Sensitivity of OCT Angiography in detecting type 1 neovascularization according to the height of the associated pigment epithelial detachment
Sarah Mrejen, MD, Audrey Giocanti-Auregan, MD, Sandrine Tabary, Salomon Yves Cohen, MD, PhD 1,4
Purpose: 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).
Methods: Consecutive age-related macular degeneration patients with either treatment-naïve or anti-VEGF treated type 1 NV were divided into two groups based on the PED height on structural OCT: greater than 250 microns (group 1) versus less than 250 microns (group 2). Two independent senior retina specialists analyzed the OCTA images using the automatic slabs alone (first reader) versus manual segmentation (second reader).
Results: In group 1, 15 men and 42 women, aged from 51 to 97 years (mean: 87.5), were included. OCTA was able to show an abnormal blood flow suggestive of type 1 neovascularization in 23 (40.3%) out of 57 eyes for the first reader, and in 32 (56.1%) out of 57 eyes for the second reader. In group 2, 7 men and 30 women, aged from 60 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.
Conclusion: 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 neovascularization using OCTA requires the use of manual segmentation and a multimodal imaging approach especially when the height of the associated PED is greater than 250 microns.