1. Optical coherence tomography in the diagnosis and managment
of age-related macular degeneration #3369
C Schmucker,1 G Virgili,2 G Ruecker,3 H T Agostini,4 C Ehlken4
Correspondence:
1German Cochrane Centre, University Medical Centre Freiburg, Germany 2Department of Ophthalmology, University of Florence, Italy 3Department of Medical Biometry and Statistics, University Medical Centre Freiburg, Germany 4Eye Center, University Medical Centre Freiburg, Germany
BACKGROUND
FIGURE 1. FOREST PLOT: DIAGNOSTIC TEST ACCURACY OF OCT FOR SUSPECTED DISEASE
STUDY N CNV OCT SENSITIVITY (95%) SPECIFICITY (95% CI)
TOTAL PREVALENCE (%) TYPE
Optical coherence tomography (OCT) became an essential tool to manage anti-VEGF therapy in patients with age-related macular degeneration (AMD). We set out a systematic review to evaluate diagnostic test accuracy of OCT in the diagnosis and management of AMD. Do
2012* 87
(patients) 15
TD-OCT
Sandhu 2005**
131
(eyes) 64
MATERIAL AND METHODS
Medline, Embase and the Cochrane Library were searched without restrictions on date. We selected studies that assessed the diagnostic accuracy (sensitivity [SE], specificity [SP]) of any OCT model for detecting or monitoring of neovascular AMD. Study quality was evaluated after the “Quality of Diagnostic Accuracy Studies” (QUADAS) checklist. All statistical analyses were done using R package meta (Doebler P. mada: Meta-Analysis of Diagnostic Accuracy (2014, version 0.5.5). R Development Core Team.
*Patients with wet AMD in the non-study eye, and no evidence of CNV in the study eye at study entry (follow-up 2 years); **Patients with suspected disease
FIGURE 2. FOREST PLOT: DIAGNOSTIC TEST ACCURACY OF OCT FOR RETREATMENT DECISION
STUDY N ACTIVE OCT CNV SENSITIVITY (95%) SPECIFICITY (95% CI)
TOTAL CNV TYPE TYPE
PREVALENCE (%)
Eter
2005 60
(patients) 83
TD-OCT
Predominantly
classic
Giani
2011 93 56
SD-OCT
Classic, occult
Henschel
2009 61
(measurements) 51
classic, occult
Khurana
2010A 59
(eyes) 49
Not reported
2010B
Salinas-Alaman 2005
176 65
Van de Moere 2006
121 58
Van Velthoven 2006 30 77
RESULTS
Of 4572 citations retrieved, 9 studies met the inclusion criteria. CNV was the target condition and fluoresceine angiography (FA) the goldstandard in all studies. Prevalence of CNV varied between 14.9 to 83.0% (median 56.9%).
Two studies included patients with suspected CNV (205 patients, 218 eyes, 218 measurements): thereby, the SE of OCT for detecting CNV lesions was 69.0% and 96.4%, respectively and SP 66% in both studies (both studies used time-domain OCT (TD-OCT).
Seven studies (8 analyses) evaluated diagnostic accuracy for retreatment decisions (427 patients, 439 eyes, 662 measurements): pooled SE was 86.3% (95% CI %) and SP was 50.7% (95% CI %). From these 7 studies, 2 studies applied spectral-domain OCT (SD-OCT).
A subgroup analysis showed no significant difference in both SE and SP between SD- and TD-OCT. Overall methodological study quality was adequate for most QUADAS items (e.g., most studies were masked, the cut-off for a positive OCT finding was intraretinal and/or subretinal fluid). However, some of the current study data show an “unit of analysis issue” as both eyes or multiple measurements in one eye of one patient were treated in the data analysis as they were independent.
FIGURE 3. SUMMARY ROC PLOT FOR RETREATMENT DECISION
DISCUSSION / CONCLUSIONS
There are disagreements between OCT and FA findings. Especially the apparent high false positive rate (low specificity) of OCT may be explained that intraretinal fluid decrease is traceable with OCT but not with FA – at least in monitoring the activity of occult CNV. Most studies evaluated TD-OCT, therefore, diagnostic accuracy of SD-OCT in comparison to FA still needs to be established. Whether retreatment based on OCT leads to a significant change in clinical outcome needs to be investigated in more rigorous trials.
Sensitivity
No author reported any commercial relationship / This research is supported by the German Health Insurance.
False Positive Rate