Kelvin Yi Chong Teo1, Srinivas R Sadda2, Chui Ming Gemmy Cheung3, Usha Chakravarthy4, Giovanni Staurenghi5, Alessandro Invernizzi6, Yuichiro Ogura7, Paisan Ruamviboonsuk8, Shih-Jen Chen9, Vishali Gupta10, Colin Tan11, Jay Chhablani12, Federico Corvi5, Judy E Kim13, Fumi Gomi14, Adrian H Koh15, Gregg Kokame16, Paul Mitchell17, Tien Y Wong18, Won Ki Lee19, Timothy Y Y Lai20. 1. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore; Save Sight Institute, The University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia. 2. Doheny Eye Institute, David Geffen, School of Medicine, University of California Los Angeles, Los Angeles, California. 3. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore. Electronic address: gemmy.cheung.c.m@singhealth.com.sg. 4. Duke-NUS Medical School, National University of Singapore, Singapore; School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom. 5. Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco" University of Milan, Milan, Italy. 6. Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco" University of Milan, Milan, Italy; Save Sight Institute, The University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia. 7. Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 8. Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand. 9. Department of Ophthalmology, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 10. Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 11. National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore. 12. Vitreo-Retinal Consultant, University of Pittsburgh Eye Center, Pittsburgh, Pennsylvania. 13. Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin. 14. Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan. 15. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore; Eye and Retina Surgeons, Camden Medical Centre, Singapore. 16. Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii. 17. University of Sydney, Westmead Institute for Medical Research, Sydney, Australia. 18. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore. 19. Nune Eye Hospital, Seoul, South Korea. 20. Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong Eye Hospital, Hong Kong.
Abstract
PURPOSE: To develop and validate OCT and color fundus photography (CFP) criteria in differentiating polypoidal choroidal vasculopathy (PCV) from typical neovascular age-related macular degeneration (nAMD) in eyes with suboptimal response to anti-vascular endothelial growth factor (VEGF) monotherapy and to determine whether OCT alone can be used to guide photodynamic therapy (PDT) treatment. DESIGN: Clinical study evaluating diagnostic accuracy. PARTICIPANTS: Patients with nAMD who received 3-month anti-VEGF monotherapy but had persistent activity defined as subretinal fluid or intraretinal fluid at month 3 assessments. METHODS: In phase 1, international retina experts evaluated OCT and CFP of eyes with nAMD to identify the presence or absence of features due to PCV. The performance of individual and combinations of these features were compared with ICGA. In phase 2, these criteria were applied to an independent image set to assess generalizability. In a separate exercise, retinal experts drew proposed PDT treatment spots using only OCT and near-infrared (NIR) images in eyes with PCV and persistent activity. The location and size of proposed spot were compared with ICGA to determine the extent of coverage of polypoidal lesions (PLs) and branching neovascular network (BNN). MAIN OUTCOME MEASURES: Sensitivity and specificity of CFP and OCT criteria to differentiate PCV from nAMD and accuracy of coverage of OCT-guided PDT compared with ICGA. RESULTS: In eyes with persistent activity, the combination of 3 non-ICGA-based criteria (sharp-peaked pigment epithelial detachment [PED], subretinal pigment epithelium [RPE] ring-like lesion, and orange nodule) to detect PCV showed good agreement compared with ICGA, with an area under the receiver operating characteristic curve of 0.85. Validation using both an independent image set and assessors achieved an accuracy of 0.77. Compared with ICGA, the OCT-guided PDT treatment spot covered 100% of PL and 90% of the BNN. CONCLUSIONS: In nAMD eyes with persistent activity, OCT and CFP can differentiate PCV from typical nAMD, which may allow the option of adjunct PDT treatment. Furthermore, OCT alone can be used to plan adjunct PDT treatment without the need for ICGA, with consistent and complete coverage of PL.
PURPOSE: To develop and validate OCT and color fundus photography (CFP) criteria in differentiating polypoidal choroidal vasculopathy (PCV) from typical neovascular age-related macular degeneration (nAMD) in eyes with suboptimal response to anti-vascular endothelial growth factor (VEGF) monotherapy and to determine whether OCT alone can be used to guide photodynamic therapy (PDT) treatment. DESIGN: Clinical study evaluating diagnostic accuracy. PARTICIPANTS: Patients with nAMD who received 3-month anti-VEGF monotherapy but had persistent activity defined as subretinal fluid or intraretinal fluid at month 3 assessments. METHODS: In phase 1, international retina experts evaluated OCT and CFP of eyes with nAMD to identify the presence or absence of features due to PCV. The performance of individual and combinations of these features were compared with ICGA. In phase 2, these criteria were applied to an independent image set to assess generalizability. In a separate exercise, retinal experts drew proposed PDT treatment spots using only OCT and near-infrared (NIR) images in eyes with PCV and persistent activity. The location and size of proposed spot were compared with ICGA to determine the extent of coverage of polypoidal lesions (PLs) and branching neovascular network (BNN). MAIN OUTCOME MEASURES: Sensitivity and specificity of CFP and OCT criteria to differentiate PCV from nAMD and accuracy of coverage of OCT-guided PDT compared with ICGA. RESULTS: In eyes with persistent activity, the combination of 3 non-ICGA-based criteria (sharp-peaked pigment epithelial detachment [PED], subretinal pigment epithelium [RPE] ring-like lesion, and orange nodule) to detect PCV showed good agreement compared with ICGA, with an area under the receiver operating characteristic curve of 0.85. Validation using both an independent image set and assessors achieved an accuracy of 0.77. Compared with ICGA, the OCT-guided PDT treatment spot covered 100% of PL and 90% of the BNN. CONCLUSIONS: In nAMD eyes with persistent activity, OCT and CFP can differentiate PCV from typical nAMD, which may allow the option of adjunct PDT treatment. Furthermore, OCT alone can be used to plan adjunct PDT treatment without the need for ICGA, with consistent and complete coverage of PL.