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Jui-Kai Wang, Randy H. Kardon, Bhavna J. Antony, Mark J. Kupersmith, Mona K. Garvin; Comparison of an Automated Method for Volumetric Quantification of Papilledema with the Frisén Scale. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2986.
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The six-stage Frisén scale is a standard, yet subjective, method to measure papilledema from fundus photography. With the goal of obtaining a more objective measure of papilledema, we developed an automated method to quantify the swollen disc volume from 3-D spectral-domain OCT scans and compared our SD-OCT volumetric measurements with the corresponding Frisén grades.
An automated 3-D graph-theoretic multi-resolution approach was developed to segment the internal limiting membrane (ILM) and two bounding surfaces of the retinal pigment epithelial (RPE) complex in 69 3-D SD-OCT (Zeiss Cirrus) ONH-centered scans from the multiple visits of 21 subjects with papilledema acquired at The University of Iowa. The SD-OCT scans were then flattened in 3-D so the RPE complex became a flat reference plane. The volume between the ILM (orange surface in figure) and the reference plane (red surface in figure) was used as a volumetric measure of the degree of disc edema and compared to the corresponding Frisén grades resulting from independent expert (RK) evaluations of fundus photographs.
The mean (± standard deviation) resulting volumes for scales 0 to scale 4 were 10.87 ± 0.68, 11.74 ± 0.92, 13.23 ± 0.91, 14.81 ± 0.7, and 16.02 ± 0.19 mm3, respectively.
Volumetric measurements of the degree of disc swelling in subjects with papilledema can be obtained from SD-OCT volumes, with the mean volume appearing to be roughly linearly related to the Frisén scale grade in this preliminary study. Using such an approach can provide a more continuous and objective means for assessing the degree of disc swelling.
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