ORIGINAL PAPER
Sensitivity and specificity of optical coherence tomography
angiography (OCT-A) for detection of choroidal
neovascularization in real-life practice and varying
retinal expertise level
Vae
¨
l Souedan
.
Eric H. Souied
.
Violaine Caillaux
.
Alexandra Miere
.
Ala El Ameen
.
Rocio Blanco-Garavito
Received: 25 December 2016 / Accepted: 10 May 2017 / Published online: 25 May 2017
Ó Springer Science+Business Media Dordrecht 2017
Abstract
Purpose To evaluate the diagnostic accuracy of OCT
angiography (OCT-A) detecting or predicting choroidal
neovascularization (CNV), by ophthalmologists of dis-
parate degrees of skills in retinal diseases, using spectral
domain optical coherence tomography (SD-OCT) and
fluorescein angiography (FA) as a standard reference.
Methods Retrospective observational case series.
Patient presenting maculopathy and complete imaging
were included. FA, SD-OCT, OCT-A and FA coupled
to SD-OCT images were graded independently for
presence or absence of CNV by ophthalmologists with
varying expertise levels.
Results Overall sensitivity of OCT-A was 85.62%
(95% CI 79.04–90.76%) and specificity was 81.51%
(95% CI 73.36–88.03). Sensitivity of FA was 74.51%
(95% CI 66.84–81.20), and specificity was 82.35%
(95% CI 74.30–88.73). Sensitivity of FA ? SD-OCT
was 92.72% (95% CI 87.34–96.30), and specificity
was 90.91% (95% CI 84.31–95.37).
Conclusion OCT-A has good sensitivity and speci-
ficity for the detection of CNV in all expertise level
groups. OCT-A may soon become a routine tool for
CNV diagnosis and follow-up.
Keywords Sensitivity Á Specificity Á Optical
coherence tomography angiography Á Choroidal
neovascularization detection Á Exudative AMD
Introduction
Choroidal neovascularization (CNV) is the hallmark
of exudative age-related macular degeneration
(wAMD) and may complicate other diseases (uveitis,
pathological myopia, etc.). In wAMD, CNV accounts
for over 80% of severe visual loss cases [1]. CNV
detection methods, other than fundus exam, consist of
fluorescein angiography (FA), indocyanine green
angiography (ICGA) and optical coherence tomogra-
phy (OCT). Leakage on late phase of the FA is the
hallmark of neovascularization, but leakage may be
hard to interpret if lesion components overlap and/or if
the lesion is in regression or not exudative, as may be
the case in lesions partially responding to therapy or
quiescent CNV [2]. Confounding factors may be
noted: Certain types of hyperfluorescence patterns
may be mistaken for leakage, often in central serous
chorioretinopathy (CSCR), in vitelliform lesions or in
fibrosis. Nevertheless, the gold standard in CNV
detection imaging remains FA because of its avail-
ability and relatively quick performance time. How-
ever, FA is considered an invasive exam, with
potential of risk of anaphylaxis [3].
V. Souedan Á E. H. Souied Á V. Caillaux Á
A. Miere Á A. E. Ameen Á R. Blanco-Garavito (&)
Department of Ophthalmology, Cre
´
teil University Eye
Clinic, Ho
ˆ
pital Intercommunal de Cre
´
teil, University Paris
Est, 40 Avenue de Verdun, 94010 Cre
´
teil, France
e-mail: rocio_blancog@hotmail.com
123
Int Ophthalmol (2018) 38:1051–1060
https://doi.org/10.1007/s10792-017-0559-6
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