Structure–Function Mapping: Variability and<i>Conviction</i>in Tracing Retinal Nerve Fiber Bundles and Comparison to a Computational Model

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We evaluated variability and conviction in tracing paths of retinal nerve fiber bundles (RNFBs) in retinal images, and compared traced paths to a computational model that produces anatomically-customized structure-function maps.Ten retinal images were overlaid with 24-2 visual field locations. Eight clinicians and 6 naïve observers traced RNFBs from each location to the optic nerve head (ONH), recording their best estimate and certain range of insertion. Three clinicians and 2 naïve observers traced RNFBs in 3 images, 3 times, 7 to 19 days apart. The model predicted 10° ONH sectors relating to each location. Variability and repeatability in best estimates, certain range width, and differences between best estimates and model-predictions were evaluated.Median between-observer variability in best estimates was 27° (interquartile range [IQR] 20°-38°) for clinicians and 33° (IQR 22°-50°) for naïve observers. Median certain range width was 30° (IQR 14°-45°) for clinicians and 75° (IQR 45°-180°) for naïve observers. Median repeatability was 10° (IQR 5°-20°) for clinicians and 15° (IQR 10°-29°) for naïve observers. All measures were worse further from the ONH. Systematic differences between model predictions and best estimates were negligible; median absolute differences were 17° (IQR 9°-30°) for clinicians and 20° (IQR 10°-36°) for naïve observers. Larger departures from the model coincided with greater variability in tracing.Concordance between the model and RNFB tracing was good, and greatest where tracing variability was lowest. When RNFB tracing is used for structure-function mapping, variability should be considered.

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