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Barteselli, Giulio MD*,†; Chhablani, Jay MD*; Lee, Su Na MD*; Wang, Haiyan MD*; El Emam, Sharif MD*; Kozak, Igor MD*; Cheng, Lingyun MD*; Bartsch, Dirk-Uwe PhD*; Azen, Stanley PhD; Freeman, William R. MD*

doi: 10.1097/IAE.0b013e318285cd84
Original Study

Purpose: To evaluate the safety of oral fluorescein angiography (FA) and to compare its efficacy in detection of macular edema (ME) with spectral-domain optical coherence tomography (SD-OCT).

Methods: Results of imaging studies for 1,928 eyes of 1,019 patients who had simultaneously undergone both oral FA and SD-OCT by a confocal laser ophthalmoscope were reviewed. Sensitivity in detecting ME, discrepancy rate, and “kappa” agreement were determined for both the techniques and with eyes stratified by disease diagnosis.

Results: No allergic reactions occurred after oral FA. Mild gastric discomfort was noted in <1% of the patients; 1,840 eyes (95.4%) showed concordance between the two techniques, and kappa agreement was 90.3%. For ME, oral FA showed an overall sensitivity of 0.97 and SD-OCT of 0.91. Equivalent sensitivity was found in cases of wet age-related macular degeneration (0.99). Oral FA was more sensitive than SD-OCT in cases of retinovascular diseases. The SD-OCT showed higher sensitivity in cases of macular holes. Detection of ME by SD-OCT was significantly higher in cases of intense leakage on oral FA (P < 0.001).

Conclusion: Oral FA proved to be a safe and an adequate technique to evaluate ME. It is more sensitive than SD-OCT in detection of ME in cases of retinovascular diseases but can fail to detect ME in cases of macular holes. A noninvasive examination with simultaneous oral FA and SD-OCT may be considered to obtain a comprehensive evaluation of the presence of ME from different pathologies.

Oral fluorescein angiography is a safe, well tolerated, and adequate technique to evaluate macular edema. It is more sensitive than spectral-domain optical coherence tomography in cases of retinovascular diseases but can fail to detect macular edema in cases of macular holes.

*Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Center, University of California San Diego, La Jolla, California;

U.O. Oculistica, Dipartimento di Scienze Cliniche e di Comunità, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; and

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.

Reprint requests: William R. Freeman, MD, Shiley Eye Center, University of California at San Diego, 0946, 9415 Campus Point Drive, La Jolla, CA 92037; e-mail:

The authors have no proprietary, financial, or conflicts of interest to disclose.

Supported by NIH grants R01EY007366 and R01EY018589 (WRF), R01EY020617 (LC), and R01EY016323 (DUB) and by “RPB incorporated and unrestricted funds from Jacobs Retina Center.” The funding organizations had no role in the design or conduct of this research.

© 2013 by Ophthalmic Communications Society, Inc.