Detection of new-onset choroidal neovascularization using optical coherence tomography

The AMD DOC study

Diana V. Do, Emily W. Gower, Sandra Cassard, David Boyer, Neil M Bressler, Susan B Bressler, Jeffrey S. Heier, Joan L. Jefferys, Lawrence J. Singerman, Sharon Solomon

Research output: Contribution to journalArticle

Abstract

Purpose: To determine the sensitivity of time domain optical coherence tomography (OCT) in detecting conversion to neovascular age-related macular degeneration (AMD) in eyes at high risk for choroidal neovascularization (CNV), compared with detection using fluorescein angiography (FA) as the gold standard. Design: Prospective, multicenter, observational study. Participants: Individuals aged ≥50 years with nonneovascular AMD at high risk of progressing to CNV in the study eye and evidence of neovascular AMD in the fellow eye. Methods: At study entry and every 3 months through 2 years, participants underwent best-corrected visual acuity, supervised Amsler grid testing, preferential hyperacuity perimetry (PHP) testing, stereoscopic digital fundus photographs with FA, and OCT imaging. A central Reading Center graded all images. Main Outcomes Measures: The sensitivity of OCT in detecting conversion to neovascular AMD by 2 years, using FA as the reference standard. Secondary outcomes included comparison of sensitivity, specificity, positive predictive value, and negative predictive value of OCT, PHP, and supervised Amsler grid relative to FA for detecting incident CNV. Results: A total of 98 participants were enrolled; 87 (89%) of these individuals either completed the 24-month visit or exited the study after developing CNV. Fifteen (17%) study eyes had incident CNV confirmed on FA by the Reading Center. The sensitivity of each modality for detecting CNV was: OCT 0.40 (95% confidence interval [CI], 0.160.68), supervised Amsler grid 0.42 (95% CI, 0.150.72), and PHP 0.50 (95% CI, 0.230.77). Treatment for incident CNV was recommended by the study investigator in 13 study eyes. Sensitivity of the testing modalities for detection of CNV in these 13 eyes was 0.69 (95% CI, 0.390.91) for OCT, 0.50 (95% CI, 0.190.81) for supervised Amsler grid, and 0.70 (95% CI, 0.350.93) for PHP. Specificity of the OCT was higher than that of the Amsler grid and PHP. Conclusions: Time-domain OCT, supervised Amsler grid, and PHP have low to moderate sensitivity for detection of new-onset CNV compared with FA. Optical coherence tomography has greater specificity than Amsler grid or PHP. Among fellow eyes of individuals with unilateral CNV, FA remains the best method to detect new-onset CNV. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Original languageEnglish (US)
Pages (from-to)771-778
Number of pages8
JournalOphthalmology
Volume119
Issue number4
DOIs
StatePublished - Apr 2012

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Choroidal Neovascularization
Optical Coherence Tomography
Macular Degeneration
Visual Field Tests
Fluorescein Angiography
Confidence Intervals
Disclosure
Reading
Visual Acuity
Multicenter Studies
Observational Studies
Research Personnel
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

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Detection of new-onset choroidal neovascularization using optical coherence tomography : The AMD DOC study. / Do, Diana V.; Gower, Emily W.; Cassard, Sandra; Boyer, David; Bressler, Neil M; Bressler, Susan B; Heier, Jeffrey S.; Jefferys, Joan L.; Singerman, Lawrence J.; Solomon, Sharon.

In: Ophthalmology, Vol. 119, No. 4, 04.2012, p. 771-778.

Research output: Contribution to journalArticle

Do, Diana V. ; Gower, Emily W. ; Cassard, Sandra ; Boyer, David ; Bressler, Neil M ; Bressler, Susan B ; Heier, Jeffrey S. ; Jefferys, Joan L. ; Singerman, Lawrence J. ; Solomon, Sharon. / Detection of new-onset choroidal neovascularization using optical coherence tomography : The AMD DOC study. In: Ophthalmology. 2012 ; Vol. 119, No. 4. pp. 771-778.
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abstract = "Purpose: To determine the sensitivity of time domain optical coherence tomography (OCT) in detecting conversion to neovascular age-related macular degeneration (AMD) in eyes at high risk for choroidal neovascularization (CNV), compared with detection using fluorescein angiography (FA) as the gold standard. Design: Prospective, multicenter, observational study. Participants: Individuals aged ≥50 years with nonneovascular AMD at high risk of progressing to CNV in the study eye and evidence of neovascular AMD in the fellow eye. Methods: At study entry and every 3 months through 2 years, participants underwent best-corrected visual acuity, supervised Amsler grid testing, preferential hyperacuity perimetry (PHP) testing, stereoscopic digital fundus photographs with FA, and OCT imaging. A central Reading Center graded all images. Main Outcomes Measures: The sensitivity of OCT in detecting conversion to neovascular AMD by 2 years, using FA as the reference standard. Secondary outcomes included comparison of sensitivity, specificity, positive predictive value, and negative predictive value of OCT, PHP, and supervised Amsler grid relative to FA for detecting incident CNV. Results: A total of 98 participants were enrolled; 87 (89{\%}) of these individuals either completed the 24-month visit or exited the study after developing CNV. Fifteen (17{\%}) study eyes had incident CNV confirmed on FA by the Reading Center. The sensitivity of each modality for detecting CNV was: OCT 0.40 (95{\%} confidence interval [CI], 0.160.68), supervised Amsler grid 0.42 (95{\%} CI, 0.150.72), and PHP 0.50 (95{\%} CI, 0.230.77). Treatment for incident CNV was recommended by the study investigator in 13 study eyes. Sensitivity of the testing modalities for detection of CNV in these 13 eyes was 0.69 (95{\%} CI, 0.390.91) for OCT, 0.50 (95{\%} CI, 0.190.81) for supervised Amsler grid, and 0.70 (95{\%} CI, 0.350.93) for PHP. Specificity of the OCT was higher than that of the Amsler grid and PHP. Conclusions: Time-domain OCT, supervised Amsler grid, and PHP have low to moderate sensitivity for detection of new-onset CNV compared with FA. Optical coherence tomography has greater specificity than Amsler grid or PHP. Among fellow eyes of individuals with unilateral CNV, FA remains the best method to detect new-onset CNV. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.",
author = "Do, {Diana V.} and Gower, {Emily W.} and Sandra Cassard and David Boyer and Bressler, {Neil M} and Bressler, {Susan B} and Heier, {Jeffrey S.} and Jefferys, {Joan L.} and Singerman, {Lawrence J.} and Sharon Solomon",
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T1 - Detection of new-onset choroidal neovascularization using optical coherence tomography

T2 - The AMD DOC study

AU - Do, Diana V.

AU - Gower, Emily W.

AU - Cassard, Sandra

AU - Boyer, David

AU - Bressler, Neil M

AU - Bressler, Susan B

AU - Heier, Jeffrey S.

AU - Jefferys, Joan L.

AU - Singerman, Lawrence J.

AU - Solomon, Sharon

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N2 - Purpose: To determine the sensitivity of time domain optical coherence tomography (OCT) in detecting conversion to neovascular age-related macular degeneration (AMD) in eyes at high risk for choroidal neovascularization (CNV), compared with detection using fluorescein angiography (FA) as the gold standard. Design: Prospective, multicenter, observational study. Participants: Individuals aged ≥50 years with nonneovascular AMD at high risk of progressing to CNV in the study eye and evidence of neovascular AMD in the fellow eye. Methods: At study entry and every 3 months through 2 years, participants underwent best-corrected visual acuity, supervised Amsler grid testing, preferential hyperacuity perimetry (PHP) testing, stereoscopic digital fundus photographs with FA, and OCT imaging. A central Reading Center graded all images. Main Outcomes Measures: The sensitivity of OCT in detecting conversion to neovascular AMD by 2 years, using FA as the reference standard. Secondary outcomes included comparison of sensitivity, specificity, positive predictive value, and negative predictive value of OCT, PHP, and supervised Amsler grid relative to FA for detecting incident CNV. Results: A total of 98 participants were enrolled; 87 (89%) of these individuals either completed the 24-month visit or exited the study after developing CNV. Fifteen (17%) study eyes had incident CNV confirmed on FA by the Reading Center. The sensitivity of each modality for detecting CNV was: OCT 0.40 (95% confidence interval [CI], 0.160.68), supervised Amsler grid 0.42 (95% CI, 0.150.72), and PHP 0.50 (95% CI, 0.230.77). Treatment for incident CNV was recommended by the study investigator in 13 study eyes. Sensitivity of the testing modalities for detection of CNV in these 13 eyes was 0.69 (95% CI, 0.390.91) for OCT, 0.50 (95% CI, 0.190.81) for supervised Amsler grid, and 0.70 (95% CI, 0.350.93) for PHP. Specificity of the OCT was higher than that of the Amsler grid and PHP. Conclusions: Time-domain OCT, supervised Amsler grid, and PHP have low to moderate sensitivity for detection of new-onset CNV compared with FA. Optical coherence tomography has greater specificity than Amsler grid or PHP. Among fellow eyes of individuals with unilateral CNV, FA remains the best method to detect new-onset CNV. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

AB - Purpose: To determine the sensitivity of time domain optical coherence tomography (OCT) in detecting conversion to neovascular age-related macular degeneration (AMD) in eyes at high risk for choroidal neovascularization (CNV), compared with detection using fluorescein angiography (FA) as the gold standard. Design: Prospective, multicenter, observational study. Participants: Individuals aged ≥50 years with nonneovascular AMD at high risk of progressing to CNV in the study eye and evidence of neovascular AMD in the fellow eye. Methods: At study entry and every 3 months through 2 years, participants underwent best-corrected visual acuity, supervised Amsler grid testing, preferential hyperacuity perimetry (PHP) testing, stereoscopic digital fundus photographs with FA, and OCT imaging. A central Reading Center graded all images. Main Outcomes Measures: The sensitivity of OCT in detecting conversion to neovascular AMD by 2 years, using FA as the reference standard. Secondary outcomes included comparison of sensitivity, specificity, positive predictive value, and negative predictive value of OCT, PHP, and supervised Amsler grid relative to FA for detecting incident CNV. Results: A total of 98 participants were enrolled; 87 (89%) of these individuals either completed the 24-month visit or exited the study after developing CNV. Fifteen (17%) study eyes had incident CNV confirmed on FA by the Reading Center. The sensitivity of each modality for detecting CNV was: OCT 0.40 (95% confidence interval [CI], 0.160.68), supervised Amsler grid 0.42 (95% CI, 0.150.72), and PHP 0.50 (95% CI, 0.230.77). Treatment for incident CNV was recommended by the study investigator in 13 study eyes. Sensitivity of the testing modalities for detection of CNV in these 13 eyes was 0.69 (95% CI, 0.390.91) for OCT, 0.50 (95% CI, 0.190.81) for supervised Amsler grid, and 0.70 (95% CI, 0.350.93) for PHP. Specificity of the OCT was higher than that of the Amsler grid and PHP. Conclusions: Time-domain OCT, supervised Amsler grid, and PHP have low to moderate sensitivity for detection of new-onset CNV compared with FA. Optical coherence tomography has greater specificity than Amsler grid or PHP. Among fellow eyes of individuals with unilateral CNV, FA remains the best method to detect new-onset CNV. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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