Multimodal imaging in wet AMD
Reviewed by Saruban Pasu

This novel study set out to determine grader agreement levels of various retinal imaging techniques, commonly used in the diagnosis of wet age-related macular degeneration (AMD). Images from 52 eyes were by examined by two different observers. All images were taken from the Heidelberg HRA/OCT Spectralis (fundus fluorescien angiography (FFA), indocyanine green (ICGA), optical coherence tomography (OCT), infrared (IR) and autofluorescence (AF)). Inter and intraobserver variability was assessed for each of the five imaging modalities and all together (multimodal imaging was the gold standard). Five separate OCT features were also analysed: intraretinal cysts, retinal pigment epithelial (RPE) detachments, subretinal fluid, tubulations and flecks. Intraobserver agreement was good for all the evaluated features. Cohen’s kappa values varied from 0.84 to 0.55 regarding the type of choroidal neovascularisation (CNV), and from one to 0.45 regarding the retreatment decision. Intraobserver agreement for each OCT sign was good. Interobserver agreement regarding CNV type ranged from 0.43 to 0.69. Interobserver agreement regarding the retreatment decision showed wider variability, revealing that some imaging techniques are much more reproducible than others. Interobserver agreement for each SD-OCT sign was good. SD-OCT showed a strong association (P<0.001) and FFA (P<0.001), but also IR (P=0.05) and ICGA (P=0.01) showed a significant association with the gold standard. By contrast, FAF (P=0.26) showed no association. This study show that SD-OCT is the most reproducible imaging technique in the definition of neovascular activity and that signs that better correlate with the presence of CNV activity are neurosensory retinal detachment and flecks.

Comparison among different diagnostic methods in the study of type and activity of choroidal neovascular membranes in age-related macular degeneration.
Ravera V, Giani A, Pellegrini M, et al.
RETINA
2019;39(2):281-7.