Prevention of Image Quality Degradation in Wider Field Optical Coherence Tomography Angiography Images Via Image Averaging

PURPOSE: To evaluate the mutual effect of widening the field of view and multiple en face image averaging on the quality of optical coherence tomography angiography (OCTA) images. METHODS: This prospective, observational, cross-sectional case series included 20 eyes of 20 healthy volunteers with no history of ocular or systemic disease. OCTA imaging of a 3 × 3-mm, 6 × 6-mm, and 12 × 12-mm area centered on the fovea was performed nine times using the PLEX Elite 9000. We acquired averaged OCTA images generated from nine en face OCTA images. The corresponding areas in the three scan sizes were evaluated for the original single-scanned OCTA images and averaged OCTA images both qualitatively and quantitatively. Quantitative measurements included vessel density (VD), vessel length density (VLD), fractal dimension (FD), and contrast-to-noise ratio (CNR). RESULTS: Significant differences in VD, VLD, FD, and CNR (P < 0.001) were observed due to the mutual effect of averaging and differences in scan size. Both qualitative and quantitative evaluations indicated that the quality of 6 × 6-mm averaged images was equal to or better than that of 3 × 3-mm single-scanned images. However, the quality of 12 × 12-mm averaged images did not reach that of 3 × 3-mm single-scanned images. CONCLUSIONS: To some extent, multiple en face OCTA image averaging can compensate for the deterioration in image quality caused by widening the field of view. TRANSLATIONAL RELEVANCE: Multiple en face OCTA image averaging can be a technique for acquiring wider field OCTA images with good quality.