Abstract

Purpose: To compare detection rates of drusen and subretinal fluid by Fourier domain optical coherence tomography (FD OCT) and orange pigment by fundus autofluorescence (FAF) with ophthalmoscopy in indeterminate choroidal melanocytic lesions.

Methods: In a consecutive case series of 38 patients with indeterminate choroidal melanocytic lesion that would have been categorized as small tumor according to the size-based nomenclature used in the Collaborative Ocular Melanoma Study, each eye was submitted to ophthalmoscopic examination, FD OCT and FAF. The presence of drusen, subretinal fluid, and orange pigment was recorded for each lesion by a single observer at the time of initial ophthalmoscopic evaluation and on fundus photographs. FD OCT and autofluorescence images were reviewed in all cases in a masked fashion.

Results: The ophthalmoscopic examination revealed drusen in 42%, subretinal fluid in 53%, and orange pigment in 50% of patients. FD-OCT detected drusen in 45% and subretinal fluid in 58% and FAF detected orange pigment in 58% of the cases. Based on the McNemar’s test, none of the differences were statistically significant at the 0.05 level.

Conclusions: FD OCT and FAF compliment clinical examination by verifying and documenting retinal and RPE changes associated with indeterminate choroidal melanocytic lesions. The detection rates by FD OCT and FAF of important qualitative prognostic factors appear to be equivalent to ophthalmoscopy by a trained observer. Once validated in a larger number of patients, FD OCT and FAF findings can be incorporated into diagnostic algorithms.