Automatic fovea detection and choroid segmentation for choroidal thickness assessment in optical coherence tomography

AIM:To develop an automated model for subfoveal choroidal thickness(SFCT)detection in optical coherence tomography(OCT)images,addressing manual fovea location and choroidal contour challenges.METHODS:Two procedures were proposed:defining the fovea and segmenting the choroid.Fovea localization from B-scan OCT image sequence with three-dimensional reconstruction(LocBscan-3D)predicted fovea location using central foveal depression features,and fovea localization from two-dimensional en-face OCT(LocEN-2D)used a mask region-based convolutional neural network(Mask R-CNN)model for optic disc detection,and determined the fovea location based on optic disc relative position.Choroid segmentation also employed Mask R-CNN.RESULTS:For 53 eyes in 28 healthy subjects,LocBscan-3D’s mean difference between manual and predicted fovea locations was 170.0μm,LocEN-2D yielded 675.9μm.LocEN-2D performed better in non-high myopia group(P=0.02).SFCT measurements from Mask R-CNN aligned with manual values.CONCLUSION:Our models accurately predict SFCT in OCT images.LocBscan-3D excels in precise fovea localization even with high myopia.LocEN-2D shows high detection rates but lower accuracy especially in the high myopia group.Combining both models offers a robust SFCT assessment approach,promising efficiency and accuracy for large-scale studies and clinical use.

Pseudophakic Malignant Glaucoma Treatment Assisted with Anterior Segment Optical Coherence Tomography: A Case Report

PSEUDOPHAKIC malignant glaucoma is diagnosedbased on the presence of a shallow or flat centraland peripheral anterior chamber in the presenceof patent iridectomy, with intraocular pressure（IOP） of 22 mm Hg or more after lens extraction andintraocular lens implantation.1 Pseudophakic malignantglaucoma is one of the most challenging complicationsfaced by surgeons. Initial medication includes topicalcycloplegics, osmotic agents.

Comparison of Anterior Segment Optical Coherence Tomography and Ultrasound Biomicroscopy for Iris Parameter Measurements in Patients with Primary Angle Closure Glaucoma

Purpose: To compare the repeatability and consistency of anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) in measuring iris parameters in patients with primary angle closure glaucoma. Methods: Twenty-two patients (38 eyes) with primary angle closure glaucoma,including 5 eyes with acute angle closure glaucoma,10 fellow eyes of acute angle closure glaucoma, and 23 eyes with chronic angle closure glaucoma, were recruited consecutively in our hospital. All subjects underwent anterior scanning by AS-OCT and UBM. Peripheral iris thickness (PIT) and iris curvature (IC) in the anterior segment image obtained by AS-OCT and UBM were measured twice. The reproducibility of these two scans was evaluated by the intraclass correlation coefficient (ICC). A paired t-test was used to compare the difference between the two scans and the 95% limits of agreement (LoA) were calculated. Results:The ICCs of PIT and IC measured by UBM were 0.892 and 0.936 respectively, while for AS-OCT these values were 0.629 and 0.859, respectively. UBM had a higher reproducibility in both PIT and IC measurements as compared with AS-OCT.Differences in PIT measurement between AS-OCT and UBM(P=0.331).were not statistically significant, the 95% LoA (-0.178～0.156) mm was 36.1～41.2% of the mean. The IC was 0.053 mm smaller when measured by UBM than by AS-OCT (P=0.017), with the 95% LoA (-0.100～0.206) mm, or 36.2～74.6% of the mean.Conclusion:UBM had a higher reproducibility in measuring iris parameters than AS-OCT. The consistency between AS- OCT and UBM in measuring iris parameters was low in primary angle closure glaucoma patients. (Eye Science 2013; 28:1-6)

Anterior segment optical coherence tomography for identifying muscle status in strabismus surgery

Anterior segment optical coherence tomography （AS-OCT） finds very few indications in the domain of strabismus surgery. Current applications remain restricted to determining limbus-muscle insertion distance and anterior segment changes after strabismus surgery. We discuss two cases of operated strabismus surgery where AS-OCT imaging helped in identifying the operated eye and/or extra ocular muscles （EOM） and thus proved instrumental in planning and management.

Lens thickness assessment : anterior segment optical coherence tomography versus A-scan ultrasonography

AIMTo assess lens thickness measurements with anterior segment-optical coherence tomography (AS-OCT) in comparison with A-scan ultrasonography (A-scan US).METHODSThere were 218 adult subjects (218 eyes) aged 59.2±9.2y enrolled in this prospective cross-sectional study. Forty-three eyes had open angles and 175 eyes had narrow angles. Routine ophthalmic exam was performed and nuclear opacity was graded using the Lens Opacities Classification System III (LOCS III). Lens thickness was measured by AS-OCT (Visante OCT, Carl Zeiss Meditec, Dublin, CA, USA). The highest quality image was selected for each eye and lens thickness was calculated using ImageJ software. Lens thickness was also measured by A-scan US.RESULTSInterclass correlations showed a value of 99.7% for intra-visit measurements and 95.3% for inter-visit measurements. The mean lens thickness measured by AS-OCT was not significantly different from that of A-scan US (4.861±0.404 vs 4.866±0.351 mm, P=0.74). Lens thickness values obtained from the two instruments were highly correlated overall (Pearson correlation coefficient=0.81, P<0.001), and in all LOCS III specific subgroups except in grade 5 of nuclear opacity. Bland-Altman analysis revealed a 95% limit of agreement from -0.45 to 0.46 mm. Lens thickness difference between the two instruments became smaller as the lens thickness increased and AS-OCT yielded smaller values than A-scan US in thicker lens (β=-0.29, P<0.001)CONCLUSIONAS-OCT-derived lens thickness measurement is valid and comparable to the results obtained by A-scan US. It can be used as a reliable noncontact method for measuring lens thickness in adults with or without significant cataract.

Optical coherence tomography enhanced depth imaging of chorioretinal folds in patients with orbital tumors

AIM:To characterize spectral-domain optical coherence tomography(SD-OCT)features of chorioretinal folds in orbital mass imaged using enhanced depth imaging(EDI).METHODS:Prospective observational case-control study was conducted in 20 eyes of 20 patients,the uninvolved eye served as a control.All the patients underwent clinical fundus photography,computed tomography,EDI SDOCT imaging before and after surgery.Two patients with cavernous hemangiomas underwent intratumoral injection of bleomycin A5;the remaining patients underwent tumor excision.Patients were followed 1 to 14mo following surgery(average follow up,5.8mo).RESULTS:Visual acuity prior to surgery ranged from 20/20 to 20/200.Following surgery,5 patients’visual acuity remained unchanged while the remaining 15 patients had a mean letter improvement of 10(range 4 to 26 letters).Photoreceptor inner/outer segment defects were found in 10 of 15 patients prior to surgery.Following surgical excision,photoreceptor inner/outer segment defects fully resolved in 8 of these 10 patients.CONCLUSION:Persistence of photoreceptor inner/outer segment defects caused by compression of the globe by an orbital mass can be associated with reduced visual prognosis.Our findings suggest that photoreceptor inner/outer segment defects on EDI SD-OCT could be an indicator for immediate surgical excision of an orbital mass causing choroidal compression.

Application of Tear Meniscus Measurement by Anterior Segment Optical Coherence Tomography in the Diagnosis of Dry Eye

Dry eye,one of the most frequent ocular surface diseases, is caused by complex ocular function and mechanism disorders. Currently, no uniform standard diagnosis of dry eye has been established. Traditional clinical examinations provide inaccurate measurement and poor reproducibility due to various factors.Anterior segment optical coherence tomography (OCT) is applicable in the diagnosis of dry eye due to its high resolution, non-invasiveness, good accuracy, and repeatability.

Comparison of Intraoperative Ultrasound Pachymetry and Postoperative Optical Coherence Tomography of Anterior Segment in the Measurement of Flap Thickness in Eyes Receiving Laser in situ Keratomileusis

Purpose:To compare the measurement of flap thickness using intraoperative ultrasound pachymetry and postoperative visante anterior segment optical coherence tomography (Visante-OCT) in eyes receiving laser in situ keratomileusis (LASIK). Methods: Seventeen patients (34 eyes) received LASIK using a Technolas-217Z100 laser and AMADEUSⅡ mechanical microkeratome(140 μm head). Flap thickness was assessed with an ultrasound pachymeter intraoperatively and a Visante-OCT postoperatively at 1 week and 1 month. Results: The intraoperative mean flap thickness by ultrasound pachymetry was (124±13.9) μm (range: 96.5 to 160 μm), and mean flap thickness by Visante-OCT was (145±7.13) μm (range: 130 to 158 μm) and (143±5.32) μm (range: 132 to 155 μm) postoperatively at 1 week and 1 month respectively (F=63.52,P<0.01). Intraoperative subtraction pachymetry underestimated flap thickness compared with postoperative Visante-OCT.(P<0.01)..There was no significant difference between postoperative Visante-OCT measurements at 1 week and 1 month after LASIK.(P=0.16). The 95% limit of agreement.(LoA).of flap thickness between ultrasound Visante-OCT and pachymetry was -5.40 to 42.10 μm. Conclusion: OCT overestimates flap thickness compared with intraoperative ultrasound pachymetry when using the AMADEUSⅡ mechanical microkeratome.

Optical coherence tomography angiography of optic disc perfusion in non-arteritic anterior ischemic optic neuropathy

AIM：To compare the optic disc blood flow of non-arteritic ischemic optic neuropathy（NAION）eyes with normal eyes.METHODS：The optic disc blood flow densities of diagnosed non-acute phase NAION eyes（21 eyes,14 individuals）and normal eyes（19 eyes,12 individuals）were detected via Optovue optical coherence tomography angiography（OCTA）.The optic disc blood flow was measured via Image J software.Correlations between optic disc perfusion and visual function variables were assessed by linear regression analysis.RESULTS：The average percentage of the optic disc nonperfusion areas in the non-acute phase NAION patients（17.84%±6.18%）was increased,when compared to the normal control eyes（8.61%±1.65%）,and the difference was statistically significant（P〈0.01）.Moreover,there was a proportional correlation between the visual field mean defect（MD）and the optic disc non-perfusion area percentage,and the relationship was statistically significant（t=3.65,P〈0.01,R2=0.4118）.In addition,the critical correlation between the best corrected visual acuity（BCVA）and the optic disc non-perfusion area percentage was statistically significant（t=4.32,P〈0.01,R2=0.4957）.CONCLUSION：The optic disc non-perfusion area percentages detected via OCTA in NAION eyes were significantly increased when compared with the normal eyes.Both the BCVA and MD were correlated with the optic disc flow detected,revealing that OCTA may be valuable in the diagnosis and estimation of NAION.

Segmentation of retinal fluid based on deep learning:application of three-dimensional fully convolutional neural networks in optical coherence tomography images

AIM: To explore a segmentation algorithm based on deep learning to achieve accurate diagnosis and treatment of patients with retinal fluid.METHODS: A two-dimensional(2D) fully convolutional network for retinal segmentation was employed. In order to solve the category imbalance in retinal optical coherence tomography(OCT) images, the network parameters and loss function based on the 2D fully convolutional network were modified. For this network, the correlations of corresponding positions among adjacent images in space are ignored. Thus, we proposed a three-dimensional(3D) fully convolutional network for segmentation in the retinal OCT images.RESULTS: The algorithm was evaluated according to segmentation accuracy, Kappa coefficient, and F1 score. For the 3D fully convolutional network proposed in this paper, the overall segmentation accuracy rate is 99.56%, Kappa coefficient is 98.47%, and F1 score of retinal fluid is 95.50%. CONCLUSION: The OCT image segmentation algorithm based on deep learning is primarily founded on the 2D convolutional network. The 3D network architecture proposed in this paper reduces the influence of category imbalance, realizes end-to-end segmentation of volume images, and achieves optimal segmentation results. The segmentation maps are practically the same as the manual annotations of doctors, and can provide doctors with more accurate diagnostic data.

Analysis of optic disc damage by optical coherence tomography in terms of therapy in non-arteritic anterior ischemic optic neuropathy

This study aimed to assess the relationship between the rate of nerve fiber loss in non-arteritic anterior ischemic optic neuropathy（NAION） and time delay before therapy.Total 24 patients received the same treatment within or after 2wk（early and late groups）.There were significantly lower level of destruction of nerve fibers（P=0.0014） and significantly better visual field sensitivity（P=0.039） in early group.The results indicate that therapy should be started within 2wk.The degree of ischemic damage due to NAION correlates well with retinal nerve fiber layer thickness and the ischemia-induced decrease in visual field sensitivity.

Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial using optical coherence tomography

BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).

Automated retinal layer segmentation on optical coherence tomography image by combination of structure interpolation and lateral mean filtering

Segmentation of layers in retinal images obtained by optical coherence tomography(OCT)has become an important clinical tool to diagnose ophthalmic diseases.However,due to the sus-ceptibility to speckle noise and shadow of blood vessels etc.,the layer segmentation technology based on a single image still fail to reach a satisfactory level.We propose a combination method of structure interpolation and lateral mean filtering(SI-LMF)to improve the signal-to-noise ratio based on one retinal image.Before performing one-dimensional lateral mean filtering to remove noise,structure interpolation was operated to eliminate thickness fluctuations.Then,we used boundary growth method to identify boundaries.Compared with existing segmentations,the method proposed in this paper requires less data and avoids the influence of microsaccade.The automatic segmentation method was verified on the spectral domain OCT volume images obtained from four normal objects,which successfully identified the boundaries of 10 physio-logical layers,consistent with the results based on the manual determination.

3D automatic segmentation method for retinal optical coherence tomography volume data using boundary surface enhancement

With the introduction of spectral-domain optical coherence tomography(SD-OCT),much larger image datasets are routinely acquired compared to what was possible using the previous generation of time-domain OCT.Thus,there is a critical need for the development of three-dimensional(3D)segmentation methods for processing these data.We present here a novel 3D automatic segmentation method for retinal OCT volume data.Brie°y,to segment a boundary surface,two OCT volume datasets are obtained by using a 3D smoothingfilter and a 3D differentialfilter.Their linear combination is then calculated to generate new volume data with an enhanced boundary surface,where pixel intensity,boundary position information,and intensity changes on both sides of the boundary surface are used simultaneously.Next,preliminary discrete boundary points are detected from the A-Scans of the volume data.Finally,surface smoothness constraints and a dynamic threshold are applied to obtain a smoothed boundary surface by correcting a small number of error points.Our method can extract retinal layer boundary surfaces sequentially with a decreasing search region of volume data.We performed automatic segmentation on eight human OCT volume datasets acquired from a commercial Spectralis OCT system,where each volume of datasets contains 97 OCT B-Scan images with a resolution of 496
512(each B-Scan comprising 512 A-Scans containing 496 pixels);experimental results show that this method can accurately segment seven layer boundary surfaces in normal as well as some abnormal eyes.

Optical coherence tomography evaluation of retinal nerve fiber layer thickness in non-arteritic anterior ischemic optic neuropathy and primary open angle glaucoma:a systematic review and Meta-analysis

AIM:To assess the differences in average and sectoral peripapillary retinal nerve fiber layer(p RNFL)thickness using spectral domain optical coherence tomography(SD-OCT)in patients with non-arteritic anterior ischemic neuropathy(NAION)compared with those with primary open angle glaucoma(POAG).METHODS:A comprehensive literature search of the Pub Med,Cochrane Library,and Embase databases were performed prior to October,2021.Studies that compared the p RNFL thickness in NAION eyes with that in POAG eyes with matched mean deviation of the visual fields were included.The weighted mean difference(WMD)with 95%confidence interval(CI)was used to pool continuous outcomes.RESULTS:Ten cross-sectional studies(11 datasets)comprising a total of 625 eyes(278 NAION eyes,347 POAG eyes)were included in the qualitative and quantitative analyses.The pooled results demonstrated that the superior p RNFL was significantly thinner in NAION eyes than in POAG eyes(WMD=-6.40,95%CI:-12.22 to-0.58,P=0.031),whereas the inferior p RNFL was significant thinner in POAG eyes than in NAION eyes(WMD=11.10,95%CI:7.06 to 15.14,P≤0.001).No difference was noted concerning the average,nasal,and temporal p RNFL thickness(average:WMD=1.45,95%CI:-0.75 to 3.66,P=0.196;nasal:WMD=-2.12,95%CI:-4.43 to 0.19,P=0.072;temporal:WMD=-1.24,95%CI:-3.96 to 1.47,P=0.370).CONCLUSION:SD-OCT based evaluation of inferior and superior p RNFL thickness can be potentially utilized to differentiate NAION from POAG,and help to understand the different pathophysiological mechanisms between these two diseases.Further longitudinal studies and studies using eight-quadrant or clock-hour classification method are required to validate the obtained findings.

Vascular Stress Analysis Based on in vivo Intravascular Optical Coherence Tomography Image Segmentation

Identification of carotid artery atherosclerosis is crucial for the diagnosis of the cerebral apoplexy and other vascular diseases.Intravascular optical tomography(IVOCT)has been employed to clinical coronary imaging for several years.Vessel morphological information on IVOCT images together with blood flow information on Doppler OCT(DOCT)images could provide a more accurate internal environment of arteries.Images integrated with fluid-structure interaction(FSI)could obtain the accurate mechanical responses and the quantitative material characters.A porcine carotid artery was imaged with an intravascular system(C7-XR,St.Jude Medical Inc.St.Paul,Minnesota,USA)in vivo,during which 120 images of one section and 600 images of a 5 mm/s pull back were captured within 6 s.Those images were then overlapped with Doppler phase changes to imply the changes in flow profiles.Segmentation and quantification of vessel structure was done in the software(MATLAB 2014b),including specifically the segmentation of lumen,imaging catheter,vessel wall and the guide wire.Appropriate interpolation functions are selected in the coordinate transformation algorithm to have smooth boundaries from images.A set of flow algorithms include image segmentation,three-dimensional/two-dimensional model reconstruction,inversion of material parameters,fitting of experimental velocity data and theoretical derivation based on simulation results is proposed.All steps are programmed to provide a theoretical basis for the future simplified process control.3D-reconstruction FSI model was built in SOLIDWORKS by lofting operation based on the segmentation results.Commercial finite element software(COMSOL 5.3,Sweden)numerically analyzed the entity model to obtain vessel stress/strain and flow shear stress data.Boundary conditions are from the OCT detection.Material of the artery was set to be the modified Mooney-Rivlin constitutive model and the parameters used were adjusted in an algorithm to match an ex vivo experiment.Wall shear stresses(WSS)and vessel deformations were chosen to measure the conditions of the artery and would serve as a target variables for future prediction.Thus,the geometric information together with the data of materials and other mechanical properties are possible to obtain during the imaging process.Segmentation process provided anatomically correct models of a two-layered artery.Numerical simulation permits reliable stress distribution in which the position of catheter and the artery curvature have a neglectable disturbance.Shear stress of the fluid is quite small compared with that of the wall at the same interface,which shows good agreement with the former studies.Moreover,a high flushing speed of 0.1 mps have little impact on the stress distributions and magnitudes,which denotes that the OCT imaging process brings little harm to the vessel.It is the first attempt to combine the OCT imaging and Doppler OCT within a full algorithm and a structural analysis.This study is helpful for the biomechanical property studies of carotid arteries and the development of medical imaging technology.

Automated retinal layer segmentation in optical coherence tomography images with intraretinal fluid

We propose a novel retinal layer segmentation method to accurately segment 10 retinal layers in optical coherence tomography(OCT)images with intraretinal fluid.The method used a fan filter to enhance the linear information pertaining to retinal boundaries in an OCT image by reducing the effect of vessel shadows and fluid regions.A random forest classifier was employed to predict the location of the boundaries.Two novel methods of boundary redirection(SR)and similarity correction(SC)were combined to carry out boundary tracking and thereby accurately locate retinal layer boundaries.Experiments were performed on healthy controls and subjects with diabetic macular edema(DME).The proposed method required an average of 415 s for healthy controls and of 482 s for subjects with DME and achieved high accuracy for both groups of subjects.The proposed method requires a shorter running time than previous methods and also provides high accuracy.Thus,the proposed method may be a better choice for small training datasets.

Automatic quantification of superficial foveal avascular zone in optical coherence tomography angiography implemented with deep learning

An accurate segmentation and quantification of the superficial foveal avascular zone(sFAZ)is important to facilitate the diagnosis and treatment of many retinal diseases,such as diabetic retinopathy and retinal vein occlusion.We proposed a method based on deep learning for the automatic segmentation and quantification of the sFAZ in optical coherence tomography angiography(OCTA)images with robustness to brightness and contrast(B/C)variations.A dataset of 405 OCTA images from 45 participants was acquired with Zeiss Cirrus HD-OCT 5000 and the ground truth(GT)was manually segmented subsequently.A deep learning network with an encoder–decoder architecture was created to classify each pixel into an sFAZ or non-sFAZ class.Subsequently,we applied largestconnected-region extraction and hole-filling to fine-tune the automatic segmentation results.A maximum mean dice similarity coefficient(DSC)of 0.976±0.011 was obtained when the automatic segmentation results were compared against the GT.The correlation coefficient between the area calculated from the automatic segmentation results and that calculated from the GT was 0.997.In all nine parameter groups with various brightness/contrast,all the DSCs of the proposed method were higher than 0.96.The proposed method achieved better performance in the sFAZ segmentation and quantification compared to two previously reported methods.In conclusion,we proposed and successfully verified an automatic sFAZ segmentation and quantification method based on deep learning with robustness to B/C variations.For clinical applications,this is an important progress in creating an automated segmentation and quantification applicable to clinical analysis.

Evaluation of the iridocorneal angle with accommodation using optical coherence tomography

The changes in the iridocorneal angle structure during accommodation are assessed by means of anterior segment optical coherence tomography.Thirteen right eyes were included in the study.The device used for the measurement was the Visante？omni system.The stimuli were set up at different vergences（0.0 D,-1.5 D,and-3.0 D）.The angle opening distance 500 and 750,the trabecular iris space area 500 and 750,and the scleral spur angle parameters were assessed at the nasal and temporal regions.The results in the iridotrabecular angle comparing the three accommodative states of the eye did not yield any statistically significant difference at nasal or temporal angle sections.In light of our results and in the conditions of our study,the structures of the iridocorneal angle are not significantly changed with accommodation.

Investigation of changes in thickness and reflectivity from layered retinal structures of healthy and diabetic eyes with optical coherence tomography

OCT is usually employed for the measurement of retinal thickness. However, coherent reflected light carries more information characterizing the optical properties of tissue. Therefore, optical property changes may provide further information regarding cellular layers and early damage in ocular diseases. We investigated the possibility of OCT in detecting changes in the optical backscattered signal from layered retinal structures. OCT images were obtained from diabetic patients without retinopathy (DM, n = 38 eyes) or mild diabetic retinopathy (MDR, n = 43 eyes) and normal healthy subjects (n = 74 eyes). The thickness and reflectivity of various layered structures were assessed using a custom-built algorithm. In addition, we evaluated the usefulness of quantifying the reflectivity of layered structures in the detection of retinal damage. Generalized estimating equations considering within-subject inter-eye relations were used to test for differences between the groups. A modified p value of <0.001 was considered statistically significant. Receiver operating characteristic (ROC) curves were constructed to describe the ability of each parameter to discriminate between the eyes of DM, MDR and healthy eyes. Thickness values of the GCL + IPL and OPL showed a significant decrease in the MDR eyes compared to controls. Significant decreases of total reflectance average values were observed in all layers in the MDR eyes compared with controls. The highest AUROC values estimated for the total reflectance were observed for the GCL+IPL, OPL and OS when comparing MDR eyes with controls. Total reflectance showed a better discriminating power between the MDR eyes and healthy eyes compared to thickness values. Our results suggest that the optical properties of the intraretinal layers may provide useful information to differentiate pathological from healthy eyes. Further research is warranted to determine how this approach may be used to improve diagnosis of early retinal neurodegeneration.