scholarly journals Optical coherence tomography for the diagnosis, monitoring and guiding of treatment for neovascular age-related macular degeneration: a systematic review and economic evaluation

2014 ◽  
Vol 18 (69) ◽  
pp. 1-254 ◽  
Author(s):  
Graham Mowatt ◽  
Rodolfo Hernández ◽  
Mayret Castillo ◽  
Noemi Lois ◽  
Andrew Elders ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Diagnostic Accuracy ◽  
Macular Degeneration ◽  
High Sensitivity ◽  
Cost Effective ◽  
Health Technology ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Age Related ◽  
Sd Oct

BackgroundAge-related macular degeneration is the most common cause of sight impairment in the UK. In neovascular age-related macular degeneration (nAMD), vision worsens rapidly (over weeks) due to abnormal blood vessels developing that leak fluid and blood at the macula.ObjectivesTo determine the optimal role of optical coherence tomography (OCT) in diagnosing people newly presenting with suspected nAMD and monitoring those previously diagnosed with the disease.Data sourcesDatabases searched: MEDLINE (1946 to March 2013), MEDLINE In-Process & Other Non-Indexed Citations (March 2013), EMBASE (1988 to March 2013), Biosciences Information Service (1995 to March 2013), Science Citation Index (1995 to March 2013), The Cochrane Library (Issue 2 2013), Database of Abstracts of Reviews of Effects (inception to March 2013), Medion (inception to March 2013), Health Technology Assessment database (inception to March 2013).Review methodsTypes of studies: direct/indirect studies reporting diagnostic outcomes. Index test: time domain optical coherence tomography (TD-OCT) or spectral domain optical coherence tomography (SD-OCT). Comparators: clinical evaluation, visual acuity, Amsler grid, colour fundus photographs, infrared reflectance, red-free images/blue reflectance, fundus autofluorescence imaging, indocyanine green angiography, preferential hyperacuity perimetry, microperimetry. Reference standard: fundus fluorescein angiography (FFA). Risk of bias was assessed using quality assessment of diagnostic accuracy studies, version 2. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic curves. A Markov model was developed (65-year-old cohort, nAMD prevalence 70%), with nine strategies for diagnosis and/or monitoring, and cost–utility analysis conducted. NHS and Personal Social Services perspective was adopted. Costs (2011/12 prices) and quality-adjusted life-years (QALYs) were discounted (3.5%). Deterministic and probabilistic sensitivity analyses were performed.ResultsIn pooled estimates of diagnostic studies (all TD-OCT), sensitivity and specificity [95% confidence interval (CI)] was 88% (46% to 98%) and 78% (64% to 88%) respectively. For monitoring, the pooled sensitivity and specificity (95% CI) was 85% (72% to 93%) and 48% (30% to 67%) respectively. The FFA for diagnosis and nurse-technician-led monitoring strategy had the lowest cost (£39,769; QALYs 10.473) and dominated all others except FFA for diagnosis and ophthalmologist-led monitoring (£44,649; QALYs 10.575; incremental cost-effectiveness ratio £47,768). The least costly strategy had a 46.4% probability of being cost-effective at £30,000 willingness-to-pay threshold.LimitationsVery few studies provided sufficient information for inclusion in meta-analyses. Only a few studies reported other tests; for some tests no studies were identified. The modelling was hampered by a lack of data on the diagnostic accuracy of strategies involving several tests.ConclusionsBased on a small body of evidence of variable quality, OCT had high sensitivity and moderate specificity for diagnosis, and relatively high sensitivity but low specificity for monitoring. Strategies involving OCT alone for diagnosis and/or monitoring were unlikely to be cost-effective. Further research is required on (i) the performance of SD-OCT compared with FFA, especially for monitoring but also for diagnosis; (ii) the performance of strategies involving combinations/sequences of tests, for diagnosis and monitoring; (iii) the likelihood of active and inactive nAMD becoming inactive or active respectively; and (iv) assessment of treatment-associated utility weights (e.g. decrements), through a preference-based study.Study registrationThis study is registered as PROSPERO CRD42012001930.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Morphological Predictive Features on Spectral-Domain Optical Coherence Tomography for Visual Outcomes in Neovascular Age-Related Macular Degeneration Treated with Ranibizumab

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Georges Azar ◽  
Benjamin Wolff ◽  
Flore De Bats ◽  
Jeremie Halfon ◽  
Mate Streho ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Morphological Features ◽  
Age Related Macular Degeneration ◽  
Spectral Domain ◽  
Prognostic Indicators ◽  
Optical Coherence ◽  
Multicentric Study ◽  
Age Related ◽  
Sd Oct

Purpose. To identify spectral-domain optical coherence tomography (SD-OCT) predictive morphological features for the outcome of Ranibizumab therapy for neovascular age-related macular degeneration (AMD). Methods. This is a retrospective multicentric study that involved 64 eyes with naïve AMD. Patients who received three monthly intravitreal injections of Ranibizumab were stratified into (1) “responders” [≥ 5 letters gain on Early Treatment Diabetic Retinopathy Study (ETDRS) scale] and (2) “nonresponders” (< 5 letters gain). Best-corrected visual acuity (BCVA) and SD-OCT morphological features were compared at baseline and one month after three consecutive injections of Ranibizumab. Univariate and multivariate analyses were carried out to correlate these morphological features with the change in BCVA. Results. Among the 64 patients enrolled, 40 (62.5%) were “responders” and 24 (37.5%) “nonresponders”. Age, sex, and BCVA were comparable between both groups. A multivariate correlational analysis found that subfoveal choroidal thickness (SFCT) and the presence of pigment epithelial detachment (PED) > 250 μm at baseline were two independent prognostic indicators of final BCVA. No other SD-OCT morphological studied features seem to affect final BCVA after Ranibizumab treatment. Conclusion. SFCT and the presence of PED > 250 μm are two significant biomarkers that may predict improvement after Ranibizumab therapy for AMD. These markers may guide ophthalmologists' treatment decision under financial constraints and limited time.

scholarly journals Low-Reflectivity Drusen With Overlying RPE Damage Revealed by Spectral-Domain OCT: Hint for the Development of Age-Related Macular Degeneration

2021 ◽  
Vol 8 ◽  
Author(s):  
Shasha Yang ◽  
Zongyin Gao ◽  
Haijiang Qiu ◽  
Chengguo Zuo ◽  
Lan Mi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Retinal Pigment ◽  
Morphological Characteristics ◽  
Age Related Macular Degeneration ◽  
Spectral Domain ◽  
Optical Coherence ◽  
Age Related ◽  
Sd Oct

Purpose: To observe the relationship between the characteristic changes in the drusen morphology revealed by the spectral-domain optical coherence tomography (SD-OCT) and the progression of age-related macular degeneration (AMD).Methods: A total of 380 drusen in 45 eyes in 35 patients with the intermediate drusen were longitudinally followed up every 6 months by SD-OCT for a period of 24 months. The drusen were divided into the dynamic group and stable group according to the following parameters: number, volume, concurrent retinal pigment epithelium (RPE)/ellipsoid zone (EZ) damage, and the development of advanced AMD. The morphological characteristics of the progressive or stable drusen were further analyzed. Odds ratios (ORs) and the risk for the drusen progression were calculated.Results: The level of interobserver and intraobserver agreement for each drusen tomographic morphological parameters ranged from 82.7 to 90%. At the end of an average follow-up of 15.92 ± 6.99 months, six patients developed choroidal neovascularization and no patients developed geographic atrophy. Finally, 139 drusen changed and 241 drusen remained stable. The drusen with low reflectivity (p &lt; 0.001; OR: 5.26; 95% CI: 2.24–12.36), non-homogeneity without a core (p &lt; 0.001; OR: 4.31; 95% CI: 2.08–8.92), RPE damage (p &lt; 0.001; OR: 28.12; 95% CI: 9.43–83.85), and the EZ damage (p &lt; 0.001; OR: 14.01; 95% CI: 5.28–37.18) were significantly associated with active change; the drusen with low reflectivity (p = 0.01; OR: 2.95; 95% CI: 1.29–6.75) and decreased overlying RPE reflectivity (p &lt; 0.001; OR: 21.67; 95% CI: 9.20–51.02) were the independent predictors for progression. The drusen with high reflectivity were significantly associated with stabilization (p = 0.03; OR: 0.17; 95% CI: 0.04–0.84).Conclusion: Spectral-domain optical coherence tomography is an optimized, accurate, and efficient method to follow-up the drusen. The intermediate non-exudative AMD prognosis of the patient was most strongly correlated with the drusen reflectivity and disruption of the overlying RPE layer. The drusen with low reflectivity and overlying RPE damage were more likely to progress and required frequent follow-up.

Spectral-Domain Optical Coherence Tomography Associations of Neovascular Conversion in Age-Related Macular Degeneration

2018 ◽  
Vol 2 (2) ◽  
pp. 69-78
Author(s):  
Siqing Yu ◽  
Sebastian Wolf ◽  
Marion R. Munk ◽  
Martin S. Zinkernagel ◽  
Andreas Ebneter
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Age Related Macular Degeneration ◽  
Spectral Domain ◽  
Optical Coherence ◽  
Time Points ◽  
Age Related ◽  
Fellow Eyes ◽  
Sd Oct

Purpose: To identify spectral-domain optical coherence tomography (SD-OCT) features associated with exudative conversion in fellow eyes of patients treated for neovascular age-related macular degeneration (nAMD) in their first eye. Methods: Retrospective observational study. Spectral-domain optical coherence tomography images of converting fellow eyes (study eyes) from 83 patients with nAMD were compared to fellow eyes of age- and sex-matched patients with nAMD who did not convert (control eyes). Parameters related to drusen, pigment epithelium detachment, hyperreflective foci (HRF), retinal pigment epithelium atrophy, small cystic cavities, and vitreoretinal interface were graded. Longitudinal analysis in study eyes and cross-sectional comparison with control eyes at the last 3 semiannual visits before nAMD conversion were performed. Results: For most biomarkers, the prevalence in study eyes increased and imaging findings worsened more than in control eyes. Drusen size and reticular pseudodrusen presence were significantly greater in converting eyes at all 3 time points. Outer retinal small cystic cavities were significantly more common in study eyes shortly before conversion. Binary logistic regression revealed that biggest drusen width was significantly associated with nAMD at all 3 time points (odds ratio [OR] > 1.010; P < .001). The presence of soft drusen was strongly associated with nAMD 18 months before conversion (OR: 7.034; P = .040). Clustering HRF in the inner retina were significantly associated with nAMD both 12 (OR: 1.324; P = .049) and 6 months (OR: 2.161; P = .035) before conversion. Conclusions: Emergence of HRF in fellow eyes, particularly in the inner retina, are sensitive SD-OCT features indicating conversion to exudative disease in patients treated unilaterally for nAMD.

scholarly journals Reliability and reproducibility of spectral and time domain optical coherence tomography images before and after correction for patients with age-related macular degeneration

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 131
Author(s):  
Aymen Rashid ◽  
Yasir J Sepah ◽  
Roomasa Channa ◽  
Elham Hatef ◽  
Matthew Shulman ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Time Domain ◽  
Intraclass Correlation ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Age Related ◽  
Before And After ◽  
Manual Correction ◽  
Sd Oct

Purpose: To evaluate the reproducibility and reliability of Optical Coherence Tomography scans (OCT) obtained using the Time Domain (TD-OCT) StratusTM OCT, and the Spectral Domain (SD-OCT) SpectralisTM and CirrusTM OCT devices before and after manual correction in eyes with either Neovascular (NV-AMD) or Non-Neovascular (NNV-AMD) Age-related Macular Degeneration.Methods: We conducted a prospective observational study of 36 patients (50 eyes) with NV-AMD or NNV-AMD at a university-based retina practice. OCT scans were taken simultaneously using one TD-OCT and two SD-OCT devices. Macular thickness measurements were assessed before and after correction of the OCT algorithm by constructing Bland-Altman plots for agreement and calculating intraclass correlation coefficients (ICCs) and coefficients of repeatability (COR) to evaluate intraclass repeatability.Results: The Spectralis device had the highest number of images needing manual correction. All machines had high ICCs, with Spectralis having the highest. Bland-Altman plots indicated that there was low agreement between both Cirrus™ and Stratus™ and Spectralis™ and Stratus™, while there was good agreement between the Cirrus™ and Spectralis™ devices. The CORs were lowest for SpectralisTM and similar with each other and had higher values for CirrusTM and StratusTM. Agreement, CORs, and ICCs generally improved after manual correction, but only minimally.  Conclusion: Agreement is low between devices, except between both SD-OCT machines. Manual correction tends to improve results.

scholarly journals Detection of Age-Related Macular Degeneration by Portable Optical Coherence Tomography Operated by Nonexpert Personnel: Potential Use for Screenings

2018 ◽  
Vol 3 (1) ◽  
pp. 16-20
Author(s):  
Chris Cho ◽  
Melissa M. Liu ◽  
Roomasa Channa ◽  
Alice Y. Zhang ◽  
Harry A. Quigley ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Spectral Domain Oct ◽  
Age Related ◽  
Johns Hopkins University ◽  
Potential Use ◽  
Control Study ◽  
Sd Oct

Purpose: The purpose of this study is to determine the sensitivity and specificity of detecting age-related macular degeneration (AMD) using portable optical coherence tomography (OCT) operated by nonexpert photographers on undilated patients. Methods: In this case-control study, 92 individuals were recruited from the glaucoma and retina clinics at the Wilmer Eye Institute (Johns Hopkins University, Baltimore, MD). Using the portable iVue (Optovue, Inc, Fremont, CA) spectral-domain OCT (SD-OCT), 2 nonexpert photographers acquired retina map scans on undilated eyes of all participants. In total, 33 AMD eyes and 105 control eyes were evaluated and graded by ophthalmologists masked to the diagnoses. Results: Detection of AMD on the portable OCT by ophthalmologists exhibited sensitivities of 0.91 and 0.94 and specificities of 0.88 and 0.89, for graders 1 and 2, respectively. A strong intergrader agreement was observed (κ = 0.87). Conclusions: Nonexpert photographers can use a portable OCT on undilated eyes to acquire images for the detection of AMD. These findings present the potential utility of implementing a portable OCT in community screenings for earlier detection and treatment of disease.

scholarly journals High-Resolution Optical Coherence Tomography Retinal Imaging: A Case Series Illustrating Potential and Limitations

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Olena Puzyeyeva ◽  
Wai Ching Lam ◽  
John G. Flanagan ◽  
Michael H. Brent ◽  
Robert G. Devenyi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Retinal Pigment ◽  
Central Retinal Artery Occlusion ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Optical Coherence ◽  
Age Related ◽  
Sd Oct

Purpose. To present a series of retinal disease cases that were imaged by spectral domain optical coherence tomography (SD-OCT) in order to illustrate the potential and limitations of this new imaging modality.Methods. The series comprised four selected cases (one case each) of age-related macular degeneration (ARMD), diabetic retinopathy (DR), central retinal artery occlusion (CRAO), and branch retinal vein occlusion (BRVO). Patients were imaged using the Heidelberg Spectralis (Heidelberg Engineering, Germany) in SD-OCT mode. Patients also underwent digital fundus photography and clinical assessment.Results. SD-OCT imaging of a case of age-related macular degeneration revealed a subfoveal choroidal neovascular membrane with detachment of the retinal pigment epithelium (RPE) and neurosensory retina. Using SD-OCT, the cases of DR and BRVO both exhibited macular edema with cystoid spaces visible in the outer retina.Conclusions. The ability of SD-OCT to clearly and objectively elucidate subtle morphological changes within the retinal layers provides information that can be used to formulate diagnoses with greater confidence.

scholarly journals Optical Coherence Tomography Angiography versus Dye Angiography in Age-Related Macular Degeneration: Sensitivity and Specificity Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Eleni Nikolopoulou ◽  
Massimo Lorusso ◽  
Luisa Micelli Ferrari ◽  
Maria Vittoria Cicinelli ◽  
Francesco Bandello ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Sensitivity And Specificity ◽  
Optical Coherence Tomography Angiography ◽  
High Sensitivity ◽  
Age Related Macular Degeneration ◽  
Type I ◽  
Optical Coherence ◽  
Type Ii ◽  
Age Related

Introduction. Optical coherence tomography angiography (OCTA) could be a valid tool to detect choroidal neovascularization (CNV) in neovascular age-related macular degeneration (nAMD), allowing the analysis of the type, the morphology, and the extension of CNV in most of the cases. Purpose. To determine the sensitivity and specificity of OCTA in detecting CNV secondary to nAMD, compared to fluorescein angiography (FA) and indocyanine green angiography (ICGA). Methods. Prospective observational study. Patients with suspected nAMD were recruited between May and December 2016. Patients underwent FA, ICGA, spectral domain OCT, and OCTA (AngioVue, Optovue, Inc.). Sensitivity and specificity of FA, with or without ICGA, were assessed and compared with OCTA. Results. Seventy eyes of 70 consecutive patients were included: 32 eyes (45.7%) with type I CNV, 8 eyes (11.4%) with type II CNV, 4 eyes (5.7%) with type III CNV, 6 eyes (8.6%) with mixed type I and type II CNV, and 20 eyes (28.6%) with no CNV. Sensitivity of OCTA was 88% and specificity was 90%. Concordance between FA/ICGA and OCTA was very good (0,91; range 0,81–1,00). Conclusions. OCTA showed high sensitivity and specificity for detection of CNV. Concordance between OCTA and gold-standard dye-based techniques was excellent. OCTA may represent a first-line noninvasive method for the diagnosis of nAMD.

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