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Assessing the Use of Incorrectly Scaled Optical Coherence Tomography Angiography Images in Peer-Reviewed Studies

DOI:10.1001/jamaophthalmol.2019.4821 期刊:JAMA Ophthalmology 出版年份:2019 更新时间:2025-09-11 14:15:04
摘要: IMPORTANCE Individual differences in axial length affect the lateral magnification of in vivo retinal images and as a result can affect the accuracy of quantitative measurements made from these images. As measurements from optical coherence tomography angiography (OCTA) images are becoming increasingly used in the diagnosis and monitoring of a wide range of diseases, evaluating which studies use correctly scaled images is crucial to their interpretation. OBJECTIVE To perform a systematic literature review to assess the percentage of articles that report correcting the scale of their OCTA images for individual differences in retinal magnification. EVIDENCE REVIEW A PubMed (MEDLINE) search was conducted for articles on OCTA retinal imaging published between June 1, 2015, and June 1, 2018. Initial results included 7552 articles. Initial exclusion criteria removed studies of animal models, as well as reviews, letters, replies, comments, and image-based or photographic essays. Articles not written in English and those that required purchase from non–English language websites were excluded. Articles that did not use OCTA for imaging the retina were also excluded. Remaining articles were reviewed in detail to assess whether the OCTA measurements required correct lateral scaling, and if so, whether axial length was reported or used to scale the images. We also determined the number of articles that mentioned the lack of correct lateral scaling as a limitation of the study. FINDINGS A total of 989 articles were included in the detailed review. Of these, 509 were determined to require correct image scaling for their analyses, but only 41 (8.0%) report measuring and using axial length to correct the lateral scale of their OCTA images. Furthermore, of the 468 articles that did not correctly scale their images, only 18 (3.8%) mentioned this as a limitation to their study. CONCLUSIONS AND RELEVANCE These findings suggest that most peer-reviewed articles in PubMed that use quantitative OCTA measurements use incorrectly scaled images. This could call into question the conclusions of such studies and warrants consideration by OCTA manufacturers, physicians, authors, journal reviewers, and journal editors.
作者: Samantha Llanas,Rachel E. Linderman,Fred K. Chen,Joseph Carroll
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To perform a systematic literature review to assess the percentage of articles that report correcting the scale of their OCTA images for individual differences in retinal magnification.

A formal literature review was conducted of studies that used OCTA retinal imaging and required correct lateral scaling for the reported analyses. We determined the number of articles that reported using correctly scaled OCTA images, from which we found that up to 92.0% did not appear to do so. Therefore, readers should proceed with caution when interpreting such studies. Where axial length measurements are not available, authors could report measurements in angular units (eg, arcmin and degrees) instead of linear units (eg, micrometers and millimeters) or use Monte Carlo simulations to model the possible outcome of scaling differences on their analyses and conclusions.

One limitation of this study is that we emphasized the use of axial length to correct the lateral scale of the images. Refractive error is known to be correlated with axial length, so using a correction based on refractive error could be better than no correction at all. This is an important point, because even axial length provides an incomplete picture of retinal magnification. Complete ocular biometry measurements (including corneal curvature and anterior chamber depth) are available and could be used, but even still, there are differences in the optical models used to estimate image magnification of the human eye. Thus, while knowledge of the lateral scale of a retinal image is often required to make certain measurements from the image, there is no agreed-on way in which to compute the scale.

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