Among patients with diabetic retinopathy, a retrospective study found widefield optical coherence tomography angiography (OCT-A) to have a high success rate for detecting retinal neovascularization (RNV) when compared to fluorescein angiography (FA), the gold standard, suggesting that this noninvasive imaging option could have clinical value in this population.
In this retrospective cross-sectional study, 114 consecutive eyes of 57 patients with proliferative diabetic retinopathy underwent ultra-widefield fluorescein angiography (FA) and widefield OCT-A. Two independent graders evaluated OCT-A images for their ability to detect RNV, utilizing separately graded FA images for comparison (control).
One hundred eight of the 114 eyes (95%) produced gradable OCT-A images. Imaging with OCT-A achieved a sensitivity of 95% and a specificity of 88% for detecting RNV of any kind. One hundred eighteen of the 156 RNV lesions detected by graders on OCT-A were confirmed on FA, an indication of true positive lesions; 57 lesions seen on FA were missed by OCT-A.
The study is limited by its relatively small sample size. Limitations associated with OCT-A imaging were also evident, particularly the tendency toward segmentation errors and restrictions in scannable regions. Of the 57 false-negative RNV lesions, the authors concluded that 21 were due to segmentation errors and 26 were due to lesions being located outside of the imaged area.
Demonstrating high sensitivity and specificity, widefield OCT-A appears to have clinical utility for detecting RNV in patients with proliferative diabetic retinopathy and could aid in clinical decision-making for these patients. Additionally, OCT-A imaging is noninvasive. As such, OCT-A may provide a viable alternative to FA for detecting peripheral RNV, especially considering the current access and cost issues associated with fluorescein dye. Lack of reimbursement for OCT-A in this setting, however, could result in additional costs.
Financial Disclosures: Dr. M. Ali Khan discloses financial relationships with Allergan, Apellis Pharmaceuticals, Genentech (Consultant/Advisor); Regeneron Pharmaceuticals (Grant Support).