title: The diagnostic accuracy of spectral-domain optical coherence tomography for neovascular age-related macular degeneration: a comparison with fundus fluorescein angiography.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of spectral-domain optical coherence tomography (SD-OCT) for neovascular age-related macular degeneration (nAMD): a comparison against fundus fluorescein angiography (FFA).
  
  
  METHODS
  A retrospective review of SD-OCT, colour fundus photographs (FP), and FFA of 411 consecutive patients referred to a rapid access Macular Clinic over a 4-year period was performed. FFA images were reviewed non-stereoscopically. SD-OCT images were acquired using the Topcon 3D OCT-1000 instrument. All FFA and OCT images were graded by at least two ophthalmologists independently. Side-by-side grading took place with immediate open discussion and adjudication. If there was disagreement between the two grading ophthalmologists or they were not 90% confident of their assigned grade, then adjudication by a third ophthalmologist was performed.
  
  
  RESULTS
  A total of 278 eyes were graded as having choroidal neovascularisation (CNV) with SD-OCT and 231 diagnosed with FFA. The main diagnostic CNV classifications on FFA were: classic no occult in 27 eyes, predominantly classic in 16, minimally classic in 50, occult in 129, and 9 peripapillary membranes. There were a total of 47 false positives with SD-OCT: a rate of 16.9%. The sensitivity and specificity of SD-OCT alone for detecting CNV was 100 and 80.8%, respectively.
  
  
  CONCLUSIONS
  Our study confirms SD-OCT in comparison to the reference standard of non-stereoscopic FFA is highly sensitive at detecting newly presenting nAMD in the setting of a specialist AMD clinic where the investigations are interpreted by trained specialists. However, it does not seem accurate enough to replace FFA in the diagnosis on nAMD in current practice.
authors.affiliation: Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Wilde
authors.affiliation: Ophthalmology, Derby Hospitals NHS Foundation Trust, Derby, UK.
authors.forename: M
authors.initials: M
authors.lastname: Patel
authors.affiliation: Eye Clinic, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK.
authors.forename: A
authors.initials: A
authors.lastname: Lakshmanan
authors.affiliation: Eye Clinic, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK.
authors.forename: R
authors.initials: R
authors.lastname: Amankwah
authors.affiliation: Eye Clinic, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK.
authors.forename: S
authors.initials: S
authors.lastname: Dhar-Munshi
authors.affiliation: Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
authors.forename: W
authors.initials: W
authors.lastname: Amoaku
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000175:diagnosis*; D005189:False Positive Reactions; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods*; D057135:Wet Macular Degeneration / Q000175:diagnosis*