The Diagnostic Accuracy of Optical Coherence Tomography Angiography for Neovascular Age-Related Macular Degeneration: A Comparison with Fundus Fluorescein Angiography

Abstract

Purpose. To describe the morphological characteristics and efficacy of OCTA in detecting CNV in nAMD. We retrospectively reviewed 53 patients (86 eyes) with suspected CNV secondary to wet AMD. All the patients underwent a multimodal assessment for CNV. Two independent readers calculated the sensitivity and specificity of OCTA in detecting CNV compared with FA. A qualitative analysis of OCTA was also performed to describe the morphological appearance of CNV. Among 86 eyes of 53 patients, 52 eyes were diagnosed as having CNV based on the FA imaging analysis. According to FA, CNV was classified as classic in 28 eyes, predominantly classic in 6 eyes, minimally classic in 9 eyes, and occult in 9 eyes. In 56 eyes, CNV was visualized on OCTA and corresponding OCT B-scans. In total, 46.4% (26/56) had well-circumscribed vessels, and 53.6% (30/56) showed poorly circumscribed vessels. There were 11 false positives and 7 false negatives using OCTA. The specificity of OCTA for the detection of CNV was 67.6%, with sensitivity of 86.5%. OCTA may help in the noninvasive diagnosis of CNV and may provide a method for monitoring the evolution of CNV.

Comparison of SD-Optical Coherence Tomography Angiography and Indocyanine Green Angiography in Type 1 and 2 Neovascular Age-related Macular Degeneration

“…Previous studies report a wide range of sensitivities between 32% and 87% for commercially available SD-OCTA systems without differentiation of lesion types. 25,36,37 By contrast, ICGA was able to detect either type 1 or type 2 nAMD in 100% of patients, who were previously selected using FA and OCT. This proves the ability of SD-OCTA to overcome the RPE barrier which is in many respects a limitation of OCT-based imaging due to nontransmission of the RPE layer.…”

“…18,20 Despite the evident benefits of OCTA, 21,22 it has not found its way into primary nAMD diagnosis, and treatment guidelines and FA/ICGA are still considered the gold standard for a comprehensive evaluation of lesion location and morphology. [11][12][13] Current efforts to fully explore and understand the capabilities of OCTA and to set the basis for future diagnostic and therapeutic criteria in nAMD include comparisons of FA and OCTA, [23][24][25] as well as ICGA and OCTA [26][27][28] with variable conclusions.…”

Comparative study between a spectral domain and a high-speed single-beam swept source OCTA system for identifying choroidal neovascularization in AMD

“…Gong et al . report a sensitivity of 87% and a specificity of 68% for the detection of CNV also using the same commercially available SD-OCTA system (AngioVue ® , OptoVue, CA, USA)20. This study shows the sensitivity of SD-OCTA being as low as 32%.…”

Szemfenéki érfestés festék nélkül: Az optikai koherencia tomográfia alapú angiográfia exsudativ típusú időskori maculadegenerációban

“…Míg a hagyományos érfestés esetén a retina felszínes, mély érhálózatai és a choriocapillaris érhálózata egymásra vetülve jelenik meg, az OCT-A segítségével szegmentáció után az egyes érrétegek külön-külön ábrá-zolhatók. Az OCT-A-felvételek interpretációjára nem alkalmas a hagyományos fluoreszcens angiográfiás (FA) nevezéktan, ezért annak kialakítása folyamatban van, szá-mos összehasonlító tanulmány látott napvilágot [11].…”

“…Gong és mtsai [11] 86 szem elemzése kapcsán az OCT-A specificitását 67,6%-ra, szenzitivitását 86,5%-ra érté-kelték, azaz volt olyan eset, amikor nem azonosították a CNV-t és olyan is akadt, amikor CNV-nek véleményez-ték az elváltozást annak ellenére, hogy az angiográfia nem mutatott ki szivárgást. A specificitás és szenzitivitás várhatóan javítható lesz a nagyobb tapasztalatszerzést követően.…”