Optical Coherence Tomography for the Monitoring of Neovascular Age-Related Macular Degeneration: A Systematic Review

doi:10.1016/j.ophtha.2014.07.055

Ophthalmology

Volume 122, Issue 2, February 2015, Pages 399-406

https://doi.org/10.1016/j.ophtha.2014.07.055 Get rights and content

Topic

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.

Clinical Relevance

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.

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Methods

The target condition was nAMD of any phenotype. Eligible participants were individuals who had been treated previously for nAMD with any type of treatment and who were monitored to detect active disease. Thus, patients could have active or stable neovascular disease.

The index test was OCT, alone or in combination with other tests; that is, we included studies that used OCT alone or associated with other test or tests to detect nAMD disease activity, including any of the following: clinical

Results

We identified 4682 titles and abstracts; for 179 of these, the full text was evaluated (Fig 1). Eight were monitoring studies involving people previously diagnosed with nAMD and undergoing follow-up12, 13, 14, 15, 16, 17, 18, 19; 1 study, by Salinas-Alaman et al,¹⁷ reported results for both diagnosis and monitoring (Table 1). No studies evaluated the performance of OCT associated with other test(s). Of the 8 included studies, 4 were prospective15, 16, 17, 19 and 3 were retrospective,12, 13, 14

Discussion

Because of the burden of nAMD on patients and health care providers, an effective and efficient monitoring strategy to detect active disease is needed. The use of frequent (every 1 or 2 months) FFA is not recommended. Fundus fluorescein angiography is hampered by its cost, the fact that it is a relatively time-consuming invasive imaging technology, and its association with rare but possible risks. Current practice patterns preferred by the American Academy of Ophthalmology advise the use of FFA

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Cited by (58)

Agreement of Spectral-Domain OCT with Fluorescein Leakage in Neovascular Age-Related Macular Degeneration: Post Hoc Analysis of the HARBOR Study
2020, Ophthalmology Retina
Citation Excerpt :
However, multiple clinical trials that have used OCT-guided PRN treatment regimens achieved inferior visual acuity outcomes compared with fixed monthly regimens.3,5 It is possible that the suboptimal diagnostic accuracy of OCT to detect active CNV activity may explain these differences.14 OCT angiography is an emerging imaging method to monitor neovascular AMD.18
To evaluate the agreement between detection of activity of choroidal neovascularization (CNV) in neovascular age-related macular degeneration (AMD) by fundus fluorescein angiography (FFA) and spectral-domain (SD) OCT in the HARBOR study. Most retina specialists rely on OCT to guide treatment decisions in neovascular AMD. However, OCT may not always detect exudative activity. Traditionally, FFA was frequently performed in clinical practice, but its use has diminished due to reliance on OCT.
Retrospective post hoc analysis of prospective clinical trial (HARBOR; ClinicalTrials.gov identifier, NCT00891735).
Patients with neovascular AMD in the HARBOR Trial.
Baseline to month 24 data from all randomized study eyes in HARBOR with both FFA and SD OCT data were analyzed for (1) evidence of CNV activity on SD OCT (presence of subretinal fluid, intraretinal fluid, and/or cystoid spaces); (2) evidence of CNV activity on FFA identified by the presence of leakage, and (3) cross-tabulation of CNV activity identified by FFA and SD OCT by office visit.
The percent agreement between FFA and SD OCT in detecting CNV activity and sensitivity and specificity of SD OCT to detect fluorescein leakage in neovascular AMD using FFA as the reference standard.
At baseline, 1094 patients (99.9%) had agreement between SD OCT and FFA in detecting CNV activity. By month 24, of the 779 total active cases, the agreement was only 36% (277 cases). By month 24, most cases (n = 452 [58%]) had evidence of CNV activity on SD OCT only, whereas 6% of cases (n = 50) had CNV activity identified by FFA only. At screening and months 3, 6, 12, and 24, 92% to 100% of cases identified by FFA only were occult CNV lesions. Using FFA as the reference standard, the sensitivity and specificity of SD OCT in detecting CNV activity was 91% (95% confidence interval [CI], 84%–99%) and 13% (95% CI, 4%–22%).
Spectral-domain OCT alone can be relied upon for detecting CNV activity while monitoring eyes with neovascular AMD. However, FFA may still be of value in those with occult lesions that appear quiescent on SD OCT, as this type of lesion may show leakage on FFA.
Indications for fluorescein angiography and optical coherence tomography angiography (OCTA) in medical retina: Changes from 2015 and 2018
2020, Journal Francais d'Ophtalmologie
Le développement de l’angiographie par tomographie par cohérence optique (OCTA) dans la prise en charge des pathologies rétiniennes permet de réduire les indications d’angiographie à la fluorescéine (AF). Depuis 2015, nous utilisons l’OCTA et nous nous efforçons de réaliser le moins d’angiographie (AF) possible. Dans cette étude, nous décrivons les taux d’OCTA et d’AF réalisés et leur indication.
Étude descriptive rétrospective monocentrique. Analyse des dossiers de patients examinés pour une pathologie rétinienne par un spécialiste en rétine médicale entre janvier 2015 et juin 2018.
3487 patients ont été examinés. Les dossiers de 651 d’entre eux (1170 yeux) ont été sélectionnés au hasard pour constituer le groupe étudié. L’âge moyen était de 72 ans (60 % de femmes). 49,4 % des yeux ont eu un OCTA et 6,5 % une AF. Après la première année, le taux d’angiographie était de 2 %. L’OCTA était réalisée principalement pour une dégénérescence maculaire liée à l’âge (DMLA) et/ou une maculopathie liée à l’âge : 50 %, une choriorétinite séreuse centrale (CRSC) : 12 % et une occlusion vasculaire rétinienne : 10 %. L’AF était réalisée principalement pour une DMLA : 49 % ; une rétinopathie diabétique (RD) : 18 % et une CRSC : 14 %. 16 % des yeux souffrant de RD, 11 % de CRSC et 10 % de DMLA ont eu une AF (p < 0,05).
En pratique courante, l’OCTA était réalisée pour la moitié des yeux examinés et l’AF pour seulement 6,5 % des yeux. Ce taux était de 2 % après la première année d’utilisation de l’OCTA. La RD était la principale pathologie nécessitant une AF.
Non-invasive multimodal imaging, including optical coherence tomography angiography (OCTA), has demonstrated high sensitivity and specificity for the management of retinal diseases. Since the availability of OCTA in 2015, we have developed a policy of “as little fluorescein angiography as possible”. In this study, we describe the rate of OCTA and fluorescein angiography (FA) performed and their indications.
Retrospective descriptive single-centre study. Chart review of patients examined for retinal disorders by one medical retina specialist between January 2015 and June 2018.
3487 patients were examined for a retinal disease. The charts of 651 of these patients (1170 eyes) were randomly selected for analysis (study group). The mean age in the study group was 72 years (60% female). Overall, OCTA and FA were performed in 49.4% and 6.5% of the studied eyes respectively. After the first year, the rate of FA decreased to 2%. The main indications for OCTA were age-related macular degeneration (AMD): 50%, central serous chorioretinopathy (CSC): 12% and retinal vascular occlusion: 10%. The most frequent indications for FA were AMD: 49%, diabetic retinopathy (DR): 18% and CSC: 14%. FA was performed in 16%, 11% and 10% of eyes diagnosed with DR, CSC and AMD respectively (P < 0.05).
In routine practice, OCTA was performed in half of the eyes examined for a retinal disorder. The overall rate of FA was 6.5% and dropped to 2% after the first year of OCTA use. DR was the main disorder still requiring FA.
Time course of swept-source optical coherence tomography angiography findings after photodynamic therapy and aflibercept in eyes with age-related macular degeneration
2019, American Journal of Ophthalmology Case Reports
Citation Excerpt :
It also is difficult to observe the detailed morphology of choroidal neovascularization (CNV) due to dye leakage.8 Optical coherence tomography (OCT) is another essential diagnostic tool for wet AMD and is indispensable for evaluating CNV activity.9 Since it is a noninvasive examination, it can be performed repeatedly.
To report swept-source optical coherence tomography angiography (SS-OCTA) findings after full-fluence photodynamic therapy (PDT) and aflibercept intravitreal injection (IVA) for age-related macular degeneration (AMD).
Five eyes of five patients with AMD treated with PDT and IVA were include into the study. We retrospectively reviewed the data obtained from the five patients using SS-OCTA before and after treatment. Three eyes had type 1 choroidal neovascularization (CNV) and two eyes had polypoidal choroidal vasculopathy.
Before treatment, the CNV signals detected in all cases, decreased in three eyes and were not detected completely in two eyes at 1 months after treatment. The areas indicating CNV increased over time, but they did not increase to the baseline level. No CNV signal was detected in one eye during follow-up. In all cases, the exudation unchanged or resolved without additional IVA; the exudation recurred in two cases. In one eye, the CNV signal and the exudation occurred simultaneously; however, there was no association in another eye. A feeder vessel, from which the CNV signal seemed to originate, was seen in one of the five eyes.
SS-OCTA is useful to monitor the morphology of CNV after PDT and IVA, indicating that the remodeling of the choroidal vasculature occurs gradually after treatment. The presence or absence of the CNV signal might indicate CNV activity.
The effect of real-world follow up delay between planned intravitreal anti-VEGF treatments for neovascular age- related macular degeneration on retinal thickness
2023, Research Square
Efficacy of nutraceutical drug in the intermediate and wet forms of age-related macular degeneration
2023, Rossiiskii Oftal'mologicheskii Zhurnal
Agreement of different OCT scan directions for individual retinal-layer thickness measurements in multiple sclerosis subjects with prior unilateral optic neuritis
2022, Scientific Reports

View all citing articles on Scopus

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: This article is based on broader research that was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project no. 10/57/22) that will be published in full in a Health Technology Assessment. The Health Services Research Unit is core-funded by the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, the NIHR, the National Health Service, the Department of Health, or the CSO.

: See Editorial on page 222.

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Original articleOptical Coherence Tomography for the Monitoring of Neovascular Age-Related Macular Degeneration: A Systematic Review

Topic

Clinical Relevance

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study

Ophthalmology

Ranibizumab for neovascular age-related macular degeneration

N Engl J Med

Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration. Results of a randomized clinical trial

Arch Ophthalmol

Laser photocoagulation for juxtafoveal choroidal neovascularization: five-year results from randomized clinical trials

Arch Ophthalmol

Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials—TAP report 1

Arch Ophthalmol

Preferred Practice Pattern Guidelines: Age-Related Macular Degeneration

Original article
Optical Coherence Tomography for the Monitoring of Neovascular Age-Related Macular Degeneration: A Systematic Review