Comparison of Clarus, Optos, and Heidelberg Systems for Geographic Atrophy Area Measurements.

PubMed ID: 42293345

Author(s): Bogost J, Saunders T, Heathcote J, Pak JW, Lopez D, Froines C, Blodi B, Channa R, Schildroth K, Kurt K, Mititelu M, Stepien K, Chang JS, Altaweel M, Gottlieb J, Conlin K, Sabb P, Patel N, Domalpally A. Comparison of Clarus, Optos, and Heidelberg Systems for Geographic Atrophy Area Measurements. Ophthalmol Sci. 2026 Apr 28;6(7):101207. doi: 10.1016/j.xops.2026.101207. eCollection 2026 Jul. PMID 42293345

Journal: Ophthalmology Science, Volume 6, Issue 7, Jul 2026

PURPOSE To compare geographic atrophy (GA) area measurements across 3 modern fundus autofluorescence (FAF) imaging platforms: Heidelberg Spectralis, Optos California, and Zeiss Clarus 700.

DESIGN A prospective, single-center, cross-sectional comparative imaging study.

PARTICIPANTS Sixty-one eyes from 39 participants aged ≥50 years with GA secondary to age-related macular degeneration.

METHODS Participants were imaged sequentially on the same day with all 3 devices: Optos California FAF (532 nm green excitation, 200° ultra-widefield), Zeiss Clarus 700 FAF (blue 435-500 nm and green 500-585 nm channels, 133° widefield), and Heidelberg Spectralis FAF (488 nm blue excitation, 30° field). Geographic atrophy was segmented with manual planimetry for all modalities; Heidelberg images were also segmented semiautomatically with RegionFinder. RegionFinder area values served as the reference standard for comparisons.

MAIN OUTCOME MEASURES Mean GA area by imaging system and agreement with RegionFinder.

RESULTS Agreement with RegionFinder was high across imaging systems (intraclass correlation coefficients: 0.96-0.99), but systematic differences were noted in GA area measurements. Geographic atrophy measured larger on average with Clarus Green and Heidelberg manual planimetry (0.49 mm2 [95% confidence interval [CI], 0.23 to 0.75] and 0.34 mm2 [95% CI, 0.22 to 0.45], respectively), while Optos California measured smaller areas (-0.47 mm2 [95% CI, -0.81 to -0.13]).

CONCLUSIONS Geographic atrophy area measurements are reproducible within each FAF imaging system but systematically differ between platforms and wavelengths. Repeated use with the same device recommended for clinical trials.

FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.