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. 2021 Jul 13;97(2):68-79.
doi: 10.1212/WNL.0000000000012125. Epub 2021 Apr 28.

APOSTEL 2.0 Recommendations for Reporting Quantitative Optical Coherence Tomography Studies

Affiliations

APOSTEL 2.0 Recommendations for Reporting Quantitative Optical Coherence Tomography Studies

Aykut Aytulun et al. Neurology. .

Abstract

Objective: To update the consensus recommendations for reporting of quantitative optical coherence tomography (OCT) study results, thus revising the previously published Advised Protocol for OCT Study Terminology and Elements (APOSTEL) recommendations.

Methods: To identify studies reporting quantitative OCT results, we performed a PubMed search for the terms "quantitative" and "optical coherence tomography" from 2015 to 2017. Corresponding authors of the identified publications were invited to provide feedback on the initial APOSTEL recommendations via online surveys following the principle of a modified Delphi method. The results were evaluated and discussed by a panel of experts and changes to the initial recommendations were proposed. A final survey was recirculated among the corresponding authors to obtain a majority vote on the proposed changes.

Results: A total of 116 authors participated in the surveys, resulting in 15 suggestions, of which 12 were finally accepted and incorporated into an updated 9-point checklist. We harmonized the nomenclature of the outer retinal layers, added the exact area of measurement to the description of volume scans, and suggested reporting device-specific features. We advised to address potential bias in manual segmentation or manual correction of segmentation errors. References to specific reporting guidelines and room light conditions were removed. The participants' consensus with the recommendations increased from 80% for the previous APOSTEL version to greater than 90%.

Conclusions: The modified Delphi method resulted in an expert-led guideline (evidence Class III; Grading of Recommendations, Assessment, Development and Evaluations [GRADE] criteria) concerning study protocol, acquisition device, acquisition settings, scanning protocol, funduscopic imaging, postacquisition data selection, postacquisition analysis, nomenclature and abbreviations, and statistical approach. It will be essential to update these recommendations to new research and practices regularly.

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Figures

Figure 1
Figure 1. Modified Delphi Method
The modified Delphi method is described as a consensus-building process. We contacted 892 authors of quantitative (optical coherence tomography [OCT]) studies identified by PubMed (I) using an online survey, in which feedback on the original Advised Protocol for OCT Study Terminology and Elements (APOSTEL) 2016 criteria was requested. The feedback of the 73 responding OCT authors was analyzed by a panel of experts (II) and changes to the APOSTEL recommendations were proposed (III). A revised version (IV) was proposed to the OCT authors (n = 116), who approved the revisions by majority vote, which led to the final revised 2020 APOSTEL criteria (V).
Figure 2
Figure 2. Consensus Nomenclature for Retinal Structures
The different layers (and their boundaries) are illustrated in a central horizontal spectral-domain optical coherence tomography scan through the middle of the fovea. Retinal structures and layers: BM = Bruch membrane; ELM = external limiting membrane; EZ = ellipsoid zone (inner and outer segment junction); GCL = ganglion cell layer; ILM = inner limiting membrane; INL = inner nuclear layer; IPL = inner plexiform layer; IZ = interdigitation zone; MZ = myoid zone; ONL = outer nuclear layer; OPL = outer plexiform layer; OSP = outer segment of the photoreceptors; RNFL = retinal nerve fiber layer; RPE = retinal pigment epithelium. Compound layers: GCIP = ganglion cell and inner plexiform layer (composite of macular GCL and IPL); IRL = inner retinal layers (composite of macular RNFL, GCL, and IPL); ONPL = outer nuclear and plexiform layer (composite of ONL and OPL). Copyright by IMSVISUAL and licensed under CC-BY-4.0 for this publication (imsvisual.org/resources/media).

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