title: Optical coherence tomography for the diagnosis of neovascular age-related macular degeneration: a systematic review.
abstract: The purpose is to study the diagnostic performance of optical coherence tomography (OCT) and alternative diagnostic tests for neovascular age-related macular degeneration (nAMD). Methods employed are as follows:systematic review and meta-analysis;
  
  
  METHODS
  OCT including time-domain (TD-OCT) and the most recently developed spectral domain (SD-OCT); comparator tests: visual acuity, clinical evaluation (slit lamp), Amsler chart, colour fundus photographs, infra-red reflectance, red-free images/blue reflectance, fundus autofluorescence imaging (FAF), indocyanine green angiography (ICGA), preferential hyperacuity perimetry (PHP), and microperimetry; reference standard: fundus fluorescein angiography. Databases searched included MEDLINE, MEDLINE In Process, EMBASE, Biosis, SCI, the Cochrane Library, DARE, MEDION, and HTA database. Last literature searches: March 2013. Risk of bias assessed using QUADAS-2. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic (HSROC) curves. Twenty-two studies (2 abstracts and 20 articles) enrolling 2124 participants were identified, reporting TD-OCT (12 studies), SD-OCT (1 study), ICGA (8 studies), PHP (3 studies), Amsler grid, colour fundus photography and FAF (1 study each). Most studies were considered to have a high risk of bias in the patient selection (55%, 11/20), and flow and timing (40%, 8/20) domains. In a meta-analysis of TD-OCT studies, sensitivity and specificity (95% CI) were 88% (46-98%) and 78% (64-88%), respectively. There was insufficient information to undertake meta-analysis for other tests. TD-OCT is a sensitive test for detecting nAMD, although specificity was only moderate. Data on SD-OCT are sparse. Diagnosis of nAMD should not rely solely on OCT.
authors.affiliation: Health Services Research Unit, University of Aberdeen, Scotland, UK.
authors.forename: M M
authors.initials: MM
authors.lastname: Castillo
authors.affiliation: Health Services Research Unit, University of Aberdeen, Scotland, UK.
authors.forename: G
authors.initials: G
authors.lastname: Mowatt
authors.affiliation: Centre for Vision and Vascular Science, Queen's University Belfast, Belfast, UK.
authors.forename: N
authors.initials: N
authors.lastname: Lois
authors.affiliation: Glasgow Caledonian University, Glasgow, UK.
authors.forename: A
authors.initials: A
authors.lastname: Elders
authors.affiliation: Health Services Research Unit, University of Aberdeen, Scotland, UK.
authors.forename: C
authors.initials: C
authors.lastname: Fraser
authors.affiliation: University of Nottingham, Nottingham, UK.
authors.forename: W
authors.initials: W
authors.lastname: Amoaku
authors.affiliation: University of St Andrews, St Andrews, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Burr
authors.affiliation: University of Southampton, Southampton, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Lotery
authors.affiliation: Health Services Research Unit, University of Aberdeen, Scotland, UK.
authors.forename: C R
authors.initials: CR
authors.lastname: Ramsay
authors.affiliation: Centre for Vision and Vascular Science, Queen's University Belfast, Belfast, UK.
authors.forename: A
authors.initials: A
authors.lastname: Azuara-Blanco
mesh_terms: D004396:Coloring Agents; D003941:Diagnostic Techniques, Ophthalmological; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green