Optical coherence tomography and color fundus photography in the screening of age-related macular degeneration: A comparative, population-based study.

Edoardo Midena,Paolo Boscolo Todaro,Elisabetta Pilotto,Giacomo Miglionico,Luisa Frizziero,Tommaso Torresin,Alfred S Lewin

doi:10.1371/journal.pone.0237352

Abstract

PurposeTo analyze the individual value and the contribution of color fundus photography (CFP) and optical coherence tomography (OCT) in the screening of age-related macular degeneration (AMD) of an unselected population.MethodsCFP and OCT images of 15957 eyes of 8069 subjects older than 55 years, obtained during a population-based screening for AMD using a single diagnostic non-mydriatic imaging device, were analyzed by a blinded examiner. The two techniques were preliminary evaluated considering the dichotomous parameter "gradable/ungradable", then gradable images were classified. CFP were graded according to the standardized classification of AMD lesions. OCT images were also categorized considering the presence of signs of early/intermediate AMD, late AMD, or other retinal diseases. Another blinded operator re-graded 1978 randomly selected images (for both CFP and OCT), to assess test reproducibility.ResultsOf the 15957 eyes, 8356 CFP (52.4%) and 15594 (97.7%) OCT scans were gradable. Moreover, most of the eyes with ungradable CFP (7339, 96.6%) were gradable at OCT. AMD signs were revealed in 7.4% of gradable CFP and in 10.4% of gradable OCT images. Moreover, at OCT, AMD signs were found in 1110 (6.9%) eyes whose CFP were ungradable or without AMD (847 and 263 eyes, respectively). The inter-operator agreement was good for the gradable versus ungradable parameter, and optimal for the AMD grading parameter of CFP. The agreement was optimal for all OCT parameters.ConclusionsOCT provided gradable images in almost all examined eyes, compared to limited CFP efficiency. Moreover, OCT images allowed to detect more AMD eyes compared to gradable photos. OCT imaging appears to significantly improve the power of AMD screening in a general, unselected population, compared to CFP alone.

Highlights

Age-related macular degeneration (AMD) is the most common cause of visual impairment and blindness in developed countries, in people older than 55 years [1,2]
AMD signs were revealed in 7.4% of gradable Color fundus photography (CFP) and in 10.4% of gradable optical coherence tomography (OCT) images
OCT imaging appears to significantly improve the power of AMD screening in a general, unselected population, compared to CFP alone

Summary

Introduction

Age-related macular degeneration (AMD) is the most common cause of visual impairment and blindness in developed countries, in people older than 55 years [1,2]. The late phases of AMD (i.e. geographic atrophy and neovascular AMD) are characterized by a significant central visual loss, causing a relevant limitation of daily life activities. The introduction of anti-vascular endothelial growth factor (VEGF) intravitreal therapy has notably improved the visual prognosis for patients affected by neovascular AMD, mainly providing a limitation of macular lesions and the maintenance of a relatively good visual acuity [3,4]. Patients often refer to physician when the disease has already caused significant and irreversible macular damage and vision loss. Color fundus photography (CFP) is currently the gold standard for AMD screening and allows the detection and grading of this disease [4,7,8]. CFP analysis may be sometimes difficult because of poor image quality (media opacities, pupil size and other technical conditions, such as technical ophthalmic imaging expertise, in particular) limiting the grading of AMD lesions [7,9]

Objectives

Methods

Results

Conclusion