Reference database size affects OCT glaucoma flag classifications

A larger real-world optical coherence tomography (OCT) reference database flagged some glaucoma eyes differently than a smaller commercial database, according to a study.

Researchers analyzed a commercial reference database (C-RDB) containing 398 eyes and a larger real-world reference database (RW-RDB) containing 4,830 eyes collected from optometry practices using a reading center method.

The databases were then applied to a test dataset of 175 healthy eyes and 183 eyes with OCT findings consistent with optic neuropathy–glaucoma. Eyes were flagged as yellow if values fell below the fifth percentile and red if they fell below the first percentile.

The databases did not flag the same eyes. Among the 183 glaucoma eyes, 16% differed in color classification for global circumpapillary retinal nerve fiber layer and 7% differed for global ganglion cell layer plus inner plexiform layer. Additional modeling and Monte Carlo simulations suggested that both databases were sampled from essentially the same underlying normal population, but that the larger RW-RDB reduced random error.

Reference
Hood DC, Durbin M, Lee C, et al. Larger Real-World OCT Reference Database Improves Accuracy of Glaucoma Flagging Using Summary Metrics. Transl Vis Sci Technol. 2026;15(3):6. doi: 10.1167/tvst.15.3.6. PMID: 41800850.