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Jan Lammer, Matthias Bolz, Bernhard Baumann, Michael Pircher, Bianca Gerendas, Ferdinand Schlanitz, Christoph K. Hitzenberger, Ursula Schmidt-Erfurth; Detection and Analysis of Hard Exudates by Polarization-Sensitive Optical Coherence Tomography in Patients With Diabetic Maculopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(3):1564-1571. doi: https://doi.org/10.1167/iovs.13-13539.
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© ARVO (1962-2015); The Authors (2016-present)
To image and analyze hard exudates (HEs) and their precursors in patients with diabetic macular edema (DME) by using polarization-sensitive optical coherence tomography (PS-OCT).
Twenty-two eyes of 16 patients with DME were imaged by using color fundus photography (CF) and PS-OCT. In PS-OCT, HEs were automatically detected by their distinct polarization-scrambling qualities. Color fundus images were manually graded for the presence of HEs by two masked graders and correlated with the corresponding PS-OCT HE maps: corresponding images were overlaid and an identical grid of 128 × 128 fields was used for correlation of detected HEs.
In all eyes, HEs were present owing to DME. Agreement of a pixel-to-pixel analysis of HEs in CF images was 0.72 (Cohen's κ) between graders and 0.44 between graders and automated detection by PS-OCT. Mean ± SD detection of HEs was significantly higher in PS-OCT than in manual grading (1180.5 ± 1009.8 fields versus 828.8 ± 695.0 fields; P = 0.02). The higher detection rate of PS-OCT was confirmed by a linear regression analysis with a slope of β = 1.18 (r = 0.81).
PS-OCT enables not only two-dimensional imaging of the extent of HEs, as in CF, but also allows tissue-specific, three-dimensional imaging of HEs throughout retinal layers, based on their distinct polarization-scrambling characteristics. The higher detection rate in PS-OCT images indicates an increased sensitivity of PS-OCT imaging over conventional CF.
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