Which Imaging Modality Is Superior in Identifying Macular Neovascularization in Eyes with Macular Atrophy?

A study compared optical coherence tomography angiography (OCTA), fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT) to detect macular neovascularization (MNV) in eyes with atrophy.

FA, ICGA, structural OCT, and OCTA imaging were performed in eyes with MNV and macular atrophy (MA) secondary to age-related macular degeneration (AMD) and AMD eyes with geographic atrophy (GA) without MNV. Senior retina specialists using all imaging specialties were considered the gold standard reference to determine MNV presence. Two expert readers then reviewed each individual modality to determine whether MNV was present.

The study included 21 patients each with MA plus MNV and with GA alone. OCTA detected MNV in 95.2% of MA plus MNV eyes and 4.7% of GA eyes, yielding a 95.2% specificity and 95.2% sensitivity rate. In the MA plus MNV group, FA detected MNV in 57.1% of eyes, ICGA in 52.3%, and OCT in 66.7%; in the GA group, the rates were 14.2%, 9.5%, and 42.8%, respectively. FA had a sensitivity of 85.7% and specificity of 57.1%; ICGA had a sensitivity and specificity of 90.5% and 52.4%, respectively; and OCT values were 66.7% and 57.1%, respectively.

“OCTA appears to be superior to other imaging modalities for identification of MNV in eyes with macular atrophy. OCTA should be considered as part of the multimodal imaging evaluation of eyes with atrophy, particularly in the context of clinical trials,” the researchers concluded.