Elsevier

Ophthalmology Retina

Volume 1, Issue 4, July–August 2017, Pages 294-303
Ophthalmology Retina

Original article
Sensitivity and Specificity of OCT Angiography to Detect Choroidal Neovascularization

Presented: at the Association for Research in Vision and Ophthalmology Annual Meeting, 2016.
https://doi.org/10.1016/j.oret.2017.02.007Get rights and content

Abstract

Purpose

To determine the sensitivity and specificity of OCT angiography (OCTA) in the detection of choroidal neovascularization (CNV) in age-related macular degeneration (AMD).

Design

Prospective case series.

Subjects

A prospective series of 72 eyes were studied, which included eyes with treatment-naive CNV due to AMD, non-neovascular AMD, and normal controls.

Methods

All eyes underwent OCTA with a spectral domain OCT. The 3-dimensional angiogram was segmented into separate en face views including the inner retinal angiogram, outer retinal angiogram, and choriocapillaris angiogram. Detection of abnormal flow in the outer retina served as candidate CNV with OCTA. Masked graders reviewed structural OCT alone, en face OCTA alone, and en face OCTA combined with cross-sectional OCTA for the presence of CNV.

Main Outcome Measure

The sensitivity and specificity of CNV detection compared to the gold standard of fluorescein angiography and OCT was determined for structural spectral domain OCT alone, en face OCTA alone, and with en face OCTA combined with cross-sectional OCTA.

Results

Of 32 eyes with CNV, both graders identified 26 true positives with en face OCTA alone, resulting in a sensitivity of 81.3%. Four of the 6 false negatives had large subretinal hemorrhage and sensitivity improved to 94% for both graders if eyes with subretinal hemorrhage were excluded. The addition of cross-sectional OCTA along with en face OCTA improved the sensitivity to 100% for both graders. Structural OCT alone also had a sensitivity of 100%. The specificity of en face OCTA alone was 92.5% for grader A and 97.5% for grader B. The specificity of structural OCT alone was 97.5% for grader A and 85% for grader B. Cross-sectional OCTA combined with en face OCTA had a specificity of 97.5% for grader A and 100% for grader B.

Conclusions

Sensitivity and specificity for CNV detection with en face OCTA combined with cross-sectional OCTA approaches that of the gold standard of fluorescein angiography with OCT, and it is better than en face OCTA alone. Structural OCT alone has excellent sensitivity for CNV detection. False positives from structural OCT can be mitigated with the addition of flow information with OCTA.

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

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