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Original Investigation
April 11, 2019

Sensitivity and Specificity of Potential Diagnostic Features Detected Using Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography for Polypoidal Choroidal Vasculopathy

Author Affiliations
  • 1Retina Division, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
  • 2Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • 4Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
  • 5Editor, JAMA Ophthalmology
JAMA Ophthalmol. 2019;137(6):661-667. doi:10.1001/jamaophthalmol.2019.0565
Key Points

Question  What are the potential diagnostic features detected using fundus photography, optical coherence tomography, and fluorescein angiography for polypoidal choroidal vasculopathy without the use of indocyanine green angiography?

Findings  In this cohort study, when at least 2 of the following 4 potential diagnostic signs were graded on deidentified images without the use of indocyanine green angiography, high sensitivity and specificity were noted: notched or hemorrhagic pigment epithelial detachment detected using fundus photography or optical coherence tomography and a sharply peaked pigment epithelial detachment or a hyperreflective ring detected using optical coherence tomography.

Meaning  These data suggest that fundus photography and optical coherence tomography provide high sensitivity and specificity for polypoidal choroidal vasculopathy without the use of indocyanine green angiography, especially when at least 2 of 4 highly suggestive signs are present.

Abstract

Importance  The use of indocyanine green angiography (ICGA) is a criterion standard for diagnosing polypoidal choroidal vasculopathy (PCV), an endemic and common cause of vision loss in Asian and African individuals that also presents in white individuals. However, the use of ICGA is expensive, invasive, and not always available at clinical centers. Therefore, knowing the value of certain features detected using fundus photography (FP), optical coherence tomography (OCT), and fluorescein angiography (FA) to diagnose PCV without ICGA could assist ophthalmologists to identify PCV when ICGA is not readily available.

Objective  To explore the sensitivity, specificity, and predictive accuracy of potential diagnostic features detected using FP, OCT, and FA in diagnosing PCV without ICGA.

Design, Setting, and Participants  Deidentified images of FP alone, OCT alone, and FA alone were graded by 3 retina specialists masked to ICGA findings for potentially diagnostic features of PCV prespecified before grading compared with the criterion standard grading of 2 other retina specialists with access simultaneously to FP, OCT, FA and ICGA. Specialists graded images of 124 eyes of 120 patients presenting between January 1, 2013, and December 31, 2016, with newly identified serous or serosanguinous maculopathy who had undergone FP, OCT, FA, and ICGA before treatment at a large referral eye center in Thailand.

Main Outcomes and Measures  Sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy from the area under the receiver operating characteristic curve (AUC).

Results  The mean (SD) age of the patients was 57.7 (12.6) years, 52 were women, 68 were men, and the diagnosis (from ICGA) was PCV for 65 eyes (52.4%), central serous chorioretinopathy for 45 eyes (36.3%), and typical neovascular age-related macular degeneration for 12 eyes (9.7%). With the use of FP, a potential diagnostic feature for PCV was notched or hemorrhagic pigment epithelial detachment (AUC, 0.77; 95% CI, 0.70-0.85). With the use of OCT, potential diagnostic features for PCV were pigment epithelial detachment notch (AUC, 0.90; 95% CI, 0.85-0.96), sharply peaked pigment epithelial detachment (AUC, 0.86; 95% CI, 0.80-0.92), and a hyperreflective ring (AUC, 0.86; 95% CI, 0.80-0.92). When at least 2 of these 4 signs were present, the AUC was 0.93 (95% CI, 0.89-0.98), with a sensitivity of 0.95 (95% CI, 0.87-0.99), a specificity of 0.95 (95% CI, 0.82-0.97), a positive predictive value of 0.92 (95% CI, 0.83-0.97), and a negative predictive value of 0.95 (95% CI, 0.86-0.99).

Conclusions and Relevance  These data suggest that the potential diagnostic features detected using FP and OCT provide high sensitivity and specificity for a diagnosis of PCV, especially when at least 2 of 4 highly suggestive signs are present.

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