An arcuate-shaped RNFL defect is considered a hallmark of glaucomatous damage.( 12 12. To identify glaucomatous optic neuropathy (GON), we need to distinguish artifacts from those findings characteristic of glaucomatous damage seen on the probability map. GLAUCOMA-LIKE ARTIFACTS DUE TO VARIATION IN THE ANATOMY OF RETINAL NERVE FIBER BUNDLES An anatomical model for understanding artifacts due to variation in retinal nerve fiber bundles Moreover, we do not discuss other retinal or neuro-ophthalmological conditions that can mimic or confuse the assessment of glaucomatous structural damage. They may lead the clinician to assume that the disease is present. Instead, we mainly focus on anatomy-related artifacts in which the retinal layer segmentation and thickness measurements are correct however, due to its anatomic variability, which must be compared to the normative database, the probability maps (also known as deviation maps) can show abnormal (red and yellow) regions. In the interest of brevity, we largely ignore technical factors such as poor scan quality and errors in segmentation. Here, we review the most common types of artifacts that may be confused with glaucomatous damage. Therefore, it is important for clinicians to become familiar with the various sources of artifacts and be able to recognize and differentiate them from actual signs of structural damage. However, there are several types of artifacts that can affect these maps and result in changes which resemble structural damage due to glaucoma. 2022:101052.) In the case of summary metrics affected by artifacts, it is possible to avoid this confusion by simply ignoring them and reviewing thickness and probability/deviation maps provided in OCT reports. Detecting glaucoma with only OCT: Implications for the clinic, research, screening, and AI development. Hood DC, La Bruna S, Tsamis E, Thakoor KA, Rai A, Leshno A, et al. Avoiding clinical misinterpretation and artifacts of optical coherence tomography analysis of the optic nerve, retinal nerve fiber layer, and ganglion cell layer. Glaucoma versus red disease: imaging and glaucoma diagnosis. 2011 52(6):3338-44.) In addition, the test is fast, requires minimal cooperation from the patient, and results in little to no discomfort to the patient, which enables repeat testing as needed.Īs with all diagnostic tests, the OCT reports can be misinterpreted due to the presence of artifacts.( 12 12. Reproducibility of retinal nerve fiber layer thickness measurements using the eye tracker and the retest function of spectralis SD-OCT in glaucomatous and healthy control eyes. Langenegger SJ, Funk J, Töteberg-Harms M. Reproducibility of peripapillary retinal nerve fiber layer thickness and optic nerve head parameters measured with Cirrus HD-OCT in glaucomatous eyes. Mwanza JC, Chang RT, Budenz DL, Durbin MK, Gendy MG, Shi W, et al. Reproducibility of peripapillary retinal nerve fiber thickness measurements with stratus OCT in glaucomatous eyes. Budenz DL, Fredette MJ, Feuer WJ, Anderson DR. Reliability of nerve fiber layer thickness measurements using optical coherence tomography in normal and glaucomatous eyes. Carpineto P, Ciancaglini M, Zuppardi E, Falconio G, Doronzo E, Mastropasqua L. Reproducibility of nerve fiber layer thickness measurements by use of optical coherence tomography. Blumenthal EZ, Williams JM, Weinreb RN, Girkin CA, Berry CC, Zangwill LM. Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography. Schuman JS, Pedut-Kloizman T, Hertzmark E, Hee MR, Wilkins JR, Coker JG, et al. 1995 119(4):415-21.) The advantage of OCT lies in the high-resolution and reproducible information provided about the retinal nerve fiber (RNFL) and ganglion cell layers (GCL), which are the most relevant for glaucoma evaluation.( 6 6. Agreement between clinicians and a confocal scanning laser ophthalmoscope in estimating cup/disk ratios. Zangwill LM, Shakiba S, Caprioli J, Weinreb RN. Agreement among optometrists, ophthalmologists, and residents in evaluating the optic disc for glaucoma. Abrams LS, Scott IU, Spaeth GL, Quigley HA, Varma R. Intraobserver and interobserver agreement in measurement of optic disc characteristics. Tielsch JM, Katz J, Quigley HA, Miller NR, Sommer A. judgement of cup-disc ratios: statistical evaluation of intraobserver and interobserver error. Variability of expert observers in evaluating the optic disc. Although the structural component of glaucoma damage, from a historical standpoint, has been evaluated predominantly with disc photographs and/or slit-lamp examination, these methods have poor reproducibility and poor inter-observer agreement.( 1 1. Glaucoma clinicians use optical coherence tomography (OCT) as an important ancillary tool for the detection of glaucoma as well as monitoring its progression.
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