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Meta-Analysis
. 2014 Dec;28(12):1399-406.
doi: 10.1038/eye.2014.214. Epub 2014 Sep 19.

Optical coherence tomography for the diagnosis of neovascular age-related macular degeneration: a systematic review

M M Castillo  1 , G Mowatt  1 , N Lois  2 , A Elders  3 , C Fraser  1 , W Amoaku  4 , J M Burr  5 , A J Lotery  6 , C R Ramsay  1 , A Azuara-Blanco  2
Affiliations
Meta-Analysis

Optical coherence tomography for the diagnosis of neovascular age-related macular degeneration: a systematic review

M M Castillo et al. Eye (Lond). 2014 Dec.

Abstract

The purpose is to study the diagnostic performance of optical coherence tomography (OCT) and alternative diagnostic tests for neovascular age-related macular degeneration (nAMD). Methods employed are as follows:systematic review and meta-analysis;

Index test: OCT including time-domain (TD-OCT) and the most recently developed spectral domain (SD-OCT); comparator tests: visual acuity, clinical evaluation (slit lamp), Amsler chart, colour fundus photographs, infra-red reflectance, red-free images/blue reflectance, fundus autofluorescence imaging (FAF), indocyanine green angiography (ICGA), preferential hyperacuity perimetry (PHP), and microperimetry; reference standard: fundus fluorescein angiography. Databases searched included MEDLINE, MEDLINE In Process, EMBASE, Biosis, SCI, the Cochrane Library, DARE, MEDION, and HTA database. Last literature searches: March 2013. Risk of bias assessed using QUADAS-2. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic (HSROC) curves. Twenty-two studies (2 abstracts and 20 articles) enrolling 2124 participants were identified, reporting TD-OCT (12 studies), SD-OCT (1 study), ICGA (8 studies), PHP (3 studies), Amsler grid, colour fundus photography and FAF (1 study each). Most studies were considered to have a high risk of bias in the patient selection (55%, 11/20), and flow and timing (40%, 8/20) domains. In a meta-analysis of TD-OCT studies, sensitivity and specificity (95% CI) were 88% (46-98%) and 78% (64-88%), respectively. There was insufficient information to undertake meta-analysis for other tests. TD-OCT is a sensitive test for detecting nAMD, although specificity was only moderate. Data on SD-OCT are sparse. Diagnosis of nAMD should not rely solely on OCT.

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Figures

Figure 1
Figure 1
Flow diagram outlining the screening process.
Figure 2
Figure 2
Summary of the risk of bias and applicability domains.
Figure 3
Figure 3
Individual study results for all OCT diagnostic studies reporting sensitivity and/or specificity.
Figure 4
Figure 4
Individual study results reporting sensitivity and specificity for TD-OCT.
Figure 5
Figure 5
Individual study results for sensitivity and specificity.
See this image and copyright information in PMC

References

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