Comparison between B-Scan and En Face Images for Incomplete and Complete Retinal Pigment Epithelium and Outer Retinal Atrophy

Purpose: To evaluate and compare the detection of incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) and complete retinal pigment epithelium and outer retinal atrophy (cRORA) assessed on OCT B-scans versus persistent choroidal hypertransmission defects (hyperTDs) assessed by en face choroidal OCT images.Design: Retrospective, cross-sectional study. Participants: Patients with late atrophic age-related macular degeneration imaged on the same day using both Spectralis OCT and Cirrus OCT.Main Outcome Measure: Agreement between the B-scan and en face OCT for the detection of hyperTDs, cRORA, and iRORA.Methods: Two independent graders examined en face OCT and structural OCT to determine the presence and location of hyperTDs, iRORA, and cRORA.Results: A total of 239 iRORA and cRORA lesions were detected on the B-scans, and 249 hyperTD lesions were identified on the en face OCT images. There was no significant difference (P = 0.88) in the number of lesions. There was no significant difference in the 134 cRORA lesions identified on B-scans and the 131 hyperTDs detected on en face OCT images (P = 0.13). A total of 105 iRORA lesions were identified by B-scan assessment; however, 50 of these iRORA lesions met the criteria for persistent hyperTDs on en face OCT images (P < 0.001). When considering the topographic correspondence between B-scan and en face OCT detected lesions, the mean percentage of agreement between B-scan detection of cRORA lesions with en face OCT detection was 97.6 % (P = 0.13).Conclusions: We observed high overall agreement between cRORA lesions identified on B-scans and persistent hyperTDs identified on en face OCT. However, en face imaging was able to detect iRORA lesions that had a greatest linear dimension >= 250 mm in a nonhorizontal en face dimension.(c) 2023 by the American Academy of Ophthalmology