Visualizing the invisible: inner plexiform layer stratification with conventional spectral-domain optical coherence tomography.

Background: The inner plexiform layer (IPL) of the retina plays a key role in visual processing, consisting of five stratified sub-bands (S1-S5) that segregate ON and OFF visual pathways. Until now, resolving these IPL sub-layers was only possible with experimental high-resolution (HR-OCT) or visible-light OCT (VIS-OCT), which remain inaccessible for clinical use. This study provides the first demonstration that IPL stratification can be visualized using commercially available spectral-domain OCT (SD-OCT) with optimized imaging and grayscale inversion.

Methods: This retrospective, cross-sectional image analysis study included three healthy individuals who underwent macular OCT imaging. Two subjects were imaged with SD-OCT devices (Nidek RS3000 Advance and Zeiss Cirrus 6000), while one subject was imaged with a swept-source OCT (SS-OCT) device (Topcon Triton DRI). High-density B-scans (1024 A-scans per B-scan) with 120 repetitions for noise reduction were analyzed in both standard and inverted grayscale display modes. The impact of scan size (12 mm, 6 mm, and 3 mm) on IPL visualization was also evaluated.

Results: In conventional grayscale, IPL stratification was indistinct. However, inverted grayscale revealed five IPL sub-bands in all cases, particularly in the parafoveal region where the IPL is thicker. Hyperreflective dots near IPL-1, likely representing the superficial capillary plexus, were also identified. The 3-mm scan protocol provided superior sub-layer differentiation compared to 12-mm scans. However, SS-OCT images did not allow for the distinction of the five IPL strata.

Conclusions: This study challenges the belief that IPL stratification cannot be identified with conventional SD-OCT. By refining imaging parameters and using grayscale inversion, this approach enhances retinal circuit analysis with standard technology. While SD-OCT enables detailed IPL visualization under specific conditions, SS-OCT does not appear to be well-suited for this purpose. These findings redefine SD-OCT's diagnostic capabilities, opening avenues for research in ophthalmology and neurodegenerative disease monitoring. Further studies should establish best practices and expand clinical applications for this novel methodology.