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Randomized Controlled Trial
. 2016 Jul;100(7):956-962.
doi: 10.1136/bjophthalmol-2015-307035. Epub 2015 Nov 14.

Assessment of estimated retinal atrophy progression in Stargardt macular dystrophy using spectral-domain optical coherence tomography

Rupert W Strauss  1   2   3 , Beatriz Muñoz  1 , Yulia Wolfson  1 , Raafay Sophie  1 , Emily Fletcher  1   4 , Millena G Bittencourt  1 , Hendrik P N Scholl  1
Affiliations
Randomized Controlled Trial

Assessment of estimated retinal atrophy progression in Stargardt macular dystrophy using spectral-domain optical coherence tomography

Rupert W Strauss et al. Br J Ophthalmol. 2016 Jul.

Abstract

Aims: To estimate disease progression based on analysis of macular volume measured by spectral-domain optical coherence tomography (SD-OCT) in patients affected by Stargardt macular dystrophy (STGD1) and to evaluate the influence of software errors on these measurements.

Methods: 58 eyes of 29 STGD1 patients were included. Numbers and types of algorithm errors were recorded and manually corrected. In a subgroup of 36 eyes of 18 patients with at least two examinations over time, total macular volume (TMV) and volumes of all nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields were obtained. Random effects models were used to estimate the rate of change per year for the population, and empirical Bayes slopes were used to estimate yearly decline in TMV for individual eyes.

Results: 6958 single B-scans from 190 macular cube scans were analysed. 2360 (33.9%) showed algorithm errors. Mean observation period for follow-up data was 15 months (range 3-40). The median (IQR) change in TMV using the empirical Bayes estimates for the individual eyes was -0.103 (-0.145, -0.059) mm3 per year. The mean (±SD) TMV was 6.321±1.000 mm3 at baseline, and rate of decline was -0.118 mm3 per year (p=0.003). Yearly mean volume change was -0.004 mm3 in the central subfield (mean baseline=0.128 mm3), -0.032 mm3 in the inner (mean baseline=1.484 mm3) and -0.079 mm3 in the outer ETDRS subfields (mean baseline=5.206 mm3).

Conclusions: SD-OCT measurements allow monitoring the decline in retinal volume in STGD1; however, they require significant manual correction of software errors.

Keywords: Dystrophy; Imaging; Macula; Retina.

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Figures

Figure 1
Figure 1
Example of the standard output of the Spectralis optical coherence tomography (OCT) measurements map using the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid for different follow-up examinations after manual correction of segmentation errors. Left side: confocal scanning laser ophthalmoscope image with scanned area (macular cube in false colour code) is provided. Right side: (from top to bottom) measurements of retinal volume (red numbers) and total macular volume (TMV, red circle) and all nine ETDRS subfields are given for the first examination (reference) and the follow-up examination (middle) including retinal and volume. The differences for these measurements are given in the average change map (bottom). In this example, a decrease in TMV of −0.06 mm3 was observed.
Figure 2
Figure 2
Confocal scanning laser ophthalmoscope image on the left side with the corresponding cross-sectional single B-scan on the right side, as provided by the software. Examples exhibit algorithm errors prior to (A) and after (B) manual correction of these segmentation errors. The example in (A) shows both a misidentification of the inner retina (arrows) and the outer (block arrows) retinal limits, respectively.
Figure 3
Figure 3
The change of total macular volume (TMV) is shown over time. (A) Examples of the measurements (retinal thickness and volume (red)) in all Early Treatment of Diabetic Retinopathy Study (ETDRS) of the right eye of one patient are given at three different visits in a yearly interval. The decrease (delta) of TMV (red circle) between the visits is illustrated. (B) Pooled data of all patients with follow-up visits are shown. The estimated change in of TMV is graphically shown (blue line). The mean (±SD) TMV was 6.321±1.000 mm3 at baseline and the rate of decline was −0.118 mm3 per year (p=0.003).
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