Diagnostic assessment of glaucoma and non-glaucomatous optic neuropathies via optical texture analysis of the retinal nerve fibre layer

Author(s): Christopher Kai Shun Leung (1,2,3,4), Alexander Ka Ngai Lam (5), Robert Neal Weinreb (6), David F Garway-Heath (7), Marco Yu (8), Philip Yawen Guo (5), Vivian Sheung Man Chiu (5), Kelvin Ho Nam Wan (9,10,11), Mandy Wong (10), Ken Zhongheng Wu (5), Carol Yim Lui Cheung (9), Chen Lin (9), Carmen Kar Mun Chan (9,10), Noel Ching Yan Chan (9,12), Ka Wai Kam (12), Gilda Wing Ki Lai (5)

1 Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong. cleung21@hku.hk.
2 Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong. cleung21@hku.hk.
3 Queen Mary Hospital, Pok Fu Lam, Hong Kong. cleung21@hku.hk.
4 Hong Kong Eye Hospital, Kowloon City, Hong Kong. cleung21@hku.hk.
5 Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
6 Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, CA, USA.
7 NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
8 Singapore Eye Research Institute, Singapore, Singapore.
9 Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.
10 Hong Kong Eye Hospital, Kowloon City, Hong Kong.
11 Department of Ophthalmology, Tuen Mun Hospital, Tuen Mun, Hong Kong.
12 Department of Ophthalmology, Prince of Wales Hospital, Shatin, Hong Kong.

The clinical diagnostic evaluation of optic neuropathies relies on the analysis of the thickness of the retinal nerve fibre layer (RNFL) by optical coherence tomography (OCT). However, false positives and false negatives in the detection of RNFL abnormalities are common. Here we show that an algorithm integrating measurements of RNFL thickness and reflectance from standard wide-field OCT scans can be used to uncover the trajectories and optical texture of individual axonal fibre bundles in the retina and to discern distinctive patterns of loss of axonal fibre bundles in glaucoma, compressive optic neuropathy, optic neuritis and non-arteritic anterior ischaemic optic neuropathy. Such optical texture analysis can detect focal RNFL defects in early optic neuropathy, as well as residual axonal fibre bundles in end-stage optic neuropathy that were indiscernible by conventional OCT analysis and by red-free RNFL photography. In a diagnostic-performance study, optical texture analysis of the RNFL outperformed conventional OCT in the detection of glaucoma, as defined by visual-field testing or red-free photography. Our findings show that optical texture analysis of the RNFL for the detection of optic neuropathies is highly sensitive and specific.

© 2022. The Author(s), under exclusive licence to Springer Nature Limited.

PMID: 34992272 DOI: 10.1038/s41551-021-00813-x

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