title: Optical coherence tomography for the monitoring of neovascular age-related macular degeneration: a systematic review.
abstract: OBJECTIVE
  To compare the accuracy of optical coherence tomography (OCT) with alternative tests for monitoring neovascular age-related macular degeneration (nAMD) and detecting disease activity among eyes previously treated for this condition.
  
  
  CONCLUSIONS
  Traditionally, fundus fluorescein angiography (FFA) has been considered the reference standard to detect nAMD activity, but FFA is costly and invasive. Replacement of FFA by OCT can be justified if there is a substantial agreement between tests.
  
  
  METHODS
  Systematic review and meta-analysis. The index test was OCT. The comparator tests were visual acuity, clinical evaluation (slit lamp), Amsler chart, color fundus photographs, infrared reflectance, red-free images and blue reflectance, fundus autofluorescence imaging, indocyanine green angiography (ICGA), preferential hyperacuity perimetry, and microperimetry. We searched the following databases: MEDLINE, MEDLINE In-Process, EMBASE, Biosis, Science Citation Index, the Cochrane Library, Database of Abstracts of Reviews of Effects, MEDION, and the Health Technology Assessment database. The last literature search was conducted in March 2013. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) to assess risk of bias.
  
  
  RESULTS
  We included 8 studies involving more than 400 participants. Seven reported the performance of OCT (3 time-domain [TD] OCT, 3 spectral-domain [SD] OCT, 1 both types) and 1 reported the performance of ICGA in the detection of nAMD activity. We did not find studies directly comparing tests in the same population. The pooled sensitivity and specificity of TD OCT and SD OCT for detecting active nAMD was 85% (95% confidence interval [CI], 72%-93%) and 48% (95% CI, 30%-67%), respectively. One study reported ICGA with sensitivity of 75.9% and specificity of 88.0% for the detection of active nAMD. Half of the studies were considered to have a high risk of bias.
  
  
  CONCLUSIONS
  There is substantial disagreement between OCT and FFA findings in detecting active disease in patients with nAMD who are being monitored. Both methods may be needed to monitor patients comprehensively with nAMD.
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Mayret M
authors.initials: MM
authors.lastname: Castillo
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Graham
authors.initials: G
authors.lastname: Mowatt
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom; Midwives and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Elders
authors.affiliation: Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom.
authors.forename: Noemi
authors.initials: N
authors.lastname: Lois
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fraser
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom; Health Economics Research Unit, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Hernández
authors.affiliation: Department of Ophthalmology, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Winfried
authors.initials: W
authors.lastname: Amoaku
authors.affiliation: Medical and Biological Sciences, School of Medicine, University of St. Andrews, St. Andrews, United Kingdom.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Burr
authors.affiliation: Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lotery
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Ramsay
authors.affiliation: Midwives and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom. Electronic address: a.azuara-blanco@qub.ac.uk.
authors.forename: Augusto
authors.initials: A
authors.lastname: Azuara-Blanco
mesh_terms: D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods*; D057135:Wet Macular Degeneration / Q000175:diagnosis*