July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Sensitivity and Specificity of Clinically Relevant Features on Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography to Diagnose Polypoidal Choroidal Vasculopathy
Author Affiliations & Notes
  • Voraporn Chaikitmongkol
    Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Amphur Muang Chiang Mai, Chiang Mai, Thailand
  • Preeyanuch Khunsongkiet
    Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Amphur Muang Chiang Mai, Chiang Mai, Thailand
  • Direk Patikulsila
    Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Amphur Muang Chiang Mai, Chiang Mai, Thailand
  • Mira Sachdeva
    Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Jun Kong
    Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Pimploy Chavengsaksongkram
    Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Amphur Muang Chiang Mai, Chiang Mai, Thailand
  • Pawara Winaikosol
    Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Amphur Muang Chiang Mai, Chiang Mai, Thailand
  • Chutikarn Dejkriengkraikul
    Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Amphur Muang Chiang Mai, Chiang Mai, Thailand
  • Janejit Choovuthayakorn
    Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Amphur Muang Chiang Mai, Chiang Mai, Thailand
  • Nawat Watanachai
    Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Amphur Muang Chiang Mai, Chiang Mai, Thailand
  • Paradee Kunavisarut
    Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Amphur Muang Chiang Mai, Chiang Mai, Thailand
  • Neil M Bressler
    Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Voraporn Chaikitmongkol, None; Preeyanuch Khunsongkiet, None; Direk Patikulsila, None; Mira Sachdeva, None; Jun Kong, None; Pimploy Chavengsaksongkram, None; Pawara Winaikosol, None; Chutikarn Dejkriengkraikul, None; Janejit Choovuthayakorn, None; Nawat Watanachai, None; Paradee Kunavisarut, None; Neil Bressler, None
  • Footnotes
    Support  Unrestricted funds to Johns Hopkins University for retina research.
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 3250. doi:
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      Voraporn Chaikitmongkol, Preeyanuch Khunsongkiet, Direk Patikulsila, Mira Sachdeva, Jun Kong, Pimploy Chavengsaksongkram, Pawara Winaikosol, Chutikarn Dejkriengkraikul, Janejit Choovuthayakorn, Nawat Watanachai, Paradee Kunavisarut, Neil M Bressler; Sensitivity and Specificity of Clinically Relevant Features on Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography to Diagnose Polypoidal Choroidal Vasculopathy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3250.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Indocyanine green angiography (ICG) is a gold standard to diagnose polypoidal choroidal vasculopathy (PCV) but invasive and not always available at clinical centers. This study explored sensitivity and specificity of clinically relevant features on fundus photography (FP), optical coherence tomography (OCT) and fluorescein angiography (FA) in diagnosing PCV without ICG.

Methods : With IRB approval, treatment-naïve eyes identified with serous/serosanguinous maculopathy that had FP, OCT, FA and ICG before treatment at Chiang Mai University Hospital between Jan 2013 and Dec 2016 were reviewed. De-identified images of each case were categorized into 3 sets (set A: FP; set B: OCT; set C: FA) and reviewed by 3 graders to confirm presence/absence of each feature, i.e., FP: subretinal orange nodule, large subretinal hemorrhage, notched/hemorrhagic pigment epithelial detachment (PED), peripapillary location, multifocal lesions, large drusen in fellow eye; OCT: multiple PED, sharply peaked PED, PED notch, hyperreflective ring beneath PED, double layer sign; FA: classic CNV, occult CNV, peripapillary location, multifocal lesions, expansile dot/smoke-stack leakage. In parallel, additional 2 graders reviewed images (including ICG) to confirm presence/absence of PCV in each case based on the EVEREST2 criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under ROC curve (AUC) of PCV diagnosis were analyzed.

Results : Of 123 study eyes (119 subjects, 56% male, mean age±SD 57.5±12.5), definite diagnosis were 53% PCV, 37% CSC, 9% typical neovascular AMD. Features provided high AUC (≥0.8) were 1) FP: notched/hemorrhagic PED (0.76, 95%CI: 0.69-0.84), 2) OCT: PED notch (0.88, 95%CI: 0.82-0.93), 3) OCT: sharply peaked PED (0.84, 95%CI: 0.77-0.90), and 4) OCT: hyperreflective ring (0.84, 95%CI: 0.77-0.90). No features on FA reached AUC 0.8. When ≥2 of 4 highly suggestive signs presented, AUC increased to 0.93 (95%CI: 0.89-0.98) with 0.95 sensitivity (95%CI: 0.87-0.99), 0.95 specificity (95%CI: 0.82-0.97), 0.92 PPV (95%CI: 0.83-0.97), and 0.95 NPV (95%CI: 0.86-0.99).

Conclusions : These data suggest fundus photography and OCT can provide high sensitivity and specificity of PCV diagnosis especially when at least 2 of 4 highly suggestive signs are present.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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