Abstract
Purpose :
Biomicroscopy and B-scan ultrasound imaging are still considered the gold standard for the diagnosis of a posterior vitreous detachment (PVD) regardless of growing evidence that swept source - optical coherence tomography (SS-OCT) produces high quality images of the vitreo-retinal interface. We performed a prospective, observational study to compare the rate of diagnosis of PVD by biomicroscopy, B-scan ultrasound imaging, and SS-OCT, as well as the agreement between the diagnostic modalities.
Methods :
We examined 95 eyes of 48 consecutive patients with biomicroscopy, B-scan ultrasound, and SS-OCT (16-mm horizontal line scan including the optic nerve and macula) for the presence or absence of a complete PVD (PVD status). Patients aged 18 years or older were included in the study. Eyes with a media opacity (i.e. dense cataract or vitreous hemorrhage) or that had undergone a previous vitrectomy were excluded from the study. One retina specialist (RWSC) evaluated all eyes by biomicroscopy and B-scan ultrasonography. All SS-OCT images were reviewed in a blinded fashion by 2 retina specialists and evaluated for agreement by Cohen’s kappa statistic. Additionally, agreement among the three diagnostic modalities was calculated using Cohen’s kappa statistic.
Results :
Agreement on PVD status between SS-OCT and biomicroscopy was 85.3% (k = 0.711), and agreement between SS-OCT and B-scan ultrasound was 83.2% (k = 0.667). Agreement between B-scan ultrasound and biomicroscopy was 87.4% (k = 0.743). The inter-rater reliability between retina specialists reading the SS-OCT images was 97.9% (k = 0.957). In the 16 cases where there were disagreements between SS-OCT and B-Scan, the SS-OCT images were reviewed and found to provide more detailed information that could definitively determine presence (13/16) or absence (3/16) of PVD.
Conclusions :
SS-OCT produces high quality images of the vitreo-retinal interface and is non-inferior to the current gold standard (B-scan and ultrasound) for the diagnosis of PVD. Additionally, SS-OCT allows for high reproducibility and agreement of observations between graders. Given the rapidity and ease of acquisition of SS-OCT in patients with clear media, SS-OCT can reliably be used to evaluate PVD status in future studies.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.