Comparison of spectral domain optical coherence tomography scan patterns and clinical review strategies in neovascular agerelated macular degeneration

Purpose: To compare various spectral domain optical coherence tomography scan patterns and review strategies to identify an optimal imaging workflow for neovascular agerelated macular degeneration. Methods: A retrospective consecutive case series was performed in eyes after antivascular endothelial growth factor therapy for neovascular age-related macular degeneration with concurrent spectral domain optical coherence tomography imaging (Zeiss Cirrus), including horizontal/vertical five-line rasters, and macular cube analysis. For each scan pattern, a single report was independently reviewed in a masked fashion within the clinical image review software, whereas the cube was reviewed line-by-line in the reader software for the presence of fluid. Results: One hundred and fifty-six reports and 39 cube scans of 39 patients were included. Among all spectral domain optical coherence tomography scans, 64% (25/39) had definitive fluid and 95% (37/39) had possible fluid. Sensitivities for definite fluid detection for horizontal, combined horizontal/vertical, and horizontal/vertical/map reviews were 68%, 76%, and 88%, respectively. When assessing for possible fluid, sensitivities for the detection for horizontal, combined horizontal/vertical, and horizontal/vertical/map reviews were 76%, 92%, and 97%, respectively. Line-by-line review of the cube scan had a sensitivity for definite and possible fluid detection of 96% and 86%, respectively. Conclusion: Optimizing both clinical accuracy and workflow are important factors in managing neovascular age-related macular degeneration. A zero-tolerance strategy with vertical/horizontal raster scans and thickness maps was comparable with line-by-line review of the cube to detect possible fluid.