As seen in Ophthalmology, http://www.aaojournal.org/article/S0161-6420%2814%2900728-3/abstract
Their conclusion is that OCT cannot replace FA:
“It is not recommended that OCT be used alone to detect reactivation of nAMD in patients being monitored.
According to current evidence, OCT should not replace the reference standard of fundus fluorescein angiography for monitoring patients with nAMD.”
OCT showed poor specificity in monitoring reactivation of neovascular age-related macular degeneration, according to a study.
In the article by Castillo et al1, the authors provide a thoughtful review of “the accuracy of optical coherence tomography (OCT) [compared] with alternative tests for monitoring neovascular age-related macular degeneration (nAMD) and detecting disease activity among eyes previously treated for this condition.” The topic is important. The article focuses mainly on whether OCT can replace fluorescein angiography (FA) because OCT is safer, more convenient, and less costly. Their conclusion is that OCT cannot replace FA: “There is a substantial disagreement between OCT and FA findings in detecting active disease in patients with nAMD who are being monitored.
“It is not recommended that OCT be used alone to detect reactivation of nAMD in patients being monitored. According to current evidence, OCT should not replace the reference standard of fundus fluorescein angiography for monitoring patients with nAMD,” the study authors said.
The authors conducted a systematic review and meta-analysis of eight monitoring studies involving 463 patients who underwent treatment for neovascular AMD; four studies were prospective, three studies were retrospective, and one study lacked that information.
Seven studies reported on the use of OCT (five on time-domain OCT, one on spectral-domain OCT and one on both) and one study reported on indocyanine green angiography (ICGA). No studies included a direct comparison of tests in the same patient population.
All OCT studies showed a sensitivity of 85% and specificity of 48% in detecting active neovascular AMD.
In studies reporting on TD-OCT, sensitivity was 70% and specificity was 65%.
There was insufficient data to calculate pooled sensitivity and specificity estimates for SD-OCT.
The ICGA study showed a sensitivity of 75.9% and specificity of 88% in detecting active disease.
Among the seven OCT studies, participants received anti-VEGF therapy in two studies and underwent photodynamic therapy in five. Participants in the ICGA study underwent laser photocoagulation. – by Matt Hasson
Disclosure: The authors report no relevant financial disclosures.
Optical Coherence Tomography for the Monitoring of Neovascular Age-Related Macular Degeneration
A Systematic Review
Mayret M. Castillo, MSc, Opth, Graham Mowatt, MA(Hons), MBA, Andrew Elders, MSc, BSc, Noemi Lois, PhD, FRCOphth, Cynthia Fraser, MA(Hons), Rodolfo Hernández, MSc, Winfried Amoaku, FRCOpth, PhD, Jennifer M. Burr, FRCOphth, MSc, Andrew Lotery, FRCOphth, Craig R. Ramsay, BSc(Hons), PhD, Augusto Azuara-Blanco, PhD, FRCOphthReceived: March 4, 2014;
Received in revised form: May 5, 2014; Accepted: July 31, 2014; Published Online: October 21, 2014. Manuscript no. 2014-340.
To compare the accuracy of optical coherence tomography (OCT) with alternative tests for monitoring neovascular age-related macular degeneration (nAMD) and detecting disease activity among eyes previously treated for this condition.
Traditionally, fundus fluorescein angiography (FFA) has been considered the reference standard to detect nAMD activity, but FFA is costly and invasive. Replacement of FFA by OCT can be justified if there is a substantial agreement between tests.
Systematic review and meta-analysis. The index test was OCT. The comparator tests were visual acuity, clinical evaluation (slit lamp), Amsler chart, color fundus photographs, infrared reflectance, red-free images and blue reflectance, fundus autofluorescence imaging, indocyanine green angiography (ICGA), preferential hyperacuity perimetry, and microperimetry. We searched the following databases: MEDLINE, MEDLINE In-Process, EMBASE, Biosis, Science Citation Index, the Cochrane Library, Database of Abstracts of Reviews of Effects, MEDION, and the Health Technology Assessment database. The last literature search was conducted in March 2013. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) to assess risk of bias.
We included 8 studies involving more than 400 participants. Seven reported the performance of OCT (3 time-domain [TD] OCT, 3 spectral-domain [SD] OCT, 1 both types) and 1 reported the performance of ICGA in the detection of nAMD activity. We did not find studies directly comparing tests in the same population. The pooled sensitivity and specificity of TD OCT and SD OCT for detecting active nAMD was 85% (95% confidence interval [CI], 72%–93%) and 48% (95% CI, 30%–67%), respectively. One study reported ICGA with sensitivity of 75.9% and specificity of 88.0% for the detection of active nAMD. Half of the studies were considered to have a high risk of bias.
There is substantial disagreement between OCT and FFA findings in detecting active disease in patients with nAMD who are being monitored. Both methods may be needed to monitor patients comprehensively with nAMD.