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Fundus autofluorescence imaging: systematic review of test accuracy for the diagnosis and monitoring of retinal conditions

Fundus autofluorescence imaging: systematic review of test accuracy for the diagnosis and monitoring of retinal conditions
Fundus autofluorescence imaging: systematic review of test accuracy for the diagnosis and monitoring of retinal conditions
Aim: To conduct a systematic review of the accuracy of fundus autofluorescence (FAF) imaging for diagnosing and monitoring retinal conditions.

Methods: Searches in November 2014 identified English language references. Sources included MEDLINE, EMBASE, the Cochrane Library, Web of Science and MEDION databases; reference lists of retrieved studies; and internet pages of relevant organisations, meetings, and trial registries. For inclusion, studies had to report FAF imaging accuracy quantitatively. Studies were critically appraised using QUADAS risk of bias criteria. Two reviewers conducted all review steps.

Results: From 2240 unique references identified, eight primary research studies met the inclusion criteria. These investigated diagnostic accuracy of FAF imaging for choroidal neovascularisation (1 study), reticular pseudodrusen (3 studies), cystoid macular oedema (2 studies) and diabetic macular oedema (2 studies). Diagnostic sensitivity of FAF imaging ranged from 32% to 100% and specificity from 34% to 100%. However, owing to methodological limitations, including high and/or unclear risks of bias, none of these studies provides conclusive evidence of the diagnostic accuracy of FAF imaging. Study heterogeneity precluded meta-analysis. In most studies the patient spectrum was not reflective of those who would present in clinical practice and no studies adequately reported whether FAF images were interpreted consistently. No studies of monitoring accuracy were identified. An update in October 2016, based on MEDLINE and internet searches, identified four new studies but did not alter our conclusions.

Conclusions: Robust quantitative evidence on the accuracy of FAF imaging and how FAF images are interpreted is lacking. We provide recommendations to address this.
0950-222X
995-1007
Frampton, Geoff K.
26c6163c-3428-45b8-b8b9-92091ff6c69f
Kalita, Neelam
da42f168-a3cc-44c9-bafb-2801ff57914b
Payne, Elizabeth
862f8fcf-711d-4146-a723-a9109339c70a
Colquitt, Jillian
741c69a3-d9e0-4f10-b457-e496541e7915
Loveman, Emma
06ff1bf1-0189-4330-b22d-f5a917e9871d
Downes, Susan M.
2c1e60a4-7a61-49e0-9f20-41db1db9afd7
Lotery, Andrew
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Frampton, Geoff K.
26c6163c-3428-45b8-b8b9-92091ff6c69f
Kalita, Neelam
da42f168-a3cc-44c9-bafb-2801ff57914b
Payne, Elizabeth
862f8fcf-711d-4146-a723-a9109339c70a
Colquitt, Jillian
741c69a3-d9e0-4f10-b457-e496541e7915
Loveman, Emma
06ff1bf1-0189-4330-b22d-f5a917e9871d
Downes, Susan M.
2c1e60a4-7a61-49e0-9f20-41db1db9afd7
Lotery, Andrew
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514

Frampton, Geoff K., Kalita, Neelam, Payne, Elizabeth, Colquitt, Jillian, Loveman, Emma, Downes, Susan M. and Lotery, Andrew (2017) Fundus autofluorescence imaging: systematic review of test accuracy for the diagnosis and monitoring of retinal conditions. Eye, 31, 995-1007. (doi:10.1038/eye.2017.19).

Record type: Article

Abstract

Aim: To conduct a systematic review of the accuracy of fundus autofluorescence (FAF) imaging for diagnosing and monitoring retinal conditions.

Methods: Searches in November 2014 identified English language references. Sources included MEDLINE, EMBASE, the Cochrane Library, Web of Science and MEDION databases; reference lists of retrieved studies; and internet pages of relevant organisations, meetings, and trial registries. For inclusion, studies had to report FAF imaging accuracy quantitatively. Studies were critically appraised using QUADAS risk of bias criteria. Two reviewers conducted all review steps.

Results: From 2240 unique references identified, eight primary research studies met the inclusion criteria. These investigated diagnostic accuracy of FAF imaging for choroidal neovascularisation (1 study), reticular pseudodrusen (3 studies), cystoid macular oedema (2 studies) and diabetic macular oedema (2 studies). Diagnostic sensitivity of FAF imaging ranged from 32% to 100% and specificity from 34% to 100%. However, owing to methodological limitations, including high and/or unclear risks of bias, none of these studies provides conclusive evidence of the diagnostic accuracy of FAF imaging. Study heterogeneity precluded meta-analysis. In most studies the patient spectrum was not reflective of those who would present in clinical practice and no studies adequately reported whether FAF images were interpreted consistently. No studies of monitoring accuracy were identified. An update in October 2016, based on MEDLINE and internet searches, identified four new studies but did not alter our conclusions.

Conclusions: Robust quantitative evidence on the accuracy of FAF imaging and how FAF images are interpreted is lacking. We provide recommendations to address this.

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Accepted/In Press date: 2 December 2016
e-pub ahead of print date: 10 March 2017
Published date: July 2017
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 403690
URI: https://eprints.soton.ac.uk/id/eprint/403690
ISSN: 0950-222X
PURE UUID: d2256bec-d540-492f-8ce9-96f69d533591
ORCID for Neelam Kalita: ORCID iD orcid.org/0000-0002-0973-0160
ORCID for Elizabeth Payne: ORCID iD orcid.org/0000-0002-6594-5668
ORCID for Andrew Lotery: ORCID iD orcid.org/0000-0001-5541-4305

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Date deposited: 09 Dec 2016 09:13
Last modified: 26 Nov 2019 06:25

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Contributors

Author: Neelam Kalita ORCID iD
Author: Elizabeth Payne ORCID iD
Author: Emma Loveman
Author: Susan M. Downes
Author: Andrew Lotery ORCID iD

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