PONE-D-24-35586Estimation of Foveal Avascular Zone Area from a B-can OCT image using Machine Learning AlgorithmsPLOS ONE

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Academic Editor

PLOS ONE

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 Author T.T. was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI (Grant Number: 22K16963). JSPS website: https://www.jsps.go.jp/english/  

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Reviewers' comments:

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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: Yes

Reviewer #2: Yes

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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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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: The manuscript states, “All relevant data are within the manuscript and its Supporting Information files.” However, I could not locate the OCT B-scans and OCTA images for the 104 subjects. Given the substantial number of images, it would be customary to use a data repository such as Figshare for sharing this kind of dataset. Could you please provide a public URL for access to these files?

As the data have been anonymized and the study was ethically approved for research use with an opt-out option, it seems that public sharing should be feasible. Could you clarify if there are any concerns regarding data availability for public access?

Comments on the Conclusion:

The conclusions may be overstated. It is unclear why the accurate inference of a single measurement from OCTA (such as FAZ) using B-scans would provide additional evidence to support the intricate interaction between neural and vascular structures within the macula. Since FAZ can be measured in a relatively short time, why is it possible to capture a B-scan but not an OCTA image in the same scenario? Are there indeed many cases where B-scans can be obtained, but OCTA imaging cannot? This point warrants further clarification.

Additionally, while the FAZ area could potentially be valuable for studies on developmental changes or age-related variations in the elderly, the more straightforward approach might involve short-time OCTA imaging of a small region focused on the FAZ, allowing for direct data acquisition. There is insufficient evidence to suggest that inference performance from low-quality B-scans, particularly in populations such as children or the elderly (who are challenging to image), is reliable.

It would be advisable to temper the conclusions and align them more closely with the specific findings of this study. Conclusions should reflect the direct implications of the data, without overextending beyond what the results demonstrate.

Reviewer #2: The authors developed machine learning models to predict FAZ metrics from OCT b scan. The subject of the manuscript can be of interest, however, I have the following comments and questions:

1. Please provide the OCT and OCTA devices used in this study

2. I think a useful statistical analysis would be Bland–Altman analysis to show 95% limit of agreement (95% LoA)

3. It is already shown that measuring FAZ in full retinal slab is more accurate that SCP or DCP. Why did you use the SCP slab

4. An important limitation of the study is including only healthy subjects as it is previously shown that in diseased eyes, even the octa built-in software is inaccurate in delineating the FAZ area (https://doi.org/10.1038/s41598-020-80058-x)

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Reviewer #1: Yes: HIDENORI TAKAHASHI

Reviewer #2: Yes: Reza Mirshahi

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Estimation of Foveal Avascular Zone Area from a B-can OCT image using Machine Learning Algorithms

PONE-D-24-35586R1

Dear Dr. Toyama,

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,

Tatsuya Inoue

Academic 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

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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: Yes

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

Reviewer #1: 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: 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

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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: In this revised version, the manuscript has been well improved according to the reviewers' comments. I believe the manuscript has reached a stage where there are no significant issues.

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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.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Hidenori Takahashi

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