PONE-D-24-05686Retinal imaging with hand-held optical coherence tomography in older people with or without postoperative delirium after hip fracture surgery: A feasibility studyPLOS ONE

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"Dr Noah’s PhD – British Journal of Anaesthesia/Royal College of Anaesthetists project grant. Grant holder - Prof Iain Moppett

Purchase of OCT – BJA/RCOA grant, Precision Imaging Beacon Centre and Academic Department of Neurology, University of Nottingham."

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Additional Editor Comments:

Please address the reviewers concerns about the limitations of obtaining OCT images by a single operator.

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Reviewers' comments:

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Revision

Retinal imaging with hand-held optical coherence tomography in older people with or

without postoperative delirium after hip fracture surgery: A feasibility study

General comments:

The authors present a feasibility study on the assessment of the peripapillary nerve fiber layer (RNFL) thickness in patients experience postoperative delirium (DOL) after surgery for unilateral hip fracture. Despite a very small sample of 26 patients without and 4 patients with DOL the authors find significant differences in RNFL thickness between the two groups. While this certainly needs verification in a much larger sample, these results are very much of interest.

Major comments:

The images were taken by one single operator who was in parts assisted by a colleague. Acquisition of OCT images using a handheld device can be very challenging for various reasons. It would have been very insightful if two people had been acquiring the images and their agreement was assessed. Same counts for retinal layer segmentation, especially if a custom tool for ImageJ was used to the assessments.

Minor comments:

p.3 l.55:

Define “older”.

P.3. L.60:

Add a reference for POD hypothesis.

P.4. l.88:

Thinning of the inner retinal layers (most notably RNFL and the IPL-GCL complex) has also been shown on macular OCT. Please include this and explain why it was chosen to assess the peripapillary RNFL. OCT acquisition of the macula is generally easier due to fixation.

P. l.88:

There is evidence of a thinning of the outer retinal layers in frontotemporal dementia. This should be included in the introduction.

P.5 l.93:

Add references.

P.6 l.138:

Define “severe myopia”. Generally, <-6 diopters is used.

P.8. L. 186:

I assume the age-adjusted normative values were taken from a measurements using a different OCT devise. This should be acknowledged and included in the limitations.

P.9. L. 206:

Please define who the “OCT experts” were and how they were trained.

Table 2:

Please include lens status in the table.

p.16 l.312:

Please stick to “cpRNFL” as the abbreviation.

Figure 2:

The size of the segments varies. Please either unitize or explain in detail why this is the case.

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Reviewer #1: Yes: Lukas Goerdt

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Retinal imaging with hand-held optical coherence tomography in older people with or without postoperative delirium after hip fracture surgery: A feasibility study

PONE-D-24-05686R1

Dear Dr. Noah,

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.

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Kind regards,

Alfred S Lewin, Ph.D.

Section Editor

PLOS ONE

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