Original article
Enhanced Depth Imaging Optical Coherence Tomography in Uveitis: An Intravisit and Interobserver Reproducibility Study

https://doi.org/10.1016/j.ajo.2016.01.004Get rights and content

Purpose

To determine the intravisit and interobserver reproducibility of subfoveal choroidal thickness (SFCT) measurements in patients with noninfectious uveitis.

Design

Reliability analysis.

Methods

Two consecutive enhanced depth imaging optical coherence tomography (EDI-OCT) scans were obtained at a single clinic visit for 97 uveitic eyes from patients ≥16 years of age with noninfectious anterior (n = 10), intermediate (n = 11), posterior (n = 26), and panuveitis (n = 13) at the National Eye Institute. SFCT was manually measured by 2 ophthalmologists using manufacturer's software. Intravisit and interobserver reproducibility of SFCT measurements were assessed by using the Bland-Altman method to determine the estimate of bias (mean difference in SFCT measurements), 95% limits of agreement, and coefficients of repeatability. The reproducibility of these measurements was also compared between groups by anatomic location and clinical activity.

Results

Of 97 eyes, 65 (67.0%) were clinically quiet, 18 (18.6%) were minimally active, and 14 (14.4%) were active at the time the scans were obtained. Manual SFCT measurements were reproducible within 32.4 ± 3.8 μm between sessions for the same observer and 51.4 ± 8.5 μm between observers for the same session. Coefficients of repeatability did not differ significantly by anatomic location or disease activity.

Conclusions

Manual SFCT measurements obtained by EDI-OCT are reproducible in uveitis patients, with coefficients of repeatability that are nearly comparable to those published for normal eyes. This study provides guidance for using manual SFCT measurements in clinical practice, but further studies are still needed to determine their utility in clinical trials.

Section snippets

Methods

A reliability analysis was conducted using 97 uveitic eyes of 60 participants with noninfectious anterior (n = 10), intermediate (n = 11), posterior (n = 26), and panuveitis (n = 13), who were seen at the National Eye Institute (NEI) from June 2012 to March 2015. This reproducibility study was conducted under a clinical research protocol registered in the National Clinical Trials database (http://www.clinicaltrials.gov; NCT00708955), which was prospectively approved by the National Institutes

Results

A total of 97 uveitic eyes from 60 participants, with a mean age of 43.6 years (range, 16–72 years), was included in the study. Thirty-eight participants were female. Twenty-six participants were non-Hispanic white, 16 were non-Hispanic black, 13 were Hispanic/Latino, and 5 were Asian. Ten participants had noninfectious anterior uveitis, 11 had noninfectious intermediate uveitis, 26 had noninfectious posterior uveitis, and 13 had noninfectious panuveitis. Fifty-one participants (76.7%) had

Discussion

The choroid is a vascular structure located most posteriorly in the uveal tract and has multiple physiologic functions, including the supply of oxygen and nutrients to the outer retina and the removal of its waste products,24 but it has also been implicated in the pathophysiology of a number of uveitides, including VKH syndrome,7, 8, 9, 10, 11 Behçet disease,12, 13, 14 and birdshot chorioretinopathy.17, 18 With the introduction of EDI-OCT, better clinical characterization of these diseases has

References (28)

  • R.F. Spaide et al.

    Enhanced depth imaging spectral-domain optical coherence tomography

    Am J Ophthalmol

    (2008)
  • R.B. Nussenblatt et al.

    Standardization of vitreal inflammatory activity in intermediate and posterior uveitis

    Ophthalmology

    (1985)
  • D.L. Nickla et al.

    The multifunctional choroid

    Prog Retin Eye Res

    (2010)
  • Heidelberg Engineering. Spectral Domain Optical Coherence Tomography (SD-OCT). Available at...
  • J.M. Bland et al.

    Statistical methods for assessing agreement between two methods of clinical measurement

    Lancet

    (1986)
  • W. Rahman et al.

    Repeatability of manual subfoveal choroidal thickness measurements in healthy subjects using the technique of enhanced depth imaging optical coherence tomography

    Invest Ophthalmol Vis Sci

    (2011)
  • L. Shao et al.

    Reproducibility of subfoveal choroidal thickness measurements with enhanced depth imaging by spectral-domain optical coherence tomography

    Invest Ophthalmol Vis Sci

    (2013)
  • E.E. Karaca et al.

    Reproducibility of choroidal thickness measurements in healthy Turkish subjects

    Eur J Ophthalmol

    (2014)
  • A.H. Fong et al.

    Choroidal evaluation using enhanced depth imaging spectral-domain optical coherence tomography in Vogt-Koyanagi-Harada disease

    Retina

    (2011)
  • I. Maruko et al.

    Subfoveal choroidal thickness after treatment of Vogt-Koyanagi-Harada disease

    Retina

    (2011)
  • K. Nakai et al.

    Choroidal observations in Vogt-Koyanagi-Harada disease using high-penetration optical coherence tomography

    Graefes Arch Clin Exp Ophthalmol

    (2012)
  • M. Nakayama et al.

    Enhanced depth imaging optical coherence tomography of the choroid in Vogt-Koyanagi-Harada disease

    Retina

    (2012)
  • F.T. da Silva et al.

    Enhanced depth imaging optical coherence tomography in long-standing Vogt-Koyanagi-Harada disease

    Br J Ophthalmol

    (2013)
  • M. Kim et al.

    Choroidal thickness in Behcet's uveitis: an enhanced depth imaging-optical coherence tomography and its association with angiographic changes

    Invest Ophthalmol Vis Sci

    (2013)

    • Cited by (12)

    View all citing articles on Scopus

    Supplemental Material available at AJO.com.

    View full text
    Published by Elsevier Inc.