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Purpose  Optical coherence tomography ( OCT ) enface visualisation of the retinal nerve fibre layer ( RNFL ) reflectance has been found to have some advantages over retinal thickness measures. However, it is not yet clear how abnormalities on enface images relate to findings of abnormalities from other clinical measures such as the circumpapillary retinal nerve fibre layer thickness ( cRNFLT ). We developed a technique to analyse the  RNFL  reflectance on the  OCT  enface images, and to investigate its relation with the  cRNFLT .    Methods  Spectralis ( www.heidelbergengineering.com )  OCT  scans of the central retinal ±24° were analysed in the study eye of 31 controls and 33 patients, ages 61 (±9) and 69 (±8) years respectively. Enface slab‐images were extracted at 16–24, 24–36, and 24–52 μm from the inner limiting membrane in the temporal raphe, perifoveal and disc regions respectively. Reflectance probability maps were generated for the patients based on the control data. Glaucomatous abnormality was defined on the slab‐images when the slab‐area with reflectance abnormality was greater than the 95th percentile, and on the  cRNFLT  when the thickness measure was less than the fifth percentile, of that found in controls. The fraction of slab‐image showing reflectance abnormality was compared to  cRNFLT  in the patient group, using Spearman's rho. Agreement between the findings of abnormality based on  cRNFLT  and slab‐image reflectance was assessed using Cohen's kappa.    Results  Slab‐image and  cRNFLT  findings were in agreement for 26/33 eyes; four subjects showed  cRNFLT  abnormality but not slab‐image abnormality, and three subjects showed slab‐image abnormality but not  cRNFLT  abnormality. Spearman's rho found  r  s (31) = −0.82. The reflectance findings and  cRNFLT  findings were consistent in 27/33 for both the superior temporal ( ST ) and inferior temporal ( IT ) sectors, and Cohen's kappa found 0.53 and 0.61 respectively.    Conclusion  The surface area of enface slab‐images showing  RNFL  reflectance were strongly related to the  cRNFLT  measures, and the classification of a subject with glaucoma based on enface reflectance findings and  cRNFLT  findings had a generally good agreement. The larger retinal area assessed by the enface method preserves the spatial location of the  RNFL  abnormalities, and makes the technique a useful approach for identifying regions of potential  RNFL  abnormality for targeted perimetry.

Evaluating glaucomatous abnormality in peripapillary optical coherence tomography enface visualisation of the retinal nerve fibre layer reflectance