Abstract
Purpose
Central serous chorioretinopathy (CSCR) demonstrates retinal pigment epithelium (RPE) alterations visible on fundus autofluorescence (FAF). Embossing is an image processing technique that replaces pixels with a shadow or a highlight, improving image visualization. We explored how embossing improves the delineation of altered RPE areas in eyes with chronic CSCR on blue-FAF images.
Methods
This study includes 52 eyes of 40 patients with chronic CSCR. Images were embossed with a coefficient of 0.5. The area of RPE alteration was assessed by two masked, double-blinded observers using ImageJ Fiji software. Accuracy was assessed based on inter-rater reliability (ICC) and compared before and after embossing using Fisher's z-transformation.
Results
The mean age of the study patients was 53.02 ± 12.87 years. The RPE alteration area measurements by the first observer for the pre-embossed images was 12.1 ± 13.1 mm2, and for the post-embossed images was 11.9 ± 13.4 mm2 (P = 0.7). The RPE alteration area measurements by the second observer for the pre-embossed images was 11.3 ± 13.3 mm2, and for the post-embossed images was 10.3 ± 12.8 mm2 (P = 0.5). The mean area for both observers in the pre-embossed images was 11.7 ± 12.8 mm2, and in the post-embossed images was 11.1 ± 13.0 mm2 (P = 0.217). The ICC in the pre-embossed images between two observers was 0.931 (CI 0.879–0.960), which increased to 0.983 (CI 0.970–0.990) in post-embossed images (P < 0.001).
Conclusions
Embossing FAF images can enhance the visibility of RPE alterations in CSCR, allowing for better delineation of borders, which improves accuracy.
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