LAUSR

PURPOSE Macular imaging with optical coherence tomography (OCT) measures the most critical retinal ganglion cells (RGC) in the human eye. The goal of this perspective is to review the challenges to detection of glaucoma progression with macular OCT imaging and propose ways to enhance its performance. DESIGN Perspective with review of relevant literature. METHODS Review of challenges and issues related to detection of change on macular OCT images in glaucoma eyes. SETTING NA. PATIENT OR STUDY POPULATION NA. INTERVENTION OR OBSERVATION PROCEDURE(S) NA. MAIN OUTCOME MEASURE Confounding factors affecting detection of change on macular OCT images. RESULTS The main challenges to detection of structural progression in the macula include the magnitude of and the variable amount of test-retest variability among patients, the confounding effect of aging, lack of a reliable and easy-to-measure functional outcome or external standard, confounding effect of macular conditions including myopia, and the measurement floor of macular structural outcomes. Potential solutions to these challenges include controlling head tilt or torsion during imaging, estimating within-eye variability for individual patients, improved data visualization, use of artificial intelligence methods, and implementation of statistical approaches suitable for multidimensional longitudinal data. CONCLUSIONS Macular OCT imaging is a crucial structural imaging modality for assessing the central RGCs. Addressing the current shortcomings in acquisition and analysis of macular volume scans can enhance its utility for measuring the health of central RGCs and hence assist clinicians with timely institution of appropriate treatment.