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Editors Selection IGR 11-1

RNFL Imaging: RNFL loss: Cirrus OCT vs Spectral OCT vs HRT3

Comment by Murray Fingeret on:

48307 Comparison of retinal nerve fiber layer imaging by spectral domain optical coherence tomography and scanning laser ophthalmoscopy, Ye C; To E; Weinreb RN et al., Ophthalmology, 2011; 118: 2196-2202

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In this cohort study, the Ye et al. (1850) compare the Cirrus Spectral Domain Optical Coherence Tomographer (OCT) and Confocal Scanning Laser Ophthalmoscopy (CSLO) as performed with the Heidelberg Retinal Tomographer (HRT 3) in their ability to identify and measure retinal nerve fiber layer (RNFL) defects. The CSLO was the reference instrument in which it detected 61 localized defects from 51 eyes from 41 individuals with glaucoma. Those 51 eyes were then scanned with the Cirrus OCT, which was able to detect RNFL defects in all eyes that were identified by CSLO. Spectral OCT was able to also identify areas of RNFL loss not visualized with the CSLO. Defects identified with the OCT were larger in area and angular width than noted with CSLO.

OCTs perform at least as well as the photographs in identifying and measuring RNFL loss

There are a several important points to take from this study. OCTs have become an important part of the glaucoma evaluation, and are commonly used to evaluate and manage glaucoma/glaucoma suspects. Health insurance data from the United States indicates that more OCTs are being reimbursed than retinal photographs, which may be an artifact due to reimbursement rates and how claims data are coded. Still as many clinicians use OCTs instead of retinal photographs to evaluate glaucoma suspects and glaucoma, it is encouraging to find evidence that they perform at least as well as the photographs in identifying and measuring RNFL loss.

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