Spectral Domain Optical Coherence Tomography Angiography (OCTA) of Choroidal Neovascularization

Abstract

 

Purpose

 

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

 

Methods

 

Patients who underwent OCTA 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 the characteristics of CNV on OCTA: size using greatest linear dimension (GLD; small if < 1mm, medium if between 1mm and 2mm, large if > 2mm), appearance (well-circumscribed, poorly-circumscribed), and presence of subretinal and intraretinal fluid. Concurrently, an overlapping second cohort of patients who received same day OCTA and fluorescein angiography (FA) for suspected CNV was evaluated to estimate the sensitivity and specificity of OCTA in detecting CNV using FA as the ground truth.

 

Results

 

CNV was visualized on OCTA in 48 eyes. Thirty-one eyes had CNV associated with neovascular age-related macular degeneration. CNV size 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 were each seen in 71% (22/31). Seven eyes had CNV associated with central serous chorioretinopathy. CNV size was small in 71% (5/7) and large in 29% (2/7). 71% (5/7) had well-circumscribed vessels, 86% (6/7) had subretinal fluid, and 14% (1/7) had intraretinal fluid. 30 eyes with OCTA and same-day FA were evaluated to determine the sensitivity and specificity of CNV detection on OCTA. Sensitivity was 50% (4/8) and specificity was 91% (20/22).

 

Conclusions

 

OCTA allows the clinician to non-invasively visualize CNV and may provide a method for identifying and guiding treatment of CNV. The specificity of CNV detection on 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.  

 

(A) OCTA of CSCR. (B) OCTA of neovascular AMD. (C) OCTA of neovascular AMD.

 

 

(A-B) OCTA of multifocal choroiditis shows CNV and PED. (C-E) Increasing hyperfluorescence and pooling on FA. (F-G) OCTA two months after anti-VEGF shows CNV and PED decreased in size. (H-J) Mild hyperfluorescence stable throughout FA on the same follow-up day as F-G.<br />