Sensitivity and Specificity of Ultra-High Speed Optical Coherence Tomography Angiography in Detection of Choroidal Neovascularization in Neovascular Age-Related Macular Degeneration

Abstract

Purpose: To estimate the sensitivity and specificity for the detection of choroidal neovascularization (CNV) using ultrahigh speed swept source optical coherence tomography angiography (SS-OCTA) in patients with neovascular age-related macular degeneration (AMD).

Methods: In this retrospective observational cross-sectional study, patients with a clinical diagnosis of neovascular AMD were evaluated at New England Eye Center between January 2014 and November 2014. 25 patients who received ultrahigh speed SS-OCTA (Massachusetts Institute of Technology, Cambridge MA) and 50-degree fluorescein angiography (FA) on the same day were evaluated. The SS-OCTA software co-registers the SS-OCTA en-face angiograms with SS-OCTA correlating b-scans allowing for visualization of structure and blood flow in tandem. FA, SS-OCTA angiograms, and SS-OCTA correlating b-scans were independently reviewed by two masked Boston Image Reading Center (BIRC) trained readers to identify CNV. Sensitivity and specificity of CNV detection using SS-OCTA were calculated using FA as the ground truth in three different ways: (1) SS-OCTA angiograms alone (2) SS-OCTA correlating b-scans alone (3) SS-OCTA angiograms and correlating b-scans.

Results: Sensitivity of CNV detection was moderate when using either SS-OCTA angiograms or SS-OCTA correlating b-scans alone. However, sensitivity improved when using the SS-OCTA images in tandem. Specificity was high in all three groups.

Conclusions: SS-OCTA is able to non-invasively visualize CNV which may provide a method for identifying and guiding treatment of CNV. The sensitivity and specificity of CNV detection on ultra-high SS-OCTA compared with FA appears high. Future studies with larger sample sizes are needed to better elaborate on the sensitivity and specificity of CNV detection and illustrate clinical utility.