A new strategy for remote monitoring of exudative AMD with macular thickness maps

Abstract

Purpose : To determine if macular thickness maps (MTMs) are sufficient to guide management of eyes with exudative age-related macular degeneration (eAMD), we compared the ability to detect change using MTMs with the ability to detect change using the entire OCT scan in patients undergoing therapy.

Methods : In this retrospective review of patients with eAMD imaged using macula centered 6x6 mm OCT scans (CIRRUS^TM HD-OCT 5000, ZEISS, Dublin, CA), graders were asked to determine if there were changes that warranted a full clinical assessment after viewing two consecutive scans using one of three different imaging strategies: a. MTMs alone (Figure A,B), b. individual foveal centered B-scans alone (Figure C,D), or c. 5 macular B-scans (Figure E-G) including the foveal-centered B-scan. Graders were told the two scans were taken two weeks apart. The consensus ground truth was reached by the graders using a CIRRUS review station to evaluate all the information contained within the OCT scans.

Results : A total of 53 eyes were included in this study, with 1385 imaging sessions. The Fleiss kappa was highest when graders were given MTMs alone compared with the ground truth. When the averages of all 5 graders were compared with the ground truth, the MTMs alone showed the highest level of agreement (90.05%; SD: 0.78%) with a sensitivity of 75% and specificity of 94% followed by the central B-scans (87.87%; SD: 1.59%) with a sensitivity of 44% and specificity of 98% and the five B-scan method (86.512%; SD: 0.64%) with a sensitivity of 28% and specificity of 98%

Conclusions : Macular thickness maps alone provide sufficient information to easily identify recurrent exudation in patients with eAMD, and these maps may be all that is needed for remote monitoring.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.