title: IDENTIFICATION OF FLUID ON OPTICAL COHERENCE TOMOGRAPHY BY TREATING OPHTHALMOLOGISTS VERSUS A READING CENTER IN THE COMPARISON OF AGE-RELATED MACULAR DEGENERATION TREATMENTS TRIALS.
abstract: OBJECTIVE
  To examine treatment decisions by ophthalmologists versus reading center fluid identification from optical coherence tomography in Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).
  
  
  METHODS
  Fluid in 6,210 optical coherence tomography scans (598 patients) in "as needed treatment" arm of CATT Year 1 was compared with ophthalmologist's treatment: positive fluid agreement (PFA, fluid+, treatment+) and positive fluid discrepancy (PFD, fluid+, treatment-), negative fluid agreement (fluid-, treatment-) and negative fluid discrepancy (fluid-, treatment+). For PFDs, fluid location and visual acuity were characterized.
  
  
  RESULTS
  Treatment and reading center fluid determination agreed in 72.1% (53.0% PFA, 19.1% negative fluid agreement) and disagreed in 27.9% (25.7% PFD, 2.2% negative fluid discrepancy) of visits, with no discrepancies for 20.9% of patients. Compared with PFA, PFD occurred more commonly with lower total foveal thickness (mean ± SD: 265 ± 103 PFD, 366 ± 151 μm PFA), presence of intraretinal fluid only, smaller fluid areas (PFA areas greater than twice those of PFD, P < 0.001), and greater decrease in retinal and lesion thickness. Mean acuities before, at, and after PFD were 65.8, 66.9, and 66.3 letters.
  
  
  CONCLUSIONS
  Treatment decisions by ophthalmologists matched reading center fluid determination in the majority of visits. More pronounced response to treatment and smaller foci of fluid likely contributed to PFD. Positive fluid discrepancy did not have substantial impact on subsequent visual acuity.
authors.affiliation: *Duke University Eye Center, Department of Ophthalmology, Durham, North Carolina; †Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania; and ‡Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Toth
authors.forename: Francis Char
authors.initials: FC
authors.lastname: Decroos
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Stinnett
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Heydary
authors.forename: Russell
authors.initials: R
authors.lastname: Burns
authors.forename: Maureen
authors.initials: M
authors.lastname: Maguire
authors.forename: Daniel
authors.initials: D
authors.lastname: Martin
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Jaffe
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use; D001813:Blood-Retinal Barrier; D002199:Capillary Permeability; D005451:Fluorescein Angiography; D006801:Humans; D009885:Ophthalmology / Q000592:standards*; D000069579:Ranibizumab / Q000627:therapeutic use; D019114:Remote Consultation / Q000592:standards*; D015203:Reproducibility of Results; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab