Semi‐automated quantification of geographic atrophy with blue‐light autofluorescence and spectral‐domain optical coherence tomography: a comparison between the region finder and the advanced retinal pigment epithelium tool in the clinical setting

Abstract

Purpose To compare inter‐ and intraobserver reliability and intermodality agreement on quantification of geographic atrophy, using two routinely available quantification tools, based on blue‐light fundus autofluorescence (BAF) and spectral‐domain optical coherence tomography (SD‐OCT). Methods Quantifications of atrophic lesions within the central 5 mm of 30 eyes from 30 patients (mean age: 76.1 years) were independently performed by two clinicians on BAF images using the region finder (RF; Heidelberg Engineering) and on SD‐OCT using the advanced retinal pigment epithelium tool (ARPET; Carl Zeiss Meditec) at baseline and follow‐up (mean interval: 336 days). Inter‐ and intraobserver reliability was determined by intraclass correlation coefficients (ICC) and Bland–Altmann plots. Additionally, graders rated the experienced difficulty of each measurement. Results Intraclass correlation coefficients (ICC) showed excellent inter‐ and intraobserver reliability with values between 0.994 and 0.998 for RF and slightly higher values for ARPET of 0.997 and 0.999. Bland–Altman plots showed smaller variability for ARPET. Mean interobserver differences (95% CI) for size measurements were −0.11 (−0.27; 0.05) (baseline) and −0.05 mm² (−0.18; 0.08) (follow‐up) for RF and −0.04 (−0.14; 0.06) and −0.06 mm² (−0.14; 0.02) for ARPET. Measurements of lesions were on average 0.57 mm² (0.35; 0.79) or 7.6% larger in ARPET. Lesion size between graders did not differ significantly. There was no statistically significant difference in relative enlargement rates between methods. There was poor to moderate agreement between graders when rating the experienced difficulty of each measurement. Conclusion Semi‐automated analysis of geographic atrophy with RF and ARPET is equally reliable and reproducible in clinical settings, despite both algorithms require frequent adjustment by users. The ARPET restricts size measurements to the central 5 mm, which limits its ability to fully track GA progression. Results of both tools are not interchangeable as measurements with ARPET result in larger lesion sizes.

Fundus Autofluorescence in Extensive Macular Atrophy With Pseudodrusen and Diffuse Trickling Geographic Atrophy

“…The atrophic area was selected on BAF images, at baseline and last follow-up visit, using the semiautomated Region Finder tool provided by Heidelberg HEYEX software. 10,11 Optical coherence tomography scans and infrared images supported the identification and confirmed the presence of foveal involvement and extension of atrophic areas, as recommended by the classification of atrophy reports. 12,13 The following parameters were provided by the software: total area, change from baseline examination, and growth rate in mm 2 per year.…”

Role of Deep Learning–Quantified Hyperreflective Foci for the Prediction of Geographic Atrophy Progression

“…STUDY DESIGN: Patients with geographic atrophy (GA) secondary to AMD aged 50 years and over were included in a reported 10,33,[40][41][42][43][44][45][46] prospective observational cohort study after giving written informed consent. The study was approved by the Ethics Committee of the Medical University of Vienna and adhered to Good Clinical Practice guidelines and the Declaration of Helsinki.…”

Fundus autofluorescence of retinal atrophy progression between fundus flavimaculatus and extensive macular atrophy with pseudo-drusen

“…23 It was found to be a both a comparatively reliable and reproducible to manual methods of FAF measurements. 20,24 To our knowledge, a comparative atrophy progression analysis using the semi-automated RegionFinder™ tool has not been previously discussed in literature in regards of both EMAP and FFM. We believe that a comparative longitudinal assessment of both, may be beneficial to the clinician when facing the early manifestations of the diseases, while assessing their imaging characteristics.…”