IDENTIFICATION OF FLUID ON OPTICAL COHERENCE TOMOGRAPHY BY TREATING OPHTHALMOLOGISTS VERSUS A READING CENTER IN THE COMPARISON OF AGE-RELATED MACULAR DEGENERATION TREATMENTS TRIALS

Abstract

Purpose: To examine treatment decisions by ophthalmologists versus reading center fluid identification from optical coherence tomography in Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).

Methods: Fluid in 6,210 optical coherence tomography scans (598 patients) in "as needed treatment" arm of CATT Year 1 was compared with ophthalmologist's treatment: positive fluid agreement (PFA, fluid+, treatment+) and positive fluid discrepancy (PFD, fluid+, treatment-), negative fluid agreement (fluid-, treatment-) and negative fluid discrepancy (fluid-, treatment+). For PFDs, fluid location and visual acuity were characterized.

Results: Treatment and reading center fluid determination agreed in 72.1% (53.0% PFA, 19.1% negative fluid agreement) and disagreed in 27.9% (25.7% PFD, 2.2% negative fluid discrepancy) of visits, with no discrepancies for 20.9% of patients. Compared with PFA, PFD occurred more commonly with lower total foveal thickness (mean ± SD: 265 ± 103 PFD, 366 ± 151 μm PFA), presence of intraretinal fluid only, smaller fluid areas (PFA areas greater than twice those of PFD, P < 0.001), and greater decrease in retinal and lesion thickness. Mean acuities before, at, and after PFD were 65.8, 66.9, and 66.3 letters.

Conclusion: Treatment decisions by ophthalmologists matched reading center fluid determination in the majority of visits. More pronounced response to treatment and smaller foci of fluid likely contributed to PFD. Positive fluid discrepancy did not have substantial impact on subsequent visual acuity.

Figures

Figure 1

Representative optical coherence tomography (OCT) images comparing areas of single largest intraretinal fluid (IRF) between cases where RC identified OCT macular fluid and treatment was administered by the ophthalmologist (Positive Fluid Agreement or PFA) compared to cases where RC identified OCT macular fluid and treatment was not administered by the ophthalmologist at corresponding visit (Positive Fluid Discrepancy or PFD): PFA IRF 5th percentile area (upper left), PFD IRF 5th percentile area (upper right), PFA IRF median area (center left), PFD IRF median area (center right), PFA IRF 95th percentile area (lower left), and PFD IRF 95th percentile area (lower right).

Figure 2

Representative optical coherence tomography (OCT) images comparing areas of single largest subretinal fluid (SRF) between cases where RC identified OCT macular fluid and treatment was administered by an treating ophthalmologist (Positive Fluid Agreement or PFA) compared to cases where RC identified OCT macular fluid and treatment not administered by treating ophthalmologist at corresponding visit (Positive Fluid Discrepancy or PFD): PFA SRF 5th percentile area (upper left), PFD SRF 5th percentile area (upper right), PFA SRF median area (center left), PFD SRF median area (center right), PFA SRF 95th percentile area (lower left), and PFD SRF 95th percentile area (lower right).

Figure 3

Representative optical coherence tomography (OCT) images comparing areas of single largest sub-retinal pigment epithelium (RPE) fluid between cases where RC identified OCT macular fluid and treatment was administered by an treating ophthalmologist (Positive Fluid Agreement or PFA) compared to cases where RC identified OCT macular fluid and treatment not administered by treating ophthalmologist at corresponding visit (Positive Fluid Discrepancy or PFD): PFA sub-RPE fluid 5th percentile area (upper left), PFD sub-RPE fluid 5th percentile area (upper right), PFA sub-RPE fluid median area (center left), PFD sub-RPE fluid median area (center right), PFA sub-RPE fluid 95th percentile area (lower left), and PFD sub-RPE fluid 95th percentile area (lower right).