Clinical Value of Optical Coherence Tomography Angiography in Neovascular Age-Related Macular Degeneration

Background/Objectives: The utility of optical coherence tomography angiography (OCTA) for neovascular age-related macular degeneration (nAMD) remains unclear. The current study investigated the choroidal neovascularization (CNV) detection rate by OCTA in comparison with standard fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT). Methods: Subjects underwent multimodal imaging, including FA, SD-OCT, and OCTA imaging, which were compared. In patients with unilateral nAMD, the contralateral eye with dry AMD (n = 39) was included to determine imaging modality sensitivity and specificity. Eyes with inaccurate automated segmentation from retinal distortion were manually resegmented. Results: The diagnostic performance for nAMD was 86% sensitivity and 100% specificity by OCT (AUC: 0.93; 95% CI 0.87–0.99; p < 0.001); 82% sensitivity and 100% specificity by FA (AUC: 0.91; 95% CI 0.84–0.98; p < 0.001); and 68% sensitivity and 100% specificity by automatically segmented OCTA (AUC: 0.84; 95% CI 0.76–0.93; p < 0.001). OCTA diagnostic accuracy improved following manual resegmentation to 88% sensitivity and 100% specificity (AUC: 0.94; 95% CI 0.89–1.0; p < 0.001). Diagnostic accuracy of OCT combined with manually resegmented OCTA (AUC: 1.0; 95% CI 1.0–1.0; p < 0.001) was greater than that of OCT or FA combined (AUC: 0.96; 95% CI 0.92–1.0; p < 0.001) but both were very accurate. Conclusions: Manual segmentation of the OCTA images can help identify CNV in eyes otherwise undetected by automated segmentation algorithms due to errors in segmentation of retinal layers. Eyes with substantial elevation in one or more layers of the retina were most likely to benefit from resegmentation.