title: An improved optical coherence tomography-derived fundus projection image for drusen visualization.
abstract: OBJECTIVE
  To develop and evaluate an improved method of generating en face fundus images from three-dimensional optical coherence tomography images which enhances the visualization of drusen.
  
  
  METHODS
  We describe a novel approach, the restricted summed-voxel projection (RSVP), to generate en face projection images of the retinal surface combined with an image processing method to enhance drusen visualization. The RSVP approach is an automated method that restricts the projection to the retinal pigment epithelium layer neighborhood. Additionally, drusen visualization is improved through an image processing technique that fills drusen with bright pixels. The choroid layer is also excluded when creating the RSVP to eliminate bright pixels beneath drusen that could be confused with drusen when geographic atrophy is present. The RSVP method was evaluated in 46 patients and 3-dimensional optical coherence tomography data sets were obtained from 8 patients, for which 2 readers independently identified drusen as the gold standard. The mean drusen overlap ratio was used as the metric to determine the accuracy of visualization of the RSVP method when compared with the conventional summed-voxel projection technique.
  
  
  RESULTS
  Comparative results demonstrate that the RSVP method was more effective than the conventional summed-voxel projection in displaying drusen and retinal vessels, and was more useful in detecting drusen. The mean drusen overlap ratios based on the conventional summed-voxel projection method and the RSVP method were 2.1% and 89.3%, respectively.
  
  
  CONCLUSIONS
  The RSVP method was more effective for drusen visualization than the conventional summed-voxel projection method, and it may be useful for macular assessment in patients with nonexudative age-related macular degeneration.
authors.affiliation: *Department of Radiology and Medicine (Biomedical Informatics Research), Stanford University School of Medicine, Stanford, CA; †School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, China; and ‡Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.forename: Theodore
authors.initials: T
authors.lastname: Leng
authors.forename: Luo Luo
authors.initials: LL
authors.lastname: Zheng
authors.forename: Lauren
authors.initials: L
authors.lastname: Kutzscher
authors.forename: Luis
authors.initials: L
authors.lastname: De Sisternes
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Rubin
mesh_terms: D000368:Aged; D000465:Algorithms; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012160:Retina / Q000473:pathology*; D015593:Retinal Drusen / Q000175:diagnosis*; D041623:Tomography, Optical Coherence / Q000379:methods*