Within‐eye and between‐subject variability for reflectance of the retinal nerve fibre layer

PURPOSE: Reflectance of retinal nerve fibre layer (RNFL) can contribute to detecting the presence of glaucomatous damage and defining its extent. As a step towards developing a normative database for RNFL reflectance, we assessed within‐eye and between‐subject variability for RNFL reflectance in healthy eyes. METHODS: Vertical 30° × 15° volume scans at the optic disc were gathered using SD‐OCT (Spectralis OCT) from people free of eye disease. Scans were gathered for both eyes of 30 younger adults (mean ± SD = 27 ± 3 years) and for one eye of 30 older adults (68 ± 8 years). Reflectance was quantified for each voxel as the depth‐resolved attenuation coefficient (AC). Values for AC were extracted for four slabs (0–52, 24–52, 24–36 and 36–60 μm) and at depths from 24 to 60 μm below the inner limiting membrane (ILM) in 4 μm steps. RESULTS: Between‐subject and within‐eye standard deviations (SDs) for the logarithm of AC were similar; median differences were 0.02–0.03 log unit across all four slabs and depths from 24 to 48 μm. Means for the logarithm of AC were higher for younger than older eyes by ~0.1 log unit; this age effect was not due to differences in the raw reflectance of the RNFL, but rather to age‐related changes in reflectance of deeper retina affecting the calculation of AC. CONCLUSIONS: In both groups, within‐eye variability in RNFL reflectance near the optic disc was similar to between‐subject variability. A better understanding of within‐eye variability would be useful for developing normative databases.