Diagnosing Polypoidal Choroidal Vasculopathy using Color Fundus Photography, Optical Coherence Tomography and Optical Coherence Tomography Angiography.

PURPOSE: To compare the diagnostic accuracy of differentiating polypoidal choroidal vasculopathy (PCV) from exudative age-related macular degeneration (AMD), using color fundus photography (CFP), optical coherence tomography (OCT), and swept-source optical coherence tomography angiography (SS-OCTA) without using fluorescein angiography/ indocyanine green angiography (FA/ICGA).

METHODS: Treatment-naïve eyes with exudative age-related macular degeneration (AMD) that underwent CFP, OCT, SS-OCTA, and FA/ICGA imaging before treatment were identified. Images of each patient were categorized into 2 sets (Set A: CFP+OCT; Set B: CFP+ SS-OCTA). In Set B, both the en face and cross-sectional B-scans were analyzed. Each set was reviewed by two graders, and it was determined whether the presumed diagnosis was PCV. Sensitivity, specificity, and area under the curve (AUC) for the diagnosis of PCV were assessed for each set by comparing diagnoses that included ICGA. The number of polypoidal lesions in each set was calculated and compared to ICGA.

RESULTS: A total of 94 study eyes from 94 patients with AMD were included in the study, of which 66.0% were male, and the mean age was 71.8±9.0 years. The PCV diagnosis rate using ICGA was 45.7%. Sensitivity of sets A, B: 0.88, 0.93; specificity: 0.94, 0.96; positive predictive value: 0.93, 0.95; negative predictive value: 0.91, 0.94, AUC: 0.90 (95% confidence interval [CI]:0.83-0.97), 0.96 (95% CI:0.90-1.00). Set A detected polypoidal lesions 1.28±0.91, Set B detected polypoidal lesions 1.47±1.01, ICGA showed 1.51±0.86. In the interclass correlation coefficient analysis, the correlation between Set A and ICGA was ICC=0.76(95% CI:0.60-0.86, p<0.001), and the correlation between Set B and ICGA was ICC=0.84(95% CI:0.72-0.91, p<0.001).

CONCLUSION: This study highlights that, without using ICGA, both CFP combined with OCT and CFP combined with SS-OCTA demonstrate high sensitivity, specificity, and AUC in diagnosing PCV. It is evident that SS-OCTA contributes to enhancing sensitivity, specificity, and AUC for PCV diagnosis.