Original articleSensitivity and Specificity of OCT Angiography to Detect Choroidal Neovascularization
Section snippets
Study Population
In this prospective case series, consecutive subjects were recruited from the retina clinics at the Casey Eye Institute (Oregon Health and Science University, Portland, Oregon) from September 2014 to September 2015. Informed consent was obtained in accordance with the Institutional Review Board/Ethics Committee of the Oregon Health and Science University and in compliance with the Declaration of Helsinki. Compliance with the Health Insurance Portability and Accountability Act was ensured for
Results
Seventy-four study participants were enrolled, of whom 50% were female; the mean age was 76.7 years (range, 51-95; standard deviation, 8.9 years). The mean age for normal, non-neovascular AMD, and neovascular AMD subjects was 70.3 ± 8.6, 81.7 ± 5.4, and 76.7 ± 9.1 years, respectively. Seventy-four OCT angiograms were obtained. All graders reviewed scans independently, and disagreements were reviewed by expert graders (STB, SSG, YJ). Two cases were excluded due to poor image quality in the study
Examples of False Negatives
In 4 eyes with neovascular AMD, both graders could not identify CNV due to the presence of large SRH. The CNV signal is attenuated on both en face OCTA and cross-sectional OCTA in all of the eyes with SRH. An example of this is illustrated in Figure 2. On FA, dye leakage is visualized within and superior to the SRH (Fig 2E). On the en face OCTA outer retinal slab, flow is visible on the outer retinal slab, but no clear vascular structures are visualized (Fig 2B). Cross-sectional OCTA shows flow
Discussion
This is the first study we are aware of comparing the sensitivity and specificity of structural SD-OCT alone, en face OCTA alone, and en face OCTA combined with cross-sectional OCTA for the detection of treatment-naïve CNV in AMD using FA and OCT as the gold standard. Of the 3 approaches studied, en face OCTA combined with cross-sectional OCTA performed the best (Table 1). With cross-sectional OCTA, both flow and structural SD-OCT information are available on the same scan. Alone, SD-OCT can
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Supported by National Institutes of Health (Bethesda, MD) Grants R01 EY024544, DP3 DK104397, R01 EY023285, P30 EY010572 and by unrestricted departmental funding from Research to Prevent Blindness (New York, NY). The sponsor or funding organization had no role in the design or conduct of this research.
Financial Disclosures: The authors made the following disclosures: Y.J.: Financial interest — Optovue, Inc. This potential conflict of interest is managed by Oregon Health & Science University. The other authors do not have financial interest in the subject of this article.
D.H.: Financial interest–Optovue, Inc. This potential conflict of interest is managed by Oregon Health & Science University; royalties—OCT patent licensed by the Massachusetts Institute of Technology to Carl Zeiss Meditec and LightLab Imaging.
Author Contributions:
Conception and design: Faridi, Jia, Huang, Bailey
Analysis and interpretation: Faridi, Jia, Gao, Bhavsar, Sill, Flaxel, Bailey
Data collection: Jia, Gao, Sill, Wilson, Flaxel, Hwang, Wilson, Lauer, Bailey
Obtained funding: N/A
Overall responsibility: Faridi, Jia, Bailey