Features and Diagnostic Accuracy of Optical Coherence Tomography Angiography in Neovascular Age-related Macular Degeneration

Usman, Maria; Iqbal, Kashif; Ali, Muhammad Hassaan; Nafees, Khurram

doi:10.7759/cureus.6485

Cited by 11 publications

(35 citation statements)

References 29 publications

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“…In the case of neovascular AMD, the disease is hallmarked by choroidal neovascularization and associated manifestations such as pigment epithelial detachment, retinal pigment epithelial tears, disciform scarring and intraretinal hemorrhages [117]. The choroidal neovessels breach the Bruch's membrane and invade sub-RPE and subretinal spaces.…”

Section: Changes In Retinal and Choroidal Vascular Structure And Funcmentioning

confidence: 99%

“…Clinical assessment of neovascular AMD is based on visual acuity testing, Amsler grid testing and slit-lamp examination, and in certain cases, to ascertain whether the disease is active, spectral-domain (SD)-OCT and fundus fluorescein angiography (FFA) are used. In fact, with fundus fluorescein angiography (FFA), the gold standard for the diagnosis of neovascular AMD, in combination with SD-OCT, that aids in both the diagnosis and follow-up of the disease, choroidal neovascularization (CNV) can be classified into three types: type 1 CNV, which involves the sub-RPE space and refers to vessels beneath the RPE (corresponds to angiographically occult CNV); type 2 CNV, which also involves the sub-RPE space and refers to neovessels growing from the choroid to the subretinal space between the neurosensory retina and the RPE (corresponds to angiographically classic CNV); and, type 3 CNV, which appears as intraretinal anastomosis originating in the deep capillary plexus of the retina [117].…”

Section: Changes In Retinal and Choroidal Vascular Structure And Funcmentioning

confidence: 99%

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Microglia Contribution to the Regulation of the Retinal and Choroidal Vasculature in Age-Related Macular Degeneration

Alves

Fernandes

Santiago

et al. 2020

Cells

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The retina is a highly metabolically active tissue with high-level consumption of nutrients and oxygen. This high metabolic demand requires a properly developed and maintained vascular system. The retina is nourished by two systems: the central retinal artery that supplies the inner retina and the choriocapillaris that supplies the outer retina and retinal pigment epithelium (RPE). Pathological neovascularization, characterized by endothelial cell proliferation and new vessel formation, is a common hallmark in several retinal degenerative diseases, including age-related macular degeneration (AMD). A limited number of studies have suggested that microglia, the resident immune cells of the retina, have an important role not only in the pathology but also in the formation and physiology of the retinal vascular system. Here, we review the current knowledge on microglial interaction with the retinal vascular system under physiological and pathological conditions. To do so, we first highlight the role of microglial cells in the formation and maintenance of the retinal vasculature system. Thereafter, we discuss the molecular signaling mechanisms through which microglial cells contribute to the alterations in retinal and choroidal vasculatures and to the neovascularization in AMD.

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Section: Changes In Retinal and Choroidal Vascular Structure And Funcmentioning

confidence: 99%

Section: Changes In Retinal and Choroidal Vascular Structure And Funcmentioning

confidence: 99%

Microglia Contribution to the Regulation of the Retinal and Choroidal Vasculature in Age-Related Macular Degeneration

Alves

Fernandes

Santiago

et al. 2020

Cells

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“…Among the remaining 81 articles, 74 were further excluded due to ineligible study design, lack of extractable data, non-English publication [16], or other reasons based on our inclusion and exclusion criteria. Eventually, 7 studies [17-23] were included for quantitative meta-analysis, and the detailed paper selection process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…The specificities in studies by Ahmed et al [17], Carnevali et al [21], Faridi et al [19], Gong et al [20], Moult et al [22], Nikolopoulou et al [18], and Usman et al [23] were 0.99 (95% CI: 0.93, 1.00), 0.97 (95% CI: 0.87, 1.00), 0.97 (95% CI: 0.84, 1.00), 0.70 (95% CI: 0.54, 0.84), 0.91 (95% CI: 0.44, 1.00), 0.90 (95% CI: 0.75, 0.98), and 0.81 (95% CI: 0.63, 0.94), respectively (Fig. 3).…”

Section: Resultsmentioning

confidence: 99%

“…Our study aimed at exploring the diagnostic value of OCTA for CNV detection in AMD patients. Over the past several years, since the use of OCTA was proposed, several studies were conducted to assess its diagnostic value for CNV detection; however, the conclusions contradicted with each other, and the reported sensitivities ranged from 0.78 to 0.92 [17-23]. The sample size of each study varied from 19 to 156 [17-22], which is one of the reasons why the reported sensitivity varied a lot across these studies.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Value of Optical Coherence Tomography Angiography for Choroidal Neovascularization in Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis

Chen

Liu²,

Cao

et al. 2020

Ophthalmic Res

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Objective: To evaluate the diagnostic value of optical coherence tomography angiography (OCTA) in detecting the choroidal neovascularization (CNV) in agerelated macular degeneration (AMD). Methods: A systematic review and meta-analysis was performed by searching Pubmed, Science Direct, Embase and Web of Science. The pooled sensitivity and specificity with 95% confidence intervals (CIs), area under the summary receiver operator characteristic curve (sROC), and the total accurate classification rate were used to evaluate OCTA’ diagnostic value of CNV in AMD patients. Results: Seven studies involving 517 eyes were included in the analysis. The mean age of subjects in each study ranged from 58.5 years to 81.7 years. Fluorescein angiography was applied as the gold standard in five studies. There were 350 eyes diagnosed with CNV, OCTA detected 301 eyes correctly, while among the 167 eyes without CNV, OCTA identified 150 correctly. The total accurate classification rate was 87.23%. The Spearman's rank correlation coefficient was 0.5, indicating that there was no significant threshold effect in the current study (S=8, p=0.103). The pooled sensitivity and pooled specificity were 0.89 (95%CI: 0.82,0.94) and 0.96 (95%CI: 0.85,1.00) respectively. The area under sROC was up to 0.911. Conclusion: The specificity of OCTA for the detection of CNV in AMD patients is extremely high, however, the sensitivity still needs to be improved. In general, the metaanalysis revealed that OCTA had a high diagnostic value for the detection of CNV in AMD patients.

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Diagnostic Accuracy of the Amsler Grid Test for Detecting Neovascular Age-Related Macular Degeneration

et al. 2023

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ImportancePatients with nonneovascular age-related macular degeneration (AMD) are encouraged to use the Amsler grid test for self-assessment to facilitate early diagnosis. The test is widely recommended, suggesting a belief that it signals worsening AMD, warranting its use in home monitoring.ObjectiveTo systematically review studies of the diagnostic test accuracy of the Amsler grid in the diagnosis of neovascular AMD and to perform diagnostic test accuracy meta-analyses.Data SourcesA systematic literature search was conducted in 12 databases for relevant titles from database inception until May 7, 2022.Study SelectionStudies included those with groups defined as having (1) neovascular AMD and (2) either healthy eyes or eyes with nonneovascular AMD. The index test was the Amsler grid. The reference standard was ophthalmic examination. After removal of obviously irrelevant reports, 2 authors (J.B. and M.S.) independently screened the remaining references in full text for potential eligibility. Disagreements were resolved by a third author (Y.S.).Data Extraction and SynthesisTwo authors (J.B. and I.P.) independently extracted all data and evaluated quality and applicability of eligible studies using the Quality Assessment of Diagnostic Accuracy Studies 2. Disagreements were resolved by a third author (Y.S.).Main Outcomes and MeasuresSensitivity and specificity of the Amsler grid for detecting neovascular AMD with comparators being either healthy control participants or patients with nonneovascular AMD.ResultsOf 523 records screened, 10 studies were included with a total of 1890 eyes (mean participant age ranging from 62 to 83 years). Sensitivity and specificity to diagnose neovascular AMD were 67% (95% CI, 51%-79%) and 99% (95% CI, 85%-100%), respectively, when comparators were healthy control participants and 71% (95% CI, 60%-80%) and 63% (95% CI, 49%-51%), respectively, when control participants were patients with nonneovascular AMD. Overall, potential sources of bias were low across studies.Conclusions and RelevanceAlthough the Amsler grid is easy and inexpensive to use for detection of metamorphopsia, its sensitivity may be at levels typically not recommended for monitoring. Coupling this lower sensitivity with only moderate specificity to identify neovascular AMD in a population at risk, these findings suggest that such patients typically should be encouraged to undergo ophthalmic examination regularly, regardless of any results of Amsler grid self-assessment.

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Features and Diagnostic Accuracy of Optical Coherence Tomography Angiography in Neovascular Age-related Macular Degeneration

Cited by 11 publications

References 29 publications

Microglia Contribution to the Regulation of the Retinal and Choroidal Vasculature in Age-Related Macular Degeneration

Microglia Contribution to the Regulation of the Retinal and Choroidal Vasculature in Age-Related Macular Degeneration

Diagnostic Value of Optical Coherence Tomography Angiography for Choroidal Neovascularization in Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis

Diagnostic Accuracy of the Amsler Grid Test for Detecting Neovascular Age-Related Macular Degeneration

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