The foveal cone mosaic can be directly visualized using adaptive optics scanning light ophthalmoscopy (AOSLO). Previous studies in individuals with normal vision report wide variability in the topography of the foveal cone mosaic, especially the value of peak cone density (PCD). While these studies often involve a human grader, there have been no studies examining intergrader reproducibility of foveal cone mosaic metrics. Here we re-analyzed published AOSLO foveal cone images from 44 individuals to assess the relationship between the cone density centroid (CDC) location and the location of PCD. Across 5 graders with variable experience, we found a measurement error of 11.7% in PCD estimates and higher intergrader reproducibility of CDC location compared to PCD location (p < 0.0001). These estimates of measurement error can be used in future studies of the foveal cone mosaic, and our results support use of the CDC location as a more reproducible anchor for cross-modality analyses.
Numerous metrics are used to analyze the morphometry of the foveal avascular zone (FAZ). Two such metrics, roundness and circularity, have recently shown a marked growth in their use. However, there have been inconsistencies across studies with respect to how these metrics are defined, as well as the algorithms used to calculate them. In some cases, the exact definition or algorithm is not disclosed. These issues significantly limit the translational utility of these biomarkers. We simulated FAZ shapes as circles or ellipses of differing aspect ratios and evaluated roundness and circularity with two commonly used approaches for FAZ analyses. Differing shape analysis algorithms produced conflicting results even with identical equations, and differing metric definitions produced incongruent results. Therefore caution should be used when comparing FAZ circularity and roundness metrics across studies, especially in the absence of detailed information about the algorithms used. Translational Relevance Quantitative assessment of OCT-A images includes evaluating circularity and roundness of the FAZ. Inconsistent or inaccurate mathematical definitions of these metrics impacts their utility as biomarkers and impairs the ability to combine and compare results across studies.
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