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Robert Courtney, Jedediah McClintic, Justis Ehlers; Comparison of Optical Coherence Tomography Scan Patterns and Clinical Review Strategies in the Management of Neovascular Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4910.
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To compare various OCT scan patterns and review strategies to identify an optimal OCT imaging strategy for NVAMD.
A retrospective chart review was performed to identify patients with exudative AMD and concurrent Cirrus (Zeiss) OCT imaging with horizontal 5-line rasters, vertical 5-line rasters, and macular cube analysis. For each encounter, a single published report was reviewed for each of the horizontal and vertical rasters within the clinical image review software (Zeiss Forum), while the cube was reviewed line-by-line in the Cirrus reader software. When available, enhanced depth imaging (EDI) and macular thickness analysis reports were also included in the image review tool. The primary variables compared were the presence or absence of definite exudation as defined by “unequivocal” intra- or subretinal fluid. In addition to “unequivocal fluid,” images were also scored for “any possible fluid” to assess the sensitivity of these review strategies with a “zero-tolerance” strategy. The gold standard for both unequivocal and the zero-tolerance strategy were the sum total findings of all scan patterns (e.g., fluid on any scan).
558 OCT scans were reviewed for 100 clinical encounters for 26 eyes of 23 patients. For unequivocal fluid, 75% of encounters showed exudation. The sensitivity of the line-by-line review (macular cube) and reports (rasters/thickness map) were 97% and 87%, respectively. For the zero-tolerance strategy, 94% of encounters showed possible fluid. The sensitivity of the line-by-line review and reports were 94% and 92%, respectively (p = 0.2). When utilizing a zero-tolerance strategy for interpreting the reports, only 2% of eyes were missed that had unequivocal fluid on the line-by-line review of the macular cube.
Different strategies for acquiring and reviewing OCT data differ in their ability to identify features of exudation. Optimizing both clinical accuracy and diagnostic testing efficiency is critical to successful management of NVAMD. Line-by-line review of the macular cube can be time consuming particularly when the reader software is housed separately from the image report review software. In this study, a zero-tolerance strategy with vertical/horizontal raster scans and thickness maps provides similar sensitivity to the line-by-line review of the cube.
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