Abstract
Purpose
To evaluate the diagnostic accuracy of spectral-domain optical coherence tomography (SD-OCT) for neovascular age-related macular degeneration (nAMD): a comparison against fundus fluorescein angiography (FFA).
Methods
A retrospective review of SD-OCT, colour fundus photographs (FP), and FFA of 411 consecutive patients referred to a rapid access Macular Clinic over a 4-year period was performed. FFA images were reviewed nonstereoscopically. SD-OCT images were acquired using the Topcon 3D OCT-1000 instrument. All FFA and OCT images were graded by at least two ophthalmologists independently. Side-by-side grading took place with immediate open discussion and adjudication. If there was disagreement between the two grading ophthalmologists or they were not 90% confident of their assigned grade, then adjudication by a third ophthalmologist was performed.
Results
A total of 278 eyes were graded as having choroidal neovascularisation (CNV) with SD-OCT and 231 diagnosed with FFA. The main diagnostic CNV classifications on FFA were: classic no occult in 27 eyes, predominantly classic in 16, minimally classic in 50, occult in 129, and 9 peripapillary membranes. There were a total of 47 false positives with SD-OCT: a rate of 16.9%. The sensitivity and specificity of SD-OCT alone for detecting CNV was 100 and 80.8%, respectively.
Conclusion
Our study confirms SD-OCT in comparison to the reference standard of nonstereoscopic FFA is highly sensitive at detecting newly presenting nAMD in the setting of a specialist AMD clinic where the investigations are interpreted by trained specialists. However, it does not seem accurate enough to replace FFA in the diagnosis on nAMD in current practice.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Congdon N, O’Colmain B, Klaver CC, Klein R, Munoz B, Friedman DS et al. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004; 122 (4): 477–485.
Pascolini D, Mariotti SP . Global estimates of visual impairment: 2010. Br J Ophthalmol 2012; 96 (5): 614–618.
Klein R, Peto T, Bird A, Vannewkirk MR . The epidemiology of age-related macular degeneration. Am J Ophthalmol 2004; 137 (3): 486–495.
Chakravarthy U Age-Related Macular Degeneration:Guidelines for Management: Royal College of Ophthalmologists; 2013 [cited November 2013]. Available at http://rcophth.ac.uk/page.asp?section=451.
Barbazetto I, Burdan A, Bressler NM, Bressler SB, Haynes L, Kapetanios AD et al. Photodynamic therapy of subfoveal choroidal neovascularization with verteporfin: fluorescein angiographic guidelines for evaluation and treatment—TAP and VIP report No. 2. Arch Ophthalmol 2003; 121 (9): 1253–1268.
MPSG. Subfoveal neovascular lesions in age-related macular degeneration. Guidelines for evaluation and treatment in the macular photocoagulation study. Macular Photocoagulation Study Group. Arch Ophthalmol 1991; 109 (9): 1242–1257.
Kwan AS, Barry C, McAllister IL, Constable I . Fluorescein angiography and adverse drug reactions revisited: the Lions Eye experience. Clin Exp Ophthalmol 2006; 34 (1): 33–38.
Yannuzzi LA, Rohrer KT, Tindel LJ, Sobel RS, Costanza MA, Shields W et al. Fluorescein angiography complication survey. Ophthalmology 1986; 93 (5): 611–617.
Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W et al. Optical coherence tomography. Science 1991; 254 (5035): 1178–1181.
Kaiser PK, Blodi BA, Shapiro H, Acharya NR, Group MS. Angiographic and optical coherence tomographic results of the MARINA study of ranibizumab in neovascular age-related macular degeneration. Ophthalmology 2007; 114 (10): 1868–1875.
Fung AE, Lalwani GA, Rosenfeld PJ, Dubovy SR, Michels S, Feuer WJ et al. An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol 2007; 143 (4): 566–583.
Castillo MM, Mowatt G, Lois N, Elders A, Fraser C, Amoaku W et al. Optical coherence tomography for the diagnosis of neovascular age-related macular degeneration: a systematic review. Eye 2014; 28 (12): 1399–1406.
Sandhu SS, Talks SJ . Correlation of optical coherence tomography, with or without additional colour fundus photography, with stereo fundus fluorescein angiography in diagnosing choroidal neovascular membranes. Br J Ophthalmol 2005; 89 (8): 967–970.
Talks J, Koshy Z, Chatzinikolas K . Use of optical coherence tomography, fluorescein angiography and indocyanine green angiography in a screening clinic for wet age-related macular degeneration. Br J Ophthalmol 2007; 91 (5): 600–601.
Do DV, Gower EW, Cassard SD, Boyer D, Bressler NM, Bressler SB et al. Detection of new-onset choroidal neovascularization using optical coherence tomography: the AMD DOC Study. Ophthalmology 2012; 119 (4): 771–778.
Mokwa NF, Ristau T, Keane PA, Kirchhof B, Sadda SR, Liakopoulos S . Grading of age-related macular degeneration: comparison between color fundus photography, fluorescein angiography, and spectral domain optical coherence tomography. J Ophthalmol 2013; 2013: 385915.
Padnick-Silver L, Weinberg AB, Lafranco FP, Macsai MS . Pilot study for the detection of early exudative age-related macular degeneration with optical coherence tomography. Retina 2012; 32 (6): 1045–1056.
Laser photocoagulation of subfoveal neovascular lesions of age-related macular degeneration. Updated findings from two clinical trials. Macular Photocoagulation Study Group. Arch Ophthalmol 1993; 111 (9): 1200–1209.
Eter N, Spaide RF . Comparison of fluorescein angiography and optical coherence tomography for patients with choroidal neovascularization after photodynamic therapy. Retina 2005; 25 (6): 691–696.
Sayanagi K, Sharma S, Yamamoto T, Kaiser PK . Comparison of spectral-domain versus time-domain optical coherence tomography in management of age-related macular degeneration with ranibizumab. Ophthalmology 2009; 116 (5): 947–955.
Keane PA, Bhatti RA, Brubaker JW, Liakopoulos S, Sadda SR, Walsh AC . Comparison of clinically relevant findings from high-speed fourier-domain and conventional time-domain optical coherence tomography. Am J Ophthalmol 2009; 148 (2): 242–8 e1.
Khurana RN, Dupas B, Bressler NM . Agreement of time-domain and spectral-domain optical coherence tomography with fluorescein leakage from choroidal neovascularization. Ophthalmology 2010; 117 (7): 1376–1380.
Sulzbacher F, Kiss C, Munk M, Deak G, Sacu S, Schmidt-Erfurth U . Diagnostic evaluation of type 2 (classic) choroidal neovascularization: optical coherence tomography, indocyanine green angiography, and fluorescein angiography. Am J Ophthalmol 2011; 152 (5): 799–806 e1.
Amissah-Arthur KN, Panneerselvam S, Narendran N, Yang YC . Optical coherence tomography changes before the development of choroidal neovascularization in second eyes of patients with bilateral wet macular degeneration. Eye 2012; 26 (3): 394–399.
Acknowledgements
This work was part funded by a research grant from the Macular Society UK. The views expressed are those of the authors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Wilde, C., Patel, M., Lakshmanan, A. et al. The diagnostic accuracy of spectral-domain optical coherence tomography for neovascular age-related macular degeneration: a comparison with fundus fluorescein angiography. Eye 29, 602–610 (2015). https://doi.org/10.1038/eye.2015.44
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2015.44
This article is cited by
-
Macular neovascularization lesion type and vision outcomes in neovascular age-related macular degeneration: post hoc analysis of HARBOR
Graefe's Archive for Clinical and Experimental Ophthalmology (2022)
-
Optical coherence tomography angiography for detection of macular neovascularization associated with atrophy in age-related macular degeneration
Graefe's Archive for Clinical and Experimental Ophthalmology (2021)
-
Prevalence of peripapillary choroidal neovascular membranes (PPCNV) in an elderly UK population—the Bridlington eye assessment project (BEAP): a cross-sectional study (2002–2006)
Eye (2019)
-
The possibility of the combination of OCT and fundus images for improving the diagnostic accuracy of deep learning for age-related macular degeneration: a preliminary experiment
Medical & Biological Engineering & Computing (2019)
-
Sensitivity and specificity of optical coherence tomography angiography (OCT-A) for detection of choroidal neovascularization in real-life practice and varying retinal expertise level
International Ophthalmology (2018)
