PONE-D-20-31372

Need for manual segmentation in optical coherence tomography angiography of neovascular age-related macular degeneration

PLOS ONE

Dear Dr. Dabir,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please change the abbreviation MNV to CNV, which is the conventional usage.  Two graders are needed to evaluate the lesions using OCTA, and present the agreement between graders..

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We note that one or more of the authors are employed by a commercial company: Rajan Eye Care Pvt Ltd

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: 1. The manuscript is interesting.

2. The abbreviation MNV may be replaced by CNV, which is more conventionally used.

3. Please mark the ‘peripheral anastomoses’ in figure 1b,

4. What is the significance of figure 2, showing 3 different eyes? Rather, it would add value to present images of the case examples exhibiting statistical difference between automated and manual segmentation. For example, cases where automated slabs failed to show deeper CNV, while manual segmentation detected the deeper CNVs

Reviewer #2: Dear Editor

Thanks very much for asking me to review this study entitled “Need for manual segmentation in optical coherence tomography angiography of neovascular age-related macular degeneration”

The study is interesting but I have some concern about several points:

- I suggest to not start the paper with “Age related macular neovascularization (MNV)” it is weird.

- Introduction: “More recently, optical coherence tomography angiography (OCTA) that enables visualization of the different vascular layers of the retina and choroid has been extensively used to detect the presence of MNV as well as to determine disease activity.5,6” I suggest to reference also: 1) Comparison of SD-Optical Coherence Tomography Angiography and Indocyanine Green Angiography in Type 1 and 2 Neovascular Age-related Macular Degeneration (doi: 10.1167/iovs.17-22902) and 2) Comparison between several optical coherence tomography angiography devices and indocyanine green angiography of choroidal neovascularization (doi: 10.1097/IAE.0000000000002471.)

- In the introduction the purpose of the authors should be explained better. I mean, it is hard to understand the reason of this study.

- Consecutive eyes with MNV were included. What about Type 3 MNV or aneurysmal Type 1 MNV?

- The disease activity based on OCTA has no reason here. It cannot be evaluated in this way. The definition of active and inactive MNV based on the appearance of the vessels it is not supported. There are some MNV with large mature linear vessels and a dead tree appearance and subretinal fluid, does it mean that is not active? The appearance of the vessels is more related to the “age” of the lesion rather than the activity. I suggest to remove all the part related to the activity evaluation. Moreover, this is not a prospective study but a cross-sectional study. It is a bet to assess the activity of the lesion in this way and it has no reason to be presented.

- Two graders are needed to evaluate the lesions using OCTA. And agreement between graders should be presented.

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Reviewer #1: No

Reviewer #2: No

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Need for manual segmentation in optical coherence tomography angiography of neovascular age-related macular degeneration

PONE-D-20-31372R1

Dear Dr. Dabir,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Alfred S Lewin, Ph.D.

Section Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The track changes should have been removed from the submitted manuscript. Otherwise the comments have been addressed.

Reviewer #2: Dear Editor,

Thank you very much for asking me to re-evaluate this interesting paper.

The issues raised in the previous submission have been favorably taken in account by the authors. The presentation of the data is more effective.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

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Reviewer #1: No

Reviewer #2: No