Optical Coherence Tomography Angiography in Eyes with Indeterminate Choroidal Neovascularization: Results from the AVATAR Study

Purpose: To evaluate the use of OCT angiography (OCTA) to detect choroidal neovascularization (CNV) in eyes with indeterminate CNV features on conventional imaging. Design: Prospective observational study of OCTA in patients undergoing routine spectral-domain optical coherence tomography (SD-OCT) for macular disease. Participants: Participants enrolled in the Observational Assessment of Visualizing and Analyzing Vessels with Optical Coherence Tomography Angiography in Retinal Diseases for which CNV was considered as part of a differential diagnosis based on clinical examination, prior imaging, or both, but in whom the presence of CNV was not definitive on SD-OCT and fluorescein angiography (FA) imaging. Methods: All patients underwent imaging with the Avanti RTVue XR HD (Optovue, Fremont, CA) and the Cirrus HD-OCT (Zeiss, Oberkochen, Germany) systems. Main Outcome Measures: OCT angiography scans were assessed for the presence or absence of CNV. Spectral-domain OCT scans were assessed for the presence of fluid, hyperreflective material, serous pigment epithelial detachment (PED), shallow irregular PED, vitreomacular adhesion, epiretinal membrane, retinal pigment epithelium (RPE) atrophy, and central subfield retinal thickness. Univariate and multivariate logistic regression analyses were performed to identify features on SD-OCT associated with the presence of CNV on OCTA. Results: Twenty-nine eyes of 29 patients met the criteria for inclusion. A CNV lesion was detected on OCTA in 8 eyes (28%); 21 eyes (72%) showed negative results for CNV. After adjusting for age, gender, and central subfield retinal thickness, the presence of shallow irregular PED (odds ratio [OR], 148; 95% confidence interval [CI], 3.22–6830; P = 0.011), as well as the combinations of intraretinal fluid and sub-RPE material (OR, 16.8; 95% CI, 1.43–198; P = 0.025) on SD-OCT were associated significantly with the presence of CNV on OCTA. Conclusions: OCT angiography enabled the identification of CNV that was otherwise indeterminate with prior imaging in select eyes. The presence of a shallow irregular PED as well as intraretinal fluid combined with sub-RPE material both were associated with the presence of CNV. OCT angiography may be a valuable adjunct to conventional SD-OCT and FA imaging in the detection and surveillance of CNV, particularly in diagnostic dilemmas.