Use of Widefield OCTA in Proliferative DR
By Lynda Seminara
Selected By: Prem S. Subramanian, MD, PhD
Journal Highlights
Graefe’s Archive for Clinical and Experimental Ophthalmology
2020;258(9):1901-1909
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Pichi et al. compared the ability of widefield optical coherence tomography angiography (WF-OCTA), ultra-widefield fluorescein angiography (UWF-FA), and ultra-widefield color fundus photography (UWF-CP) to detect retinal neovascularization in eyes with proliferative diabetic retinopathy (PDR). They found that WF-OCTA was superior to UWF-CP and noninferior to UWF-FA.
For this cross-sectional study, the authors evaluated treatment-naive patients with active PDR. All patients were imaged with the three widefield modalities. Retina specialists examined the imaging results for neovascularization, which was defined on OCTA as extra-retinal proliferation of vessels in the vitreoretinal interface slab and was subcategorized by location as neovascularization “of the disc” (NVD) or “elsewhere” (NVE). Statistical analysis was performed to estimate the diagnostic accuracy of each modality, and B-scan OCT with flow overlay was applied as the reference standard.
Overall, 82 eyes (48 patients) were evaluated. NVD was detected in 13 eyes by UWF-CP, in 35 eyes by UWF-FA, and in 37 eyes by WF-OCTA. NVD was confirmed in the same 37 eyes by the reference standard, indicating 100% sensitivity and 100% specificity for WF-OCTA, 94.6% sensitivity and 100% specificity for UWF-FA, and 35.1% sensitivity and 97.8% specificity for UWF-CP. For NVE, 196 foci in 62 of the 82 eyes were identified by the reference standard. UWF-CP enabled detection of 62 of these foci and misclassified 11 others, corresponding to a detection rate of 31.6% and a false-positive rate of 15.1%. The detection rate for UWF-FA was 91.3%. WF-OCTA identified all 196 foci (100% detection rate). False-positive rates for UWF-FA and WF-OCTA were below 2%.
Although FA is the gold standard for detecting subtle signs of neovascularization in PDR, it is invasive and is accompanied by safety concerns. WF-OCTA is safer and faster, said the authors, and the diagnostic accuracy in their hands was similar to that of UWF-FA (and significantly better than that of UWF-CP). They concluded that WF-OCTA may have clinical utility for routine monitoring of PDR.
The original article can be found here.