Abstract
Background/objectives
Optical coherence tomography angiography (OCT-A) allows non-invasive imaging of chorio-retinal vasculature, and is a potential alternative to fluorescein angiography (FA). Sensitivity and specificity of OCT-A for detecting choroidal neovascularisation (CNV) in treatment-naïve neovascular age-related macular degeneration (nAMD) patients is examined, using the Heidelberg Spectralis in a ‘real world’ setting.
Subject/methods
Overall, 43 eyes from 26 patients were included in the study. Spectral domain OCT (SD-OCT), OCT-A and FA images were obtained at baseline. Each of the three retinal image modalities was systematically assessed by three masked clinicians. Decisions about the presence/absence of CNV were recorded using an automated segmentation for OCT-A, a manual method, and using both OCT-A and SD-OCT in conjunction. Additional information about the presence of sub-retinal hyper-reflective material (SHRM) and the ‘double layer sign’ (DLS) were recorded.
Results
The average sensitivity and specificity of the OCT-A for the detection of CNV in treatment naïve AMD was 89% and 87% for the combined SD-OCT and OCT-A, 76% and 91% for the automated segmentation and 84% and 85% for the manual segmentation, respectively. Inter-clinician agreement was 0.59–65 kappa. In patients without CNV, SHRM was present in only 6% while DLS was present in 28%. Sensitivity and specificity was >78% for both SHRM and DLS.
Conclusions
OCT-A provides a reliable tool for detecting CNV in treatment naïve nAMD patients, with high sensitivity and specificity. Combined use of SD-OCT images and SHRM as an additional bio-marker, OCT-A could become an alternative to FA in routine clinical practice.
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S Moss for helping to identify patients to be included in the present study.
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FDG received a lecture fee from Heidelberg Ltd. CF, ZM and FM—none.
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Ghanchi, F.D., Fulcher, C., Madanat, Z. et al. Optical coherence tomography angiography for identifying choroidal neovascular membranes: a masked study in clinical practice. Eye 35, 134–141 (2021). https://doi.org/10.1038/s41433-020-01285-0
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DOI: https://doi.org/10.1038/s41433-020-01285-0
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