Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema

John H. Kempen, Elizabeth Sugar, Glenn J. Jaffe, Nisha R. Acharya, James P. Dunn, Susan G. Elner, Susan L. Lightman, Jennifer Thorne, Albert T. Vitale, Michael M. Altaweel

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate agreement between fluorescein angiography (FA) and optical coherence tomography (OCT) results for diagnosis of macular edema in patients with uveitis. Design: Multicenter cross-sectional study. Participants: Four hundred seventy-nine eyes with uveitis from 255 patients. Methods: The macular status of dilated eyes with intermediate uveitis, posterior uveitis, or panuveitis was assessed via Stratus-3 OCT and FA. To evaluate agreement between the diagnostic approaches, κ statistics were used. Main Outcome Measures: Macular thickening (MT; center point thickness, ≥240 μm per reading center grading of OCT images) and macular leakage (ML; central subfield fluorescein leakage, ≥0.44 disc areas per reading center grading of FA images), and agreement between these outcomes in diagnosing macular edema. Results: Optical coherence tomography (90.4%) more frequently returned usable information regarding macular edema than FA (77%) or biomicroscopy (76%). Agreement in diagnosis of MT and ML (κ = 0.44) was moderate. Macular leakage was present in 40% of cases free of MT, whereas MT was present in 34% of cases without ML. Biomicroscopic evaluation for macular edema failed to detect 40% and 45% of cases of MT and ML, respectively, and diagnosed 17% and 17% of cases with macular edema that did not have MT or ML, respectively; these results may underestimate biomicroscopic errors (ophthalmologists were not explicitly masked to OCT and FA results). Among eyes free of ML, phakic eyes without cataract rarely (4%) had MT. No factors were found that effectively ruled out ML when MT was absent. Conclusions: Optical coherence tomography and FA offered only moderate agreement regarding macular edema status in uveitis cases, probably because what they measure (MT and ML) are related but nonidentical macular pathologic characteristics. Given its lower cost, greater safety, and greater likelihood of obtaining usable information, OCT may be the best initial test for evaluation of suspected macular edema. However, given that ML cannot be ruled out if MT is absent and vice versa, obtaining the second test after negative results on the first seems justified when detection of ML or MT would alter management. Given that biomicroscopic evaluation for macular edema erred frequently, ancillary testing for macular edema seems indicated when knowledge of ML or MT status would affect management. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Original languageEnglish (US)
Pages (from-to)1852-1859
Number of pages8
JournalOphthalmology
Volume120
Issue number9
DOIs
StatePublished - Sep 2013

Fingerprint

Macular Edema
Fluorescein Angiography
Optical Coherence Tomography
Uveitis
Disclosure
Reading
Intermediate Uveitis
Panuveitis
Posterior Uveitis
Fluorescein
Cataract
Cross-Sectional Studies
Outcome Assessment (Health Care)
Safety
Costs and Cost Analysis

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Kempen, J. H., Sugar, E., Jaffe, G. J., Acharya, N. R., Dunn, J. P., Elner, S. G., ... Altaweel, M. M. (2013). Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema. Ophthalmology, 120(9), 1852-1859. https://doi.org/10.1016/j.ophtha.2013.01.069

Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema. / Kempen, John H.; Sugar, Elizabeth; Jaffe, Glenn J.; Acharya, Nisha R.; Dunn, James P.; Elner, Susan G.; Lightman, Susan L.; Thorne, Jennifer; Vitale, Albert T.; Altaweel, Michael M.

In: Ophthalmology, Vol. 120, No. 9, 09.2013, p. 1852-1859.

Research output: Contribution to journalArticle

Kempen, JH, Sugar, E, Jaffe, GJ, Acharya, NR, Dunn, JP, Elner, SG, Lightman, SL, Thorne, J, Vitale, AT & Altaweel, MM 2013, 'Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema', Ophthalmology, vol. 120, no. 9, pp. 1852-1859. https://doi.org/10.1016/j.ophtha.2013.01.069
Kempen, John H. ; Sugar, Elizabeth ; Jaffe, Glenn J. ; Acharya, Nisha R. ; Dunn, James P. ; Elner, Susan G. ; Lightman, Susan L. ; Thorne, Jennifer ; Vitale, Albert T. ; Altaweel, Michael M. / Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema. In: Ophthalmology. 2013 ; Vol. 120, No. 9. pp. 1852-1859.
@article{7770df2da36949dbb55aa1d2506fe76b,
title = "Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema",
abstract = "Objective: To evaluate agreement between fluorescein angiography (FA) and optical coherence tomography (OCT) results for diagnosis of macular edema in patients with uveitis. Design: Multicenter cross-sectional study. Participants: Four hundred seventy-nine eyes with uveitis from 255 patients. Methods: The macular status of dilated eyes with intermediate uveitis, posterior uveitis, or panuveitis was assessed via Stratus-3 OCT and FA. To evaluate agreement between the diagnostic approaches, κ statistics were used. Main Outcome Measures: Macular thickening (MT; center point thickness, ≥240 μm per reading center grading of OCT images) and macular leakage (ML; central subfield fluorescein leakage, ≥0.44 disc areas per reading center grading of FA images), and agreement between these outcomes in diagnosing macular edema. Results: Optical coherence tomography (90.4{\%}) more frequently returned usable information regarding macular edema than FA (77{\%}) or biomicroscopy (76{\%}). Agreement in diagnosis of MT and ML (κ = 0.44) was moderate. Macular leakage was present in 40{\%} of cases free of MT, whereas MT was present in 34{\%} of cases without ML. Biomicroscopic evaluation for macular edema failed to detect 40{\%} and 45{\%} of cases of MT and ML, respectively, and diagnosed 17{\%} and 17{\%} of cases with macular edema that did not have MT or ML, respectively; these results may underestimate biomicroscopic errors (ophthalmologists were not explicitly masked to OCT and FA results). Among eyes free of ML, phakic eyes without cataract rarely (4{\%}) had MT. No factors were found that effectively ruled out ML when MT was absent. Conclusions: Optical coherence tomography and FA offered only moderate agreement regarding macular edema status in uveitis cases, probably because what they measure (MT and ML) are related but nonidentical macular pathologic characteristics. Given its lower cost, greater safety, and greater likelihood of obtaining usable information, OCT may be the best initial test for evaluation of suspected macular edema. However, given that ML cannot be ruled out if MT is absent and vice versa, obtaining the second test after negative results on the first seems justified when detection of ML or MT would alter management. Given that biomicroscopic evaluation for macular edema erred frequently, ancillary testing for macular edema seems indicated when knowledge of ML or MT status would affect management. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.",
author = "Kempen, {John H.} and Elizabeth Sugar and Jaffe, {Glenn J.} and Acharya, {Nisha R.} and Dunn, {James P.} and Elner, {Susan G.} and Lightman, {Susan L.} and Jennifer Thorne and Vitale, {Albert T.} and Altaweel, {Michael M.}",
year = "2013",
month = "9",
doi = "10.1016/j.ophtha.2013.01.069",
language = "English (US)",
volume = "120",
pages = "1852--1859",
journal = "Ophthalmology",
issn = "0161-6420",
publisher = "Elsevier Inc.",
number = "9",

}

TY - JOUR

T1 - Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema

AU - Kempen, John H.

AU - Sugar, Elizabeth

AU - Jaffe, Glenn J.

AU - Acharya, Nisha R.

AU - Dunn, James P.

AU - Elner, Susan G.

AU - Lightman, Susan L.

AU - Thorne, Jennifer

AU - Vitale, Albert T.

AU - Altaweel, Michael M.

PY - 2013/9

Y1 - 2013/9

N2 - Objective: To evaluate agreement between fluorescein angiography (FA) and optical coherence tomography (OCT) results for diagnosis of macular edema in patients with uveitis. Design: Multicenter cross-sectional study. Participants: Four hundred seventy-nine eyes with uveitis from 255 patients. Methods: The macular status of dilated eyes with intermediate uveitis, posterior uveitis, or panuveitis was assessed via Stratus-3 OCT and FA. To evaluate agreement between the diagnostic approaches, κ statistics were used. Main Outcome Measures: Macular thickening (MT; center point thickness, ≥240 μm per reading center grading of OCT images) and macular leakage (ML; central subfield fluorescein leakage, ≥0.44 disc areas per reading center grading of FA images), and agreement between these outcomes in diagnosing macular edema. Results: Optical coherence tomography (90.4%) more frequently returned usable information regarding macular edema than FA (77%) or biomicroscopy (76%). Agreement in diagnosis of MT and ML (κ = 0.44) was moderate. Macular leakage was present in 40% of cases free of MT, whereas MT was present in 34% of cases without ML. Biomicroscopic evaluation for macular edema failed to detect 40% and 45% of cases of MT and ML, respectively, and diagnosed 17% and 17% of cases with macular edema that did not have MT or ML, respectively; these results may underestimate biomicroscopic errors (ophthalmologists were not explicitly masked to OCT and FA results). Among eyes free of ML, phakic eyes without cataract rarely (4%) had MT. No factors were found that effectively ruled out ML when MT was absent. Conclusions: Optical coherence tomography and FA offered only moderate agreement regarding macular edema status in uveitis cases, probably because what they measure (MT and ML) are related but nonidentical macular pathologic characteristics. Given its lower cost, greater safety, and greater likelihood of obtaining usable information, OCT may be the best initial test for evaluation of suspected macular edema. However, given that ML cannot be ruled out if MT is absent and vice versa, obtaining the second test after negative results on the first seems justified when detection of ML or MT would alter management. Given that biomicroscopic evaluation for macular edema erred frequently, ancillary testing for macular edema seems indicated when knowledge of ML or MT status would affect management. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

AB - Objective: To evaluate agreement between fluorescein angiography (FA) and optical coherence tomography (OCT) results for diagnosis of macular edema in patients with uveitis. Design: Multicenter cross-sectional study. Participants: Four hundred seventy-nine eyes with uveitis from 255 patients. Methods: The macular status of dilated eyes with intermediate uveitis, posterior uveitis, or panuveitis was assessed via Stratus-3 OCT and FA. To evaluate agreement between the diagnostic approaches, κ statistics were used. Main Outcome Measures: Macular thickening (MT; center point thickness, ≥240 μm per reading center grading of OCT images) and macular leakage (ML; central subfield fluorescein leakage, ≥0.44 disc areas per reading center grading of FA images), and agreement between these outcomes in diagnosing macular edema. Results: Optical coherence tomography (90.4%) more frequently returned usable information regarding macular edema than FA (77%) or biomicroscopy (76%). Agreement in diagnosis of MT and ML (κ = 0.44) was moderate. Macular leakage was present in 40% of cases free of MT, whereas MT was present in 34% of cases without ML. Biomicroscopic evaluation for macular edema failed to detect 40% and 45% of cases of MT and ML, respectively, and diagnosed 17% and 17% of cases with macular edema that did not have MT or ML, respectively; these results may underestimate biomicroscopic errors (ophthalmologists were not explicitly masked to OCT and FA results). Among eyes free of ML, phakic eyes without cataract rarely (4%) had MT. No factors were found that effectively ruled out ML when MT was absent. Conclusions: Optical coherence tomography and FA offered only moderate agreement regarding macular edema status in uveitis cases, probably because what they measure (MT and ML) are related but nonidentical macular pathologic characteristics. Given its lower cost, greater safety, and greater likelihood of obtaining usable information, OCT may be the best initial test for evaluation of suspected macular edema. However, given that ML cannot be ruled out if MT is absent and vice versa, obtaining the second test after negative results on the first seems justified when detection of ML or MT would alter management. Given that biomicroscopic evaluation for macular edema erred frequently, ancillary testing for macular edema seems indicated when knowledge of ML or MT status would affect management. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

UR - http://www.scopus.com/inward/record.url?scp=84883829880&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84883829880&partnerID=8YFLogxK

U2 - 10.1016/j.ophtha.2013.01.069

DO - 10.1016/j.ophtha.2013.01.069

M3 - Article

C2 - 23706700

AN - SCOPUS:84883829880

VL - 120

SP - 1852

EP - 1859

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 9

ER -