Ophthalmology, Harvard Medical School Glaucoma Service, Massachusetts Eye and Ear Infirmary
– Department of Defense: Grant Support – Harvard Foundation Grant (Fidelity Charitable Fund): Grant Support
to help diagnose glaucoma
Lin SC, Singh K, Jampel HD, Hodapp EA, 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.
Lin SC, Singh K, Jampel HD, Hodapp EA, 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.
Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K, Radhakrishnan S, Takusagawa H, Chen PP. Spectral Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018;125:1817‐1827. SLD Light Source Reference Mirror Photo Detector A-line Beam Splitter
Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, Hee MR, Flotte T, Gregory K, Puliafito CA, Fujimoto JG. Optical Coherence Tomography. Science, 1991.
SLD Light Source Reference Mirror Spectrometer Beam Splitter
Fourier transform
American Glaucoma Society Sarasota, Florida, 2004
“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
Domain Optical Doppler Tomography. Optics Express 2003; 11 (25): 3490-7.
by Ultrahigh-Speed Spectral Domain OCT. Opt Lett 2004;29(5):480-482.
Video-Rate Spectral Domain OCT of the Human Retina and Optic Nerve. Opt Express 2004;12(3):367-376.
High-speed Retinal Imaging Using Spectral Domain OCT. Opt Express 2004;12(11):2435-2447.
for the first time in 3D (video-rate)
wide field!
708 articles Inclusion criteria:
Exclusion criteria:
Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K, Radhakrishnan S, Takusagawa H, Chen PP. Spectral Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018;125:1817‐1827.
708 articles Inclusion criteria:
Exclusion criteria:
Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K, Radhakrishnan S, Takusagawa H, Chen PP. Spectral Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018;125:1817‐1827.
708 articles Inclusion criteria:
Exclusion criteria:
Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K, Radhakrishnan S, Takusagawa H, Chen PP. Spectral Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018;125:1817‐1827.
Inclusion & exclusion criteria yielded:
708 articles Inclusion criteria:
Exclusion criteria:
Chen TC, Hoguet A, Junk A, Nouri‐Mahdavi K, Radhakrishnan S, Takusagawa H, Chen PP. Spectral Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018;125:1817‐1827.
Many different SD‐OCT machines
Spectralis Spectral OCT SLO SOCT Copernicus Bioptigen RTVue Cirrus Topcon 3D OCT time domain OCT
Dublin, California)
GmbH, Heidelberg, Germany)
Paramus, New Jersey)
Research Triangle Park, North Carolina)
SA, Zawiercie, Poland)
Spectralis Spectral OCT SLO SOCT Copernicus Bioptigen RTVue Cirrus Topcon 3D OCT
Dublin, California)
GmbH, Heidelberg, Germany)
Paramus, New Jersey)
time domain OCT
Spectralis Spectral OCT SLO SOCT Copernicus Bioptigen RTVue Cirrus Topcon 3D OCT
SDOCT machines appear to have similar clinical 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)
GmbH, Heidelberg, Germany)
Paramus, New Jersey)
time domain OCT Spectralis Spectral OCT SLO SOCT Copernicus Bioptigen RTVue Cirrus Topcon 3D OCT
RNFL thickness values between machines are not 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.
Dublin, California)
GmbH, Heidelberg, Germany)
Paramus, New Jersey)
time domain OCT
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 values are not interchangeable for different SDOCT machines…
RNFL “thinning” due to different SDOCT machines…
Stratus Cirrus Spectralis
2009 2013 2014
∼ 104 microns ∼ 97 microns ∼ 105 microns
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
Ishikawa, Ellen Hertzmark, Robert Noecker, Joel
different normative databases
Similar diagnostic data Different machines… RNFL values not interchangeable signal strength ranges normative databases software
Many different SD‐OCT machines
RNFL
macula
RNFL
macula most commonly used Table 1. 3.4mm to 3.46 mm diameter scan circle
RNFL
macula most commonly used Table 1. 3.4mm to 3.46 mm diameter scan circle
FDA approved in 2016
* Gmeiner et al. IOVS 2016;57(9):575‐584. RNFL
macula
FDA approved in 2016
* Gmeiner et al. IOVS 2016;57(9):575‐584. RNFL
macula
RNFL
macula Table 1. reference plane vs. reference plane independent
○ Spectralis – BMO‐MRW
AGS 2004
Chen TC, Zeng A, Sun W, Mujat M, de Boer JF. Spectral Domain Optical Coherence Tomography in Glaucoma. International Ophthalmology Clinics 2008 Fall; 48 (4): 29‐45. Chen TC. Trans Am Oph Soc 2009;107:254‐81.
…better than reference plane parameters Chauhan et al. Ophthalmology 2013. Tsikata et al. IOVS 2016.
minimum distance band (MDB) BMO‐MRW minimum circumpapillary band (MCB)
MDB (16 eyes) area and thickness RPE/BM complex (193 raster lines) (Chen, Int Oph Clinics 2008 Chen, Trans Am Oph Soc 2009) MCB (3 eyes) area Elschnig’s ring (60 raster lines) (Povazay, JBO 2007) BMO‐MRW (155 patients) area and width BMO (24 radial lines) (Chauhan, Ophthalmol 2013)
reference plane independent neuroretinal rim parameter
RNFL
macula RNFL
macula
3D OCT GCC GCIPL NFL Spectralis Total retina thickness 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 GCC: Ganglion Cell Complex = NFL + GCL + IPL Cirrus GCA: Ganglion Cell Analysis GCC = NFL + GCL + IPL GCIPL = GCL + IPL
macula
diagram from Akashi et al. IOVS 2013
Spectralis Glaucoma Module Premium Edition (GMPE) GMPE FDA approved in 2016
Posterior Pole Asymmetry Analysis (PPAA)
Miraftabi et al TVST 2016
ganglion cell thickness maps
Miraftabi, Amini, Morales, Henry, Yu, Afifi, Coleman, Caprioli, Nouri‐Mahdavi. IOVS 2016.
“Measuring GCL does not provide any advantage for detection of progression with current SD‐OCT technology”
Similar diagnostic data Different machines… RNFL values not interchangeable signal strength ranges normative databases software
Many different SD‐OCT machines
location severe disease signal strength Cirrus RTVue Spectralis 3D OCT
Accuracy of a test is quantified by AUROC:
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 RTVue Spectralis 3D OCT
RNFL
macula
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) 26 articles studied Cirrus RNFL thickness: RNFL
macula
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 Studies comparing Cirrus SD‐OCT versus Stratus TD‐OCT RNFL thickness:
RNFL
macula
8 articles studied Cirrus disc parameters: Rim area Disc area Average cup‐to‐disc ratio Vertical cup‐to‐disc ratio Cup volume RNFL
macula
8 articles studied Cirrus disc parameters: Rim area AUROC 0.655 – 0.960 (poor to excellent) Disc area Average cup‐to‐disc ratio Vertical cup‐to‐disc ratio AUROC 0.400 – 0.962 (uninformative to excellent) Cup volume
RNFL
macula
8 articles studied Cirrus disc parameters: Rim area AUROC 0.655 – 0.960 (poor to excellent) Disc area Average cup‐to‐disc ratio Vertical cup‐to‐disc ratio AUROC 0.400 – 0.962 (uninformative to excellent) Cup volume better diagnostic ability for worse disease severity advanced glaucoma ‐ rim area AUROC 0.937 (excellent) advanced glaucoma – vertical cup‐to‐disc ratio AUROC 0.911‐0.941 (excellent) RNFL
macula
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)
macula
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)
RNFL
RNFL
macula
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) RNFL
macula
19 articles studied RTVue RNFL thickness: better diagnostic ability for worse disease severity 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)
RNFL
macula
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 8 articles studied RTVue disc parameters: RNFL
macula
Cup area Disc area Rim area AUROC 0.720 – 0.960 (fair to excellent) Rim volume Nerve head volume Cup volume Cup disc area ratio Horizontal cup‐to‐disc ratio Vertical cup‐to‐disc ratio AUROC 0.621 – 0.970 (poor to excellent) 8 articles studied RTVue disc parameters: Inferior
RNFL
macula
Cup area Disc area Rim area AUROC 0.720 – 0.960 (fair to excellent) Rim volume Nerve head volume Cup volume Cup disc area ratio Horizontal cup‐to‐disc ratio Vertical cup‐to‐disc ratio AUROC 0.621 – 0.970 (poor to excellent) 8 articles studied RTVue disc parameters: Inferior RNFL
macula
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)
RNFL
macula
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) RNFL
macula
19 articles studied RTVue macular parameters: 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)
RNFL
macula
2 articles studied RTVue macular parameters: 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) macula 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
RNFL
RNFL
macula
* Gmeiner et al. IOVS 2016;57(9):575‐584.
RNFL
macula
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) 12 articles studied Spectralis RNFL parameters best parameters were… RNFL
macula
BMO‐MRW (24 radial line scan) AUROC 0.929 – 0.960 (excellent) Unclear if BMO‐MRW better than RNFL thickness
RNFL
macula
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 RNFL
macula
inferior macular retina thickness best AUROC 0.858 (good)
RNFL macula
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)
abilities to distinguish between normal & glaucoma patients
interchangeable
(RNFL ~ macula ~ disc)
diagnostic performance
1) RNFL thickness 2) Macula
3) Disc
that should always be correlated with clinical data
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 and VU University
Massachusetts Eye and Ear Infirmary
Pictures from Carl Zeiss Meditec, Inc
pictures courtesy Mary Beth Cunnane, MD
(A-line) (frame) C-mode
B-scan
2D 3D 1D
A-scan
best disc parameters: global rim area inferior rim area vertical cup-to-disc ratio best disc parameters: MDB
Software 2D 3D
best disc parameters: global rim area inferior rim area vertical cup-to-disc ratio best disc parameters: MDB
Software 2D 3D
best disc parameters: global rim area inferior rim area vertical cup-to-disc ratio best disc parameters: MDB BMO-MRW
Software 2D 3D
best disc parameters: global rim area inferior rim area vertical cup-to-disc ratio best disc parameters: MDB BMO-MRW rim volume
Software 2D 3D
minimum distance band (MDB) rim width ‐ RW minimum circumpapillary band (MCB)
MDB (16 eyes) area and thickness RPE/BM complex (193 raster lines) (Chen, Int Oph Clinics 2008 Chen, Trans Am Oph Soc 2009) MCB (3 eyes) area Elschnig’s ring (60 raster lines) (Povazay, JBO 2007) RW (9 monkeys) area and width BMO (80 radial lines) (Strouthidis, IOVS 2011)
minimum distance band (MDB) rim width ‐ RW minimum circumpapillary band (MCB)
MDB (16 eyes) area and thickness RPE/BM complex (193 raster lines) (Chen, Int Oph Clinics 2008 Chen, Trans Am Oph Soc 2009) MCB (3 eyes) area Elschnig’s ring (60 raster lines) (Povazay, JBO 2007) RW (9 monkeys) area and width BMO (80 radial lines) (Strouthidis, IOVS 2011)
minimum distance band (MDB) rim width ‐ RW minimum circumpapillary band (MCB)
MDB (16 eyes) area and thickness RPE/BM complex (193 raster lines) (Chen, Int Oph Clinics 2008 Chen, Trans Am Oph Soc 2009) MCB (3 eyes) area Elschnig’s ring (60 raster lines) (Povazay, JBO 2007) RW (9 monkeys) area and width BMO (80 radial lines) (Strouthidis, IOVS 2011)
minimum distance band (MDB) rim width ‐ RW minimum circumpapillary band (MCB)
MDB (16 eyes) area and thickness RPE/BM complex (193 raster lines) (Chen, Int Oph Clinics 2008 Chen, Trans Am Oph Soc 2009) MCB (3 eyes) area Elschnig’s ring (60 raster lines) (Povazay, JBO 2007) RW (9 monkeys) area and width BMO (80 radial lines) (Strouthidis, IOVS 2011)
disc photos HVF
minimum distance band (MDB) rim width ‐ RW minimum circumpapillary band (MCB)
MDB (16 eyes) area and thickness RPE/BM complex (193 raster lines) (Chen, Int Oph Clinics 2008 Chen, Trans Am Oph Soc 2009) MCB (3 eyes) area Elschnig’s ring (60 raster lines) (Povazay, JBO 2007) RW (9 monkeys) area and width BMO (80 radial lines) (Strouthidis, IOVS 2011)