Influence of age and averaging on band visibility in high-resolution optical coherence tomography

Abstract This study assessed the influence of age on band visibility in spectral-domain optical coherence tomography (SD-OCT) with < 3 μm axial resolution and evaluated intergrader reliability using a custom review tool incorporating 28 retinal bands. Seventy-two eyes of 72 individuals with normal retinas (< 45 years: n = 16; 45–65 years: n = 30; > 65 years: n = 26) were imaged using a prototype SD-OCT device with varying automatic real-time averaging (ART) levels. Scans were acquired through the foveal center (ART 9, 25, 100) and at 5° superior (ART 9). Band visibility was graded using custom software supported by longitudinal reflectivity profiles at nine locations and analyzed using chi-square and regression models. Intergrader reliability varied between larger hyperreflective and thin hyporeflective bands (inner plexiform layers (IPL) 2 and 4; retinal pigment epithelium layers (RPE) 1, 3, 5). Higher ART levels improved visibility of the nerve fiber layer, IPL-3, -4, and − 5, RPE-1, and − 5. RPE sub-bands were more frequently detected at 5° superior than at the fovea. Higher age was associated with reduced visibility of the internal limiting membrane, inner nuclear layer and RPE-5. These findings suggest a modest age-related decline in retinal band visibility under high-resolution conditions, which should be accounted for in clinical trials.