To evaluate the ability of optical coherence tomography angiography (OCTA) to detect abnormal vascular blood flow in Type 1 neovascularization (NV) with or without significant pigment epithelial detachment (PED).
Consecutive age-related macular degeneration patients with either treatment-naive or anti–vascular endothelial growth factor–treated Type 1 NV were divided into 2 groups based on the PED height on structural OCT: greater than 250 μm (Group 1) versus less than 250 μm (Group 2). Two independent senior retina specialists analyzed the OCTA images (Zeiss Angioplex OCT, Carl Zeiss AG, Jena, Germany) using the automatic slabs alone (first reader) versus automatic and manual segmentation slabs (second reader).
In Group 1, 15 men and 42 women, aged from 51 years to 97 years (mean: 87.5), were included. Optical coherence tomography angiography was able to show an abnormal blood flow suggestive of Type 1 NV in 23 (40.3%) of 57 eyes for the first reader and in 32 (56.1%) of 57 eyes for the second reader. In Group 2, 7 men and 30 women, aged from 60 years to 96 years (mean: 80.2), were included. The first and second readers were able to observe an image suggestive of Type 1 NV in 33/37 (89.2%) and 37/37 (100%) of eyes, respectively.
The ability of OCTA to detect an abnormal blood flow in Type 1 NV was found to highly depend on the height of the associated PED and the use of manual segmentation slabs. Our results suggest that automatic slabs of OCTA should be interpreted with caution for the diagnosis of vascularized PED. The diagnosis of Type 1 NV using OCTA requires the use of manual segmentation and a multimodal imaging approach, especially when the height of the associated PED is >250 μm.
In a comparative case series of consecutive Type 1 neovascularization analyzed with optical coherence tomography angiography, detection of abnormal blood flow was observed in 89% cases when the height of the pigment epithelial detachment was <250 μm and in 40% of cases when it was >250 μm (P < 0.0001). In the latter, manual segmentation slabs were more useful than automatic slabs to detect the abnormal blood flow (56 vs. 40%).
*Ophthalmic Center for Imaging and Laser, Paris, France;
†Department of Ophthalmology, XV-XX National Ophthalmic Center, Paris, France;
‡Department of Ophthalmology, Avicenne Hospital, APHP, Bobigny, France; and
§Department of Ophthalmology, Intercity Hospital, University Paris Est, Créteil, France.
Reprint requests: Salomon Y. Cohen, MD, PhD, Centre Ophtalmologique d'Imagerie et de Laser, 11 Rue Antoine Bourdelle, 75015 Paris, France; e-mail: firstname.lastname@example.org
Supported by an unrestricted grant from CIL-ASSOC (Paris, France), an association for research and education.
None of the authors has any financial/conflicting interests to disclose.