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The following is a summary of “Agreement between Color, Fluorescein Angiography, and SD-OCT in the Detection of Macular Fibrosis in Neovascular AMD,” published in the January 2025 issue of Ophthalmology by Csincsik et al.
Color imaging is the standard reference for detecting macular fibrosis in neovascular age-related macular degeneration, with fluorescein angiography (FA) and spectral domain optical coherence tomography (SD-OCT) also used, though no formal agreement studies exist.
Researchers conducted a retrospective study to evaluate the agreement between fibrosis on color imaging, FA, and SD-OCT-detected hyperreflective material (HRM) and clinical relevance.
They analyzed multimodal fundus images (color, FA, and SD-OCT) of 130 eyes with neovascular age-related macular degeneration from the EDNA study, 18 months post-initiation of anti-vascular endothelial growth factor (anti-VEGF) treatment. Fibrosis and HRM were regraded, with HRM locations classified as subretinal (SR) or subretinal pigment epithelial (SPE). The kappa statistic assessed the agreement between detection methods, and regression analysis evaluated clinical relevance using best corrected visual acuity (BCVA) as the outcome variable.
The results showed the kappa value for FA was 0.56, while for HRM on SD-OCT, it was 0.40, using color as the reference. Regression analysis against BCVA revealed low R2 values for all tests (R2 < 0.09). However, in the HRM-OCT model, using no HRM as the reference and location/dimensions as covariates, R2 improved to 0.301. Letter loss was 21.1 (P < 0.0001) for SR and 8.1 (P = 0.045) for SPE. When HRM on SD-OCT served as the reference, sensitivity for color or FA was 87.5% for SR but dropped to 15.2%-33.3% for subretinal pigment epithelial (sub-RPE).
Investigators concluded that well-defined HDM detected by SD-OCT during the maintenance phase of anti-VEGF therapy accounted for significant variability in BCVA, suggesting SD-OCT might be a superior standard for detecting fibrosis compared to other methods.
Source: ajo.com/article/S0002-9394(25)00031-5/abstract
