Performance of automated anterior segment OCT-based quantitative imaging in adult anterior chamber inflammation
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Objective
To investigate the performance of anterior segment (AS-) OCT quantitative imaging of anterior chamber inflammation in uveitis patients with diverse demographics.
Design
Prospective cross-sectional study.
Participants
144 adult patients managed at a tertiary care service in the UK
Methods
Repeated swept-source AS-OCT imaging was performed pre- and post-pupil dilation (i.e. 4 scan sets). Inflammation was quantified using a validated human-in-the-loop automated image analysis pipeline, Minuscule Cell Detection (MCD), which identified and counted putative inflammatory cells on AS-OCT.
Main Outcome Measures
Test-retest variability of AS-OCT and diagnostic accuracy of various AS-OCT derived measurands (minimum, maximum, median counts per cross sectional image, and total counts across volume image sets per eye or MINCC, MAXCC, MEDCC and TOTCC) versus Standardization of Uveitis Nomenclature (SUN) grading system as assessed by a uveitis specialist.
Results
A total of 281 eyes were included in the analysis. Median age was 48 years (IQR 36-64). Strong test-retest measurand reliability was demonstrated, with a 95% tolerance interval ratio 0.3 - 3.0. The best diagnostic performances for SUN activity were observed with the MINCC threshold of 3 particles (negative predictive value for clinical activity of 89.8%, 95% CI 83.0 - 94.1). Associations between AS-OCT measurands and patient age (adjusted coefficient 7.5 additional particles, 95% CI 0.5 – 14.6, p<0.04 for age over 60 years versus under 44), and pigment load (52.8, 11.8 - 92.9, p<0.01 in eyes with AC pigment versus without) were noted.
Conclusions
AS-OCT assessment of anterior chamber inflammation in uveitis meets current recommendations for quantitative imaging biomarkers, demonstrating strong repeatability, linearity with clinical assessment scores and stability with pupil dilation and patient characteristics of ethnicity and lens status. The absence of variability in diagnostic indices across derived measurands suggests similar performance across different acquisition protocols. Further longitudinal cross-platform studies are needed to determine limitations of use.
