Back to back comparison of diagnostic accuracy of optical coherence tomography angiography and fundus fluorescein angiography in patients with retinal disease

Author: Dmitriy Chernov (United Kingdom)

Co-authors: Dmitriy Chernov, Neelima Ahmed, Alexandros Kogiantis

Purpose

Fundus fluorescein angiography (FFA) is considered the gold-standard diagnostic modality for evaluating retinal disorders associated with underlying choroidal and retinal vascular pathology. This has been challenged by the introduction of non-invasive ocular coherence tomography angiography (OCT-A). Our study is a direct comparison of the diagnostic performance of OCT-A and FFA.

Setting/Venue

This is a single-centre retrospective direct comparison between OCT-A and FFA findings in patients with retinal disease in order to establish whether OCT-A can be used as a non-inferior diagnostic alternative to FFA in patients with retinal disease.

Methods

All patients who underwent both OCT-A and FFA were identified via electronic search over an 18-month period. Reports of OCT-A and FFA were compared for concordance between the key findings. Three groups were identified based on the reports: concordant findings; OCT-A superior to FFA; FFA superior to OCT-A . Superiority was judged on whether the modality offered additional information critical for diagnosis or treatment. Explicitly mentioned adverse events were recorded.

Results

Thirty nine eyes were identified. In 88% of eyes (n = 34), OCT-A findings were concordant with (62%; n = 24) or superior to findings of FFA, (26%; n = 10). FFA outperformed OCT-A in 13% (n=5). One patient experienced vomiting after FFA. Optical coherence tomography angiography had no adverse events.

Conlusions

OCT-A was superior at identifying choroidal neovascular membranes and subtle neovascularisation, for example in age related macular degeneration and retinal haemorrhage. FFA was superior in cases mainly due to lesion lying outside of OCT-A field of view. This could be addressed by focusing the OCT-A scanner on the area of interest identified on fundoscopy or during routine SD-OCT. OCT-A offers a non-inferior non-invasive diagnostic alternative in a selected group of patients. OCT-A should be used with caution in patients with peripheral retinal disease but may be superior in those with early choroidal neovascularisation. OCT-A is a more acceptable non-invasive tool for monitoring disease progression and subsequent response to treatment.

Financial Disclosure

No financial interest to declare.