Research shows that, except for in cases of occult lesions, a non-invasive imaging technology is highly comparable to traditional monitoring methods for patients undergoing neovascular age-related macular degeneration (AMD) treatment.
Clinicians depend on imaging technologies to measure the microvascular changes of patients undergoing anti-vascular endothelial growth factor (anti-VEGF) treatments for neovascular AMD. Historically, physicians would utilize fundus fluorescein angiography (FA) to monitor a variety of vascular disorders. However, FA is an invasive procedure and it requires an injection of dye into the arm. Spectral-domain (SD)-OCT offers a potential non-invasive alternative. A study published in the American Academy of Ophthalmology’s Ophthalmology Retina journal considers how SD-OCT measures up to FA’s accuracy in monitoring patients with neovascular AMD.
A retrospective post hoc analysis of the HARBOR trial compared the agreement between SD-OCT and FA in 1094 patients. It found that SD-OCT alone was reliable in detecting choroidal vascular membrane (CNV) activity in eyes with neovascular AMD. However, the data also shows that FA was still valuable for the detection and monitoring of occult CNV.
The study reviewed HARBOR trial data from baseline to 24 months from all eyes that had undergone both FA and SD-OCT evaluation. The study focused on reviewing evidence of CNV activity that was identified by FA and activity identified by SD-OCT, and comparing the 2 sets of data. Using FA as the standard, the researchers measured the ability of SD-OCT to accurately detect CNV activity.
The 2 tests showed a 99.9% agreement at baseline; however, by month 24 the agreement was only 36%. During screenings on months 3, 5, 12, and 24 the majority of cases, 92% to 100% that were only identified by FA were occult CNV lesions. The sensitivity of SD-OCT in detecting CNV activity was 91% and the specificity was 13%.
The researchers conclude that SD-OCT alone is a reliable method for monitoring eyes with neovascular AMD treated with anti-VEGF injections. This affirms common clinical practice, according to the researchers. The report also indicates that FA is still necessary to monitor patients with occult lesions that appear quiescent on SD-OCT. However, researchers note that another emerging technology, OCT angiography, features an ability to image the microvasculature of the retina and choroid that SD-OCT cannot. The investigators suggest that “It would be helpful if OCT angiography could identify leakage by FA from occult CNV that SD-OCT may miss. Future studies should address this shortcoming of SD-OCT.”
Disclosure: Several of the study’s authors declared affiliations with the biotech and pharmaceutical industries. Please see the original reference for a full list of authors’ disclosures.
Khurana RN, Hill L, Ghanekar A, Gune S. Agreement of spectral-domain oct with fluorescein leakage in neovascular age-related macular degeneration: post hoc analysis of the HARBOR study. Ophthalmol Retina. 2020;4(11):1054-1058. doi:10.1016/j.oret.2020.04.016