Interpretation of SD-OCT imaging data in real-life conditions versus standardized reading centre analysis in eyes with neovascular age-related macular degeneration – 24 months results of the ORCA study

Session Details

Session Title: Free Paper Session 22: AMD V

Session Date/Time: Sunday 10/09/2017 | 08:00-09:30

Paper Time: 08:06

Venue: Room 115

First Author: : S.Schmitz-Valckenberg GERMANY

Co Author(s): :    G. Spital   F. Ziemssen   J. Voegeler   M. Koch   C. Brinkmann   S. Liakopoulos              

Abstract Details

Purpose:

Use and interpretation of spectral-domain optical coherence tomography (SD-OCT) imaging is key for successful and optimized treatment decisions in eyes with neovascular age-related macular degeneration (nAMD) undergoing anti-VEGF (Vascular Endothelial Growth factor)-therapy. Within the non-interventional OCEAN (NCT02194803) trial, the “ORCA” module was implemented to assess the status quo of SD-OCT image analysis by ophthalmologists both in referral hospitals and private practice settings versus standardized reading centre analysis in patients undergoing ranibizumab therapy. The aim of the current analysis was to evaluate the detection rate of signs for CNV activity on SD-OCT during 24 months follow-up in patients with nAMD.

Setting:

Three reading centres (GRADE Reading centre Bonn, CIRCL Cologne Image Reading centre, and M3 Macula Monitor Muenster) developed standardized imaging protocols and grading parameters for the management of anti-VEGF therapy in accordance with the guidelines published by German ophthalmological societies.

Methods:

Patients with nAMD underwent SD-OCT volume scans at the discretion of the treating physician during 24 months follow-up and according to a pre-specified imaging protocol. Using a pre-specified questionnaire, analysis of imaging data was conducted independently by both the treating physician and the reading centres. Signs for CNV activity on SD-OCT included presence of intraretinal fluid, subretinal fluid and increase of pigment epithelium detachment (PED). In addition, the Reading centres noted whether intra- and subretinal fluid were obviously discernible or only discreet. All eyes in which the presence of active nAMD was confirmed by the reading centres at baseline were included in the current analysis.

Results:

A total of 199 eyes of 199 patients with a confirmed diagnosis of active nAMD at baseline were included. Data of 2112 visits were available for analysis. In 1460 visits (69%), at least one sign of CNV activity was detected by the reading centres on SD-OCT. In those cases, CNV activity was also identified by the treating physicians in 1056 visits (72%). In 112 of the other 404 visits (28%), either intraretinal or subretinal fluid was found to be “obviously discernible” by the reading centres. In the majority of cases in which signs for CNV activity were not documented by the treating physicians, intra- or subretinal fluid were considered to be discreet or CNV activity was suspected because of an increased PED.

Conclusions:

The overall approximately 72% consensus rate between independent Reading centres and treating physicians indicate that signs for CNV activity are identified in most patients in real-life conditions. Further detailed analysis of the ORCA-data will be performed to evaluate the effect of non-detection of signs for CNV activity on functional outcome parameters.

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