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. 2017 Dec:184:108-114.
doi: 10.1016/j.ajo.2017.10.005. Epub 2017 Oct 14.

Macular Fluid Reduces Reproducibility of Choroidal Thickness Measurements on Enhanced Depth Optical Coherence Tomography

Sophia S Wong  1 , Vivian S Vuong  1 , David Cunefare  2 , Sina Farsiu  3 , Ala Moshiri  1 , Glenn Yiu  4
Affiliations

Macular Fluid Reduces Reproducibility of Choroidal Thickness Measurements on Enhanced Depth Optical Coherence Tomography

Sophia S Wong et al. Am J Ophthalmol. 2017 Dec.

Abstract

Purpose: To determine if different types of retinal fluid in the central macula affect the reproducibility of choroidal thickness (CT) measurements on enhanced depth imaging optical coherence tomography (EDI-OCT).

Design: Retrospective reliability analysis.

Methods: EDI-OCT images were obtained and the choroidal-scleral junction was analyzed through semiautomated segmentation. CT was measured at the fovea and averaged across the central 3-mm horizontal segment. Demographic data, central macular thickness, and type of fluid present were recorded. Intragrader and intergrader repeatability were assessed using the intraclass correlation coefficient (ICC) and coefficient of repeatability (CR).

Results: Of 124 eyes analyzed, 60 (48.4%) had diabetic macular edema, 32 (25.8%) had neovascular age-related macular degeneration, and 32 (25.8%) had other causes of fluid. Intergrader ICC (CR) was 0.95 (74.1 μm) and 0.96 (63.9 μm) for subfoveal and average CT, respectively. CR was similar across various causes of retinal fluid, but was worst for subretinal fluid compared to intraretinal or sub-retinal pigment epithelial fluid. CR also worsened with increasing choroidal thickness, but was not affected by retinal thickness. Intragrader repeatability was generally greater than intergrader values, and followed the same trend.

Conclusions: The presence of macular fluid reduces CT measurement reproducibility, particularly in eyes with subretinal fluid and greater choroidal thickness. A difference of 74.1 μm in subfoveal CT or 63.9 μm in average CT may be necessary to detect true clinical change in eyes with macular fluid.

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Figures

FIGURE 1
FIGURE 1
Enhanced-depth imaging optical coherence tomography (EDI-OCT) images of eyes with macular fluid using semi-automated segmentation. Scans are shown before (top) and after (bottom) segmentation, including eyes with intraretinal fluid (left), subretinal fluid (center), and sub-retinal pigment epithelial (sub-RPE) fluid (right). Segmentation lines delineate the internal limiting membrane (top line), Bruch’s membrane (middle line), and choroidal-scleral junction (bottom line).
FIGURE 2
FIGURE 2
Bland-Altman plots of intergrader agreement for measuring choroidal thickness in eyes with macular fluid. Plots are shown by diagnosis (top) and fluid type (bottom). Solid lines represent the mean difference, while dashed lines show the 95% limits of agreement.
See this image and copyright information in PMC

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