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A. Khondkaryan, P. A. Keane, S. Liakopoulos, A. C. Walsh, S. R. Sadda; Comparison of Optical Coherence Tomography and Fluorescein Angiography for the Classification of Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5259.
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To investigate whether optical coherence tomography (OCT) can be used to predict the fluorescein angiographic (FA) classification of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD), and to compare the assessment of disease activity using each imaging modality.
Fifty one consecutive patients (51 eyes) newly diagnosed with neovascular AMD, who underwent StratusOCT imaging and fluorescein angiography at the time of diagnosis, were retrospectively collected. CNV lesions were graded according to the modified Macular Photocoagulation Study (MPS) grading protocol utilized in the Treatment of AMD with Photodynamic Therapy (TAP) study. Raw exported StratusOCT images (Radial Lines scanning protocol) were assessed in a masked fashion (i.e. no knowledge of FA) and used to predict the angiographic classification for each subject. Sensitivity, specificity, and positive predictive value, were determined for the detection of occult and classic leakage components, as well as for retinal angiomatous proliferation (RAP).
For the detection of occult angiographic leakage, OCT displayed a sensitivity of 81.1%, a specificity of 42.9%, and a positive predictive value of 58.8%. For the detection of classic angiographic leakage, OCT displayed a sensitivity of 80.9%, a specificity of 56.7%, and a positive predictive value of 58.8%. For the detection of RAP, OCT displayed a sensitivity of 57.1%, a specificity of 81.8%, and a positive predictive value of 7.8%.
Accurate classification of CNV lesion type is less important in the current era of intravitreal anti-angiogenic therapies, however, it may still provide information regarding the natural history and response to treatment of CNV lesions. The results of our study suggest that Stratus OCT is not an adequate substitute for fluorescein angiography in the current classification system for neovascular AMD.
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