Enhanced Objective Detection of Retinal Nerve Fiber Bundle Defects in Glaucoma With a Novel Method for En Face OCT Slab Image Construction and Analysis

Purpose To introduce and evaluate the performance in detecting glaucomatous abnormalities of a novel method for extracting en face slab images (SMAS), which considers varying individual anatomy and configuration of retinal nerve fiber bundles. Methods Dense central retinal spectral domain optical coherence tomography scans were acquired in 16 participants with glaucoma and 19 age-similar controls. Slab images were generated by averaging reflectivity over different depths below the inner limiting membrane according to several methods. SMAS considered multiple 16 µm thick slabs from 8 to 116 µm below the inner limiting membrane, whereas 5 alternative methods considered single summary slabs of various thicknesses and depths. Superpixels in eyes with glaucoma were considered abnormal if below the first percentile of distributions fitted to control data for each method. The ability to detect glaucoma defects was measured by the proportion of abnormal superpixels. Proportion of superpixels below the fitted first percentile in controls was used as a surrogate false-positive rate. The effects of slab methods on performance measures were evaluated with linear mixed models. Results The ability to detect glaucoma defects varied between slab methods, χ 2 (5) = 120.9, P < 0.0001, with SMAS showing proportion of abnormal superpixels 0.05 to 0.09 greater than alternatives (all P < 0.0001). No slab method found abnormal superpixels in controls. Conclusions SMAS outperformed alternatives in detecting abnormalities in eyes with glaucoma. SMAS evaluates all depths with potential retinal nerve fiber bundle presence by combining multiple slabs, resulting in greater detection of reflectance abnormalities with no increase in surrogate false positives. Translational Relevance SMAS may be used to objectively detect glaucoma defects in en face optical coherence tomography images.