To report frequencies of image artifacts associated with spectral-domain optical coherence tomography (SD-OCT) and to evaluate the impact of artifacts on foveal thickness measurements.

This retrospective study included 267 eyes of 267 patients who underwent OCT volume scanning using Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany). Macular volume scans of normal and diseased eyes were systematically evaluated for image artifacts within each scan overall and within the center 1-mm area. The frequency of each artifact type was compared for scans stratified by diagnosis category.

Among the volume scans, 79.4% had at least 1 artifact overall, and 26.6% had at least 1 artifact in the center 1-mm area. The highest percentage of inner retina misidentification occurred in the epiretinal membrane (36.1%), whereas the highest percentage of outer retina misidentification occurred in neovascular age-related macular degeneration (wet AMD, 40.0%). Clinically significant artifacts involving the center 1-mm area were observed in 6.4% of volume scans and were most common in wet AMD (43.3%).

Image artifacts in SD-OCT volume scanning are common, but relatively less common in the center 1-mm area of scans. Clinicians should carefully review scans for artifacts when using SD-OCT images and retinal thickness measurements because clinically significant artifacts may affect retinal thickness measurements.