Abstract
Purpose :
In nAMD, intraretinal (IRF) and subretinal fluid (SRF) on spectral domain optical coherence tomography (SDOCT) are used to tailor anti-VEGF treatment. Automated quantification of fluid on SDOCT using artificial intelligence (AI) may allow clinicians to identify patients requiring treatment. However, studies have shown poor agreement between assessment of fluid between AI and retina specialist. This study is designed to develop better reference standards to train AI algorithms with a robust qualitative and quantitative assessment of fluid related to nAMD.
Methods :
SD OCT cube scans of 20 patients with nAMD undergoing anti-VEGF treatment were included. Experienced reading center graders assessed the following qualitative fluid variables: presence, grid location, center subfield (CSF) involvement, and type of IRF (cystoid vs non-cystoid) and SRF (presence of sub-retinal hyperreflective material or SHRM). Both IRF and SRF were categorized as mild or more than mild (mtmIRF/mtmSRF) based on subjective assessment. For quantitative assessment, volumes of IRF (internal limiting membrane to inner segment/outer segment (IS/OS)) and SRF (IS/OS to retinal pigment epithelium) were documented using custom segmentation software. All images were independently reviewed by two expert graders.
Results :
IRF was evaluated in 10 (50%) eyes and categorized as mtmIRF in 6 (60%) eyes. IRF was located within CSF in 8 (80%) eyes and was associated with cysts in 10 (100%) eyes. SRF was evaluated in 14 (70%) eyes and categorized as mtmSRF in 9 (64.2%) eyes. SRF was located within CSF in 13 (92.8%) eyes and associated with SHRM in 14 (100%) eyes. The mean IRF volume was 6.3 (SD=0.27) in eyes with mild IRF and 7.9 (SD=1.2) in eyes with mtmIRF (p=0.03). The mean SRF volume was 0.7 (SD=0.1) in eyes with mild SRF and 1.3 (SD=0.85) in eyes with mtmSRF (p=0.07). Agreement on fluid severity between the two graders was 93% (k=0.85 SE= 0.14; 95% CI=0.57-1) for SRF and 89% (k= 0.73 SE= 0.25; 95% CI= 0.24-1) for IRF.
Conclusions :
Detailed and reproducible evaluation of fluid on SDOCT in nAMD can be performed to provide qualitative and quantitative evaluation of SRF and IRF. Employing these methods in a dataset to correlate with physician decision to treat and patients’ visual outcomes will further refine the reference standards and help train clinically useful AI algorithms.
This is a 2021 ARVO Annual Meeting abstract.