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Optical coherence tomography for the monitoring of neovascular age-related macular degeneration: a systematic review

Optical coherence tomography for the monitoring of neovascular age-related macular degeneration: a systematic review
Optical coherence tomography for the monitoring of neovascular age-related macular degeneration: a systematic review
Topic: To compare the accuracy of optical coherence tomography (OCT) with alternative tests for monitoring neovascular age-related macular degeneration (nAMD) and detecting disease activity among eyes previously treated for this condition.

Clinical Relevance: Traditionally, fundus fluorescein angiography (FFA) has been considered the reference standard to detect nAMD activity, but FFA is costly and invasive. Replacement of FFA by OCT can be justified if there is a substantial agreement between tests.

Methods: Systematic review and meta-analysis. The index test was OCT. The comparator tests were visual acuity, clinical evaluation (slit lamp), Amsler chart, color fundus photographs, infrared reflectance, red-free images and blue reflectance, fundus autofluorescence imaging, indocyanine green angiography (ICGA), preferential hyperacuity perimetry, and microperimetry. We searched the following databases: MEDLINE, MEDLINE In-Process, EMBASE, Biosis, Science Citation Index, the Cochrane Library, Database of Abstracts of Reviews of Effects, MEDION, and the Health Technology Assessment database. The last literature search was conducted in March 2013. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) to assess risk of bias.

Results: We included 8 studies involving more than 400 participants. Seven reported the performance of OCT (3 time-domain [TD] OCT, 3 spectral-domain [SD] OCT, 1 both types) and 1 reported the performance of ICGA in the detection of nAMD activity. We did not find studies directly comparing tests in the same population. The pooled sensitivity and specificity of TD OCT and SD OCT for detecting active nAMD was 85% (95% confidence interval [CI], 72%–93%) and 48% (95% CI, 30%–67%), respectively. One study reported ICGA with sensitivity of 75.9% and specificity of 88.0% for the detection of active nAMD. Half of the studies were considered to have a high risk of bias.

Conclusions: There is substantial disagreement between OCT and FFA findings in detecting active disease in patients with nAMD who are being monitored. Both methods may be needed to monitor patients comprehensively with nAMD.
399-406
Castillo, Mayret M.
11a70ca0-e837-4d8c-a7b3-56b5ff9db336
Mowatt, Graham
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Elders, Andrew
f82e20bf-ea3b-4aff-aeb4-c149e11def60
Lois, Noemi
bbac68dd-a228-47f1-91b8-b4b0340a2e7b
Fraser, Cynthia
66578e93-8ce5-4c61-89c7-e11315152d5d
Hernández, Rodolfo
3dca2c3c-d8fa-41ed-8644-816313cb5f6a
Amoaku, Winfried
c438c8d7-a9f4-4c49-b568-d35138deb061
Burr, Jennifer M.
92cb0534-d3b0-41a6-90ae-3f01114336c4
Lotery, Andrew
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Ramsay, Craig R
89aca787-249b-4a1c-b9ad-e0a30e2997e8
Azuara-Blanco, Augusto
b67a8c87-d4bf-451a-b199-9356ef3b3534
Castillo, Mayret M.
11a70ca0-e837-4d8c-a7b3-56b5ff9db336
Mowatt, Graham
49d22771-a3ea-4ee1-8b6a-0577e494fb91
Elders, Andrew
f82e20bf-ea3b-4aff-aeb4-c149e11def60
Lois, Noemi
bbac68dd-a228-47f1-91b8-b4b0340a2e7b
Fraser, Cynthia
66578e93-8ce5-4c61-89c7-e11315152d5d
Hernández, Rodolfo
3dca2c3c-d8fa-41ed-8644-816313cb5f6a
Amoaku, Winfried
c438c8d7-a9f4-4c49-b568-d35138deb061
Burr, Jennifer M.
92cb0534-d3b0-41a6-90ae-3f01114336c4
Lotery, Andrew
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Ramsay, Craig R
89aca787-249b-4a1c-b9ad-e0a30e2997e8
Azuara-Blanco, Augusto
b67a8c87-d4bf-451a-b199-9356ef3b3534

Castillo, Mayret M., Mowatt, Graham, Elders, Andrew, Lois, Noemi, Fraser, Cynthia, Hernández, Rodolfo, Amoaku, Winfried, Burr, Jennifer M., Lotery, Andrew, Ramsay, Craig R and Azuara-Blanco, Augusto (2015) Optical coherence tomography for the monitoring of neovascular age-related macular degeneration: a systematic review. Ophthalmology, 122 (2), 399-406. (doi:10.1016/j.ophtha.2014.07.055). (PMID:25444343)

Record type: Article

Abstract

Topic: To compare the accuracy of optical coherence tomography (OCT) with alternative tests for monitoring neovascular age-related macular degeneration (nAMD) and detecting disease activity among eyes previously treated for this condition.

Clinical Relevance: Traditionally, fundus fluorescein angiography (FFA) has been considered the reference standard to detect nAMD activity, but FFA is costly and invasive. Replacement of FFA by OCT can be justified if there is a substantial agreement between tests.

Methods: Systematic review and meta-analysis. The index test was OCT. The comparator tests were visual acuity, clinical evaluation (slit lamp), Amsler chart, color fundus photographs, infrared reflectance, red-free images and blue reflectance, fundus autofluorescence imaging, indocyanine green angiography (ICGA), preferential hyperacuity perimetry, and microperimetry. We searched the following databases: MEDLINE, MEDLINE In-Process, EMBASE, Biosis, Science Citation Index, the Cochrane Library, Database of Abstracts of Reviews of Effects, MEDION, and the Health Technology Assessment database. The last literature search was conducted in March 2013. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) to assess risk of bias.

Results: We included 8 studies involving more than 400 participants. Seven reported the performance of OCT (3 time-domain [TD] OCT, 3 spectral-domain [SD] OCT, 1 both types) and 1 reported the performance of ICGA in the detection of nAMD activity. We did not find studies directly comparing tests in the same population. The pooled sensitivity and specificity of TD OCT and SD OCT for detecting active nAMD was 85% (95% confidence interval [CI], 72%–93%) and 48% (95% CI, 30%–67%), respectively. One study reported ICGA with sensitivity of 75.9% and specificity of 88.0% for the detection of active nAMD. Half of the studies were considered to have a high risk of bias.

Conclusions: There is substantial disagreement between OCT and FFA findings in detecting active disease in patients with nAMD who are being monitored. Both methods may be needed to monitor patients comprehensively with nAMD.

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More information

Accepted/In Press date: 31 July 2014
e-pub ahead of print date: 22 October 2014
Published date: February 2015
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 390421
URI: http://eprints.soton.ac.uk/id/eprint/390421
PURE UUID: a9f90fc3-43f8-4d71-82b7-eba4f03d5c9b
ORCID for Andrew Lotery: ORCID iD orcid.org/0000-0001-5541-4305

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Date deposited: 01 Apr 2016 13:16
Last modified: 10 Dec 2019 01:46

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Contributors

Author: Mayret M. Castillo
Author: Graham Mowatt
Author: Andrew Elders
Author: Noemi Lois
Author: Cynthia Fraser
Author: Rodolfo Hernández
Author: Winfried Amoaku
Author: Jennifer M. Burr
Author: Andrew Lotery ORCID iD
Author: Craig R Ramsay
Author: Augusto Azuara-Blanco

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