OCT Angiography-Based Detection and Quantification of the Neovascular Network in Exudative AMD.
Lindner M., Fang PP., Steinberg JS., Domdei N., Pfau M., Krohne TU., Schmitz-Valckenberg S., Holz FG., Fleckenstein M.
Purpose: To investigate the potential of optical coherence tomography (OCT) angiography to detect and quantify the neovascular network in exudative AMD. Methods: Treatment-naïve eyes that were diagnosed with exudative AMD were prospectively examined by OCT angiography (OCT-A). The extent of the neovascular network was measured by three independent readers. Interclass-correlation coefficient and area overlap coefficients (OC) were calculated to assess locally precise agreement between measurements. As a reference for interreader agreement, the extent of the neovascular network was further measured on fluorescein angiography (FA) images. Results: A total of 31 eyes (27 patients, mean age 82.5 years, 15 female) were included in the study. Neovascularization subtype was classified as type I in 5, type II in 11, type III in 9, and mixed in 6 eyes, respectively. Interreader agreement for measurements of the neovascular network was 0.884 for OCT-A and 0.636 for FA. Overlap coefficient was 0.705 (interquartile [IQR]: 0.450-0.76) for OCT-A and 0.704 (IQR: 0.673-0.750) for FA, respectively. Area agreement was weaker in type III and mixed lesions. Conclusions: Optical coherence tomography angiography-based measurements of the new vessel complex in neovascular AMD are feasible with interreader agreement comparable with the values obtained for FA. The results underscore the potential of OCT-A as a noninvasive diagnostic tool in neovascular AMD. Yet, further studies will be required to reveal the origin of poor agreement observed in single eyes and to advance OCT-A toward dependable use (e.g., in a reading center context).