Grading of Age-Related Macular Degeneration: Comparison between Color Fundus Photography, Fluorescein Angiography, and Spectral Domain Optical Coherence Tomography

Abstract

Purpose. To compare color fundus photography (FP), fluorescein angiography (FA), and spectral domain optical coherence tomography (SDOCT) for the detection of age-related macular degeneration (AMD), choroidal neovascularisation (CNV), and CNV activity. Methods. FPs, FAs, and SDOCT volume scans from 120 eyes of 66 AMD and control patients were randomly collected. Control eyes were required to show no AMD, but other retinal pathology was allowed. The presence of drusen, pigmentary changes, CNV, and signs for CNV activity was independently analyzed for all imaging modalities. Results. AMD was diagnosed based on FP in 75 eyes. SDOCT and FA showed sensitivity (specificity) of 89% (76%) and 92% (82%), respectively. CNV was present on FA in 68 eyes. Sensitivity (specificity) was 78% (100%) for FP and 94% (98%) for SDOCT. CNV activity was detected by SDOCT or FA in 60 eyes with an agreement in 46 eyes. Sensitivity was 88% for SDOCT and 88% for FA. FP showed sensitivity of 38% and specificity of 98%. Conclusions. CNV lesions and activity may be missed by FP alone, but FP may help identifying drusen and pigmentary changes. SDOCT is highly sensitive for the detection of AMD, CNV, and CNV activity; however, it cannot fully replace FA.

Figure 1

Eye with active CNV. Color fundus photography (a) demonstrates hemorrhage and fibrovascular tissue, fluorescein angiography (b) shows classic and occult CNV leakage, and SDOCT (c) presents intraretinal cystoid spaces, subretinal fluid, subretinal hyperreflective material, and a pigment epithelial detachment.

Figure 2

Discrepancy between imaging modalities regarding identification of signs considered to indicate CNV activity: color fundus photography (a) demonstrates fibrosis and RPE changes, fluorescein angiography (b) demonstrates staining of CNV, and SDOCT (c) shows intraretinal cystoid spaces.