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Taha Soomro, James Talks; Improving diagnostic findings with OCT angiography. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2309.
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© ARVO (1962-2015); The Authors (2016-present)
OCT angiography (OCTA) can show choroidal neovascularization (CNV) in some cases compared to fundus fluorescein angiography (FFA) but does it just replicate FFA findings or can it add to a multimodal imaging approach?We reviewed the images obtained from a Heidelberg OCTA (beta version), compared to those from OCT, FFA and indocyanine green angiography (ICG), in cases being assessed for CNV.
A random sample of patients having OCT, FFA and ICG were imaged with OCTA, (Heidelberg Spectralis OCTA beta). The OCTA images were assessed for detection of a vascular network and compared to the OCT, FFA and ICG images. Standard diagnostic criteria were used to classify classic and occult imaging findings. Manual segmentation and assessment through the enface layers of the OCTA were correlated with the cross sectional OCT findings and allowance made for projection artefacts and areas of loss of RPE. In cases where a CNV was seen on OCTA but not clearly defined on FFA a repeat OCTA was performed after antiVEGF treatment to check for response.
49 patients were imaged, 36 had confirmed CNV on FFA/ICG. 19 of these patients had CNV on OCTA. A vascular network was seen with OCTA, compared with FFA in 11/12 (92%) classic lesions, 2/10 (20%) occult lesions, 2/4 (50%) RAP lesions, 2/6 (33%) polyps, 0/2 (0%) peripapillary CNV and 2/2 (100%) myopic CNV. Overall OCTA sensitivity was 56% (95% CI 39-73%) and specificity 92% (95% CI 78-107%). In subgroup analysis for classic neovascular AMD the sensitivity was 92% (95% CI 76-107%) and specificity was 100% (95% CI 100-100%). The neovascular network was more clearly defined on OCTA compared to FFA/ICG, as the availability of early shots varied and FFA leakage obscured the vascular pattern. In two cases OCT showed subretinal fluid with subtle RPE thickening where it was uncertain if the diagnosis was CSR or CNV. In both cases FFA showed a non-specific leak, which could have been occult CNV or CSR, ICG was more suggestive of a CNV and OCTA showed a CNV. Both cases responded to antiVEGF therapy with decrease of the subretinal fluid. Repeat OCTA showed shrinkage of the CNV confirming we had not seen a projection artefact or window defect.
This OCTA system can detect CNV, particularly type 2, classic CNV, often providing a clearer image of the network than seen in FFA. In some cases it can detect a CNV not seen on FFA, which can alter a patient’s management.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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