Clinical Utility of Triplicate En Face Image Averaging for Optical Coherence Tomography Angiography in Glaucoma and Glaucoma Suspects.

PReCIS:: Averaging triplicate en face angiograms of the radial peripapillary capillary plexus with optical coherence tomography angiography (OCTA) improves vessel visualization, reduces vessel density parameters, and increases the diagnostic accuracy for glaucoma of one such parameter. Purpose To test the hypothesis that triplicate averaging of the radial peripapillary capillary (RPC) layer improves visualization and diagnostic accuracy of optical coherence tomography angiography (OCTA) for glaucoma. Methods This is a cross-sectional study involving 63 primary open angle glaucoma patients and 70 age-matched glaucoma suspects. Triplicate 6×6mm OCTA scans of the optic nerve head were acquired, and the RPC layer was extracted. RPC en face images were registered and averaged. Parameters of global entropy (GE), global standard deviation (GSD), local texture correlation (LC), local homogeneity (LH), signal-to-noise ratio (SNR), and intercapillary distance (ICD) were used to measure the change in visualization with averaging. Vessel area density (VAD), vessel skeleton density (VSD), and flux parameters were calculated in a 2.8▒mm annulus excluding the optic disc. Diagnostic accuracy of these parameters for glaucoma was assessed by calculating area under the receiver operating curve (AUC) values. Results 3-frame averaging resulted in decreased GE and GSD (Ps Conclusions Triplicate averaging improves visualization of the RPC layer and the diagnostic accuracy of VSD for glaucoma. The impact of image averaging on OCTA diagnostic performance and other potential applications warrants further exploration.