title: IMPROVED SPECIFICITY OF POLYPOIDAL CHOROIDAL VASCULOPATHY DIAGNOSIS USING A MODIFIED EVEREST CRITERIA.
abstract: OBJECTIVE
  To evaluate the performance of polypoidal choroidal vasculopathy (PCV) diagnosis using fundus camera-based indocyanine green angiography, comparing a single sign of "subretinal focal hyperfluorescence" on indocyanine green angiography with a modification of the EVEREST criteria.
  
  
  METHODS
  Color fundus photograph, flash fundus camera-based fluorescein angiography, and indocyanine green angiography of 241 eyes of 230 consecutive patients with exudative maculopathy due to PCV or typical age-related macular degeneration were graded independently by 2 retinal specialists using a modified EVEREST criteria, which requires the presence of subretinal focal hyperfluorescence plus any 1 of 5 additional criteria. Discordant cases were adjudicated by a senior retinal specialist to arrive at the final diagnosis. Sensitivity, specificity, and area under the receiver operating curve of subretinal focal hyperfluorescence versus the EVEREST criteria and combinations of individual EVEREST criteria were compared.
  
  
  RESULTS
  Among the 241 eyes with exudative maculopathy, 131 eyes had PCV and 110 eyes had typical age-related macular degeneration. Using a single sign of subretinal focal hyperfluorescence alone for the diagnosis of PCV, sensitivity was 85.3% and specificity was 80.9%, with an area under the receiver operating curve of 83.1%. When applying the EVEREST definition, sensitivity was reduced to 78.4% but specificity improved to 87.1% with a similar area under the receiver operating curve of 82.8%. The frequency of individual criteria was highly variable, with stereo nodular appearance (73.7%) and orange nodule (55.0%) being the most common and branching vascular network, massive hemorrhage, and hypofluorescent halo in the presence of subretinal focal hyperfluorescence being less common (21.5%-28.1%).
  
  
  CONCLUSIONS
  The EVEREST criteria have a higher specificity for the diagnosis of PCV than subretinal focal hyperfluorescence alone and may be applied to flash fundus camera-based indocyanine green angiography in a clinical setting. Stereo nodular appearance is the most important additional criterion.
authors.affiliation: *Medical Retina Service, Singapore National Eye Center, Singapore, Singapore; †Singapore Eye Research Institute, Singapore, Singapore; ‡Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; §Academic Clinical Program in Ophthalmology and Visual Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore; and ¶National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Chui Ming Gemmy
authors.initials: CM
authors.lastname: Cheung
authors.forename: Augustinus
authors.initials: A
authors.lastname: Laude
authors.forename: Wanling
authors.initials: W
authors.lastname: Wong
authors.forename: Ranjana
authors.initials: R
authors.lastname: Mathur
authors.forename: Choi Mun
authors.initials: CM
authors.lastname: Chan
authors.forename: Edmund
authors.initials: E
authors.lastname: Wong
authors.forename: Doric
authors.initials: D
authors.lastname: Wong
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.forename: Tock Han
authors.initials: TH
authors.lastname: Lim
mesh_terms: D000368:Aged; D019540:Area Under Curve; D020256:Choroidal Neovascularization / Q000175:diagnosis*; D004396:Coloring Agents / Q000737:chemistry*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green / Q000737:chemistry*; D008297:Male; D015588:Observer Variation; D011127:Polyps / Q000175:diagnosis*; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D058471:Subretinal Fluid
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green