Detection Of Exfoliative Material In Exfoliation Syndrome And Glaucoma Using Ultrahigh-Resolution Oct, With Subclinical Findings In Fellow Eyes

To evaluate the clinical utility of ultrahigh-resolution optical coherence tomography (UHR-OCT) for detecting exfoliative material (XFM) on the anterior lens capsule in eyes with Exfoliation Syndrome (XFS) and Exfoliation Glaucoma (XFG), and to investigate whether subtle or early deposits can be detected in fellow eyes indicating subclinical involvement.

This cross-sectional study was conducted at two tertiary ophthalmology centres: Singapore National Eye Centre, Singapore and Ozaki Eye Hospital, Japan. Patients with XFS or XFG, as well as control subjects, were recruited from both centres.

All eyes underwent anterior segment imaging using UHR-OCT. AI-assisted post-processing was used to generate enface projections to visualize XFM on the anterior lens capsule and within the anterior chamber. Each volume was reviewed for the presence, morphology, and distribution of XFM and lens surface abnormalities in individual B-scans and corresponding enface images. Slit-lamp photographs were independently reviewed and graded by a trained examiner. For fellow-eye analysis in unilateral cases, UHR-OCT images were carefully examined for subtle XFM not identifiable on slit-lamp lens photographs. Discrepancies were resolved by consensus with clinician adjudication.

A total of 96 patients with XFS/XFG and 23 controls were recruited. Disease was bilateral in 23 patients and unilateral in 73. Of unilateral cases, 62 fellow eyes were analysed after excluding poor-quality scans. In affected eyes, UHR-OCT enfaces consistently visualized XFM that was evident on lens photographs, with clearer borders and higher contrast. In fellow eyes, UHR-OCT identified subtle XFM deposits not detectable on lens photographs. Of 62 fellow eyes, 19 eyes (30.6%) demonstrated definite XFM, consistent with XFM-features in affected eyes, while 11 eyes (17.7%) showed possible XFM-like features. XFM-like features were also observed in 11 of 23 control eyes (47.8%) from Ozaki Eye Hospital, a high-prevalence exfoliation population.

UHR-OCT provides clearer visualization of XFM than slit-lamp photography by enhancing contrast and reducing interference from anterior lens opacities. Detection of XFM features in fellow eyes and control eyes suggests increased sensitivity of UHR-OCT for identifying subtle deposits and assessing XFM burden. These findings indicate that UHR-OCT may facilitate detection of early or subclinical exfoliative involvement and support its potential utility in screening and monitoring eyes affected by or at risk of XFS and XFG.