Automated quantification of volumetric optic disc swelling in papilledema using spectral-domain optical coherence tomography

PURPOSE. To develop an automated method for the quantification of volumetric optic disc swelling in papilledema subjects using spectral-domain optical coherence tomography (SDOCT) and to determine the extent that such volumetric measurements correlate with Friśen scale grades (from fundus photographs) and two-dimensional (2-D) peripapillary retinal nerve fiber layer (RNFL) and total retinal (TR) thickness measurements from SD-OCT. METHODS. A custom image-analysis algorithm was developed to obtain peripapillary circular RNFL thickness, TR thickness, and TR volume measurements from SD-OCT volumes of subjects with papilledema. In addition, peripapillary RNFL thickness measures from the commercially available Zeiss SD-OCT machine were obtained. Expert Friśen scale grades were independently obtained from corresponding fundus photographs. RESULTS. In 71 SD-OCT scans, the mean (6 standard deviation) resulting TR volumes for Friśen scale 0 to scale 4 were 11.36 ± 0.56, 12.53 ± 1.21, 14.42 ± 2.11, 17.48 ± 2.63, and 21.81 ± 3.16 mm³, respectively. The Spearman's rank correlation coefficient was 0.737. Using 55 eyes with valid Zeiss RNFL measurements, Pearson's correlation coefficient (r) between the TR volume and the custom algorithm's TR thickness, the custom algorithm's RNFL thickness, and Zeiss' RNFL thickness was 0.980, 0.929, and 0.946, respectively. Between Zeiss' RNFL and the custom algorithm's RNFL, and the study's TR thickness, r was 0.901 and 0.961, respectively. CONCLUSIONS. Volumetric measurements of the degree of disc swelling in subjects with papilledema can be obtained from SDOCT volumes, with the mean volume appearing to be roughly linearly related to the Friśen scale grade. Using such an approach can provide a more continuous, objective, and robust means for assessing the degree of disc swelling compared with presently available approaches.