Elsevier

Ophthalmology

Volume 122, Issue 6, June 2015, Pages 1228-1238
Ophthalmology

Original article
Spectral-Domain Optical Coherence Tomography Angiography of Choroidal Neovascularization

https://doi.org/10.1016/j.ophtha.2015.01.029Get rights and content

Purpose

To describe the characteristics as well as the sensitivity and specificity of detection of choroidal neovascularization (CNV) on optical coherence tomography angiography (OCTA) using spectral-domain optical coherence tomography.

Design

Observational, retrospective study.

Participants

Seventy-two eyes of 61 subjects (48 eyes of 43 subjects with CNV, 24 eyes of 18 subjects without CNV).

Methods

Patients imaged using the prototype AngioVue OCTA system (Optovue, Inc, Fremont, CA) between August 2014 and October 2014 at New England Eye Center were assessed. Patients in whom CNV was identified on OCTA were evaluated to define characteristics of CNV on OCTA: size using greatest linear dimension (small, <1 mm; medium, 1–2 mm; large, >2 mm), appearance (well-circumscribed, poorly circumscribed), and presence of subretinal and intraretinal fluid. Concurrently, an overlapping second cohort of patients who underwent same-day OCTA and fluorescein angiography (FA) for suspected CNV was evaluated to estimate sensitivity and specificity of OCTA in detecting CNV using FA as ground truth.

Main Outcome Measures

Choroidal neovascularization appearance, CNV size, and presence of subretinal and intraretinal fluid.

Results

In 48 eyes, CNV was visualized on OCTA. Thirty-one eyes had CNV associated with neovascular age-related macular degeneration. Size of CNV was small in 23% (7/31), medium in 42% (13/31), and large in 35% (11/31). Poorly circumscribed vessels, subretinal fluid, and intraretinal fluid each were seen in 71% (22/31). Seven eyes had CNV associated with central serous chorioretinopathy. Size of CNV was small in 71% (5/7) and large in 29% (2/7). Seventy-one percent (5/7) had well-circumscribed vessels, 86% (6/7) had subretinal fluid, and 14% (1/7) had intraretinal fluid. Thirty eyes with OCTA and same-day FA were evaluated to determine sensitivity and specificity of CNV detection on OCTA. Sensitivity was 50% (4/8) and specificity was 91% (20/22).

Conclusions

Using OCTA allows the clinician to visualize CNV noninvasively and may provide a method for identifying and guiding treatment of CNV. The specificity of CNV detection on OCTA compared with FA seems to be high. Future studies with larger sample sizes are needed to elaborate better on the sensitivity and specificity of CNV detection and to illustrate clinical usefulness.

Section snippets

Methods

This study was approved by the institutional review board of Tufts Medical Center. Informed consent was obtained from patients in accordance with the Tufts Medical Center Institutional Review Board before examination. The research adhered to the tenets of the Declaration of Helsinki and complied with the Health Insurance Portability and Accountability Act of 1996. In this retrospective review, patients who underwent OCTA using the prototype AngioVue OCTA system on the commercially available

Results

Choroidal neovascularization was visualized on OCTA in 48 eyes of 43 subjects. Six of these eyes of 6 patients also were reviewed in the overlapping cohort in which same-day FA and OCTA were evaluated for sensitivity and specificity calculations. Including these 6 eyes, the cohort contained 30 eyes of 24 subjects. Therefore, in total, this study included 72 eyes from 61 subjects. All eyes evaluated in this study demonstrated agreement between 3×3-mm and 6×6-mm OCTA images.

Forty-eight eyes of 43

Discussion

Jia et al4 reported 5 cases of CNV and compared them with normal eyes using OCTA from a prototype SS OCT and hinted at the potential future usefulness of OCTA in quantifying CNV. Their prototype system operated at 100 000 A-scans per second to acquire 200×200 A-scans in 3.5 seconds. Orthogonal registration and merging of 4 scans then were used to create 3×3-mm OCTA images. The series presented in this manuscript is a larger qualitative and quantitative study that investigated OCTA imaging using

References (19)

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Financial Disclosure(s): The author(s) have made the following disclosure(s): J.S.D.: Consultant and financial support − Carl Zeiss Meditec, Inc. (Dublin, CA) and OptoVue, Inc. (Fremont, CA).

Supported in part by an unrestricted grant form Research to Prevent Blindness, Inc., New York, New York, to the New England Eye Center/Department of Ophthalmology, Tufts University School of Medicine; and by the Massachusetts Lions Eye Research Fund, Inc (New Bedford, MA).

Author Contributions:

Conception and design: de Carlo, Bonini Filho, Ferrara, Baumal, Witkin, Duker, Waheed

Analysis and interpretation: de Carlo, Bonini Filho, Chin, Adhi, Waheed

Data collection: de Carlo, Bonini Filho, Chin, Baumal, Witkin, Reichel, Duker, Waheed

Obtained funding: Not applicable

Overall responsibility: de Carlo, Bonini Filho, Chin, Adhi, Ferrara, Baumal, Witkin, Reichel, Duker, Waheed

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