AAO Preferred Practice Pattern: history and examination

“Metamorphopsia” (opens the source at this quote in a new tab)
“Decreased vision” (opens the source at this quote in a new tab)
“Scotoma” (opens the source at this quote in a new tab)
“Photopsia” (opens the source at this quote in a new tab)
“Difficulties in dark adaptation” (opens the source at this quote in a new tab)
“Binocular slit-lamp biomicroscopy of the ocular fundus is often necessary to detect subtle clinical signs of MNV. These include small areas of hemorrhage, hard exudates, subretinal fluid, macular edema, subretinal fibrosis, or pigment epithelial elevation.” (opens the source at this quote in a new tab)

AAO Preferred Practice Pattern: optical coherence tomography

“Optical coherence tomography defines the cross-sectional architecture of the retina, which is not possible with any other imaging technology. It may reveal the presence of fluid that is not apparent on biomicroscopy alone.” (opens the source at this quote in a new tab)
“Newer-generation OCT modalities, including SD-OCT and swept-source (SS) OCT, are preferred technologies.” (opens the source at this quote in a new tab)

AAO Preferred Practice Pattern: optical coherence tomography angiography

“Optical coherence tomography angiography (OCTA) is a noninvasive imaging modality that provides evaluation of the retinal and choroidal vasculature; it is becoming more commonly applied in the evaluation and management of AMD, but it has not replaced other angiographic methods.” (opens the source at this quote in a new tab)
“A meta-analysis of OCTA for detection of MNV revealed a sensitivity of 0.87 and specificity of 0.97.” (opens the source at this quote in a new tab)
“Optical coherence tomography angiography may detect subclinical MNV, which needs close monitoring and not treatment.” (opens the source at this quote in a new tab)

AAO Preferred Practice Pattern: fluorescein angiography indications and risks

“To detect the presence of and determine the extent, type, size, and location of MNV.” (opens the source at this quote in a new tab)
“The role and indications for fluorescein angiography are evolving as continued advances in OCT occur.” (opens the source at this quote in a new tab)
“Even death from anaphylaxis has been reported (approximately 1 in 200,000 patients).” (opens the source at this quote in a new tab)

AAO Preferred Practice Pattern: indocyanine green angiography for polypoidal choroidal vasculopathy

“Indocyanine green angiography has been shown to be useful in evaluating specific forms of AMD, such as PED, poorly defined MNV, occult MNV, and lesions including retinal angiomatous proliferation or idiopathic PCV.” (opens the source at this quote in a new tab)
“An indocyanine green (ICG) angiogram is often useful in confirming the diagnosis. Multicolor fundus imaging and optical coherence tomography (OCT) can be used to detect some PCV cases as well.” (opens the source at this quote in a new tab)

Imaging modalities for diagnosis and management

Imaging modality	Quoted considerations
Optical coherence tomography	“Most suitable for monitoring treatment effects in exudative neovascular AMD”
Fluorescein angiography	“Gold standard for assessing exudative neovascular AMD due to visualization of dye leakage”
Fluorescein angiography	“Invasive with intravenous dye injection and risk of anaphylaxis”
Optical coherence tomography angiography	“Noninvasive and a potential replacement for fluorescein angiography in detecting neovascular AMD”

Sensitivity and specificity of monitoring tests for exudative neovascular AMD in fellow eyes

Diagnostic test	Quoted sensitivity and specificity, % (95% CI)
Self-reported vision changes	“Sensitivity: 4.2 (1.6-9.8); specificity: 97.0 (94.6-98.5)”
Amsler chart	“Sensitivity: 33.7 (25.1-43.5); specificity: 81.4 (76.4-85.5)”
Visual acuity	“Sensitivity: 30.0 (22.5-38.7); specificity: 66.3 (61.0-71.1)”
Biomicroscopic examination	“Sensitivity: 53.8 (44.8-62.5); specificity: 97.6 (95.3-98.9)”
Optical coherence tomography	“Sensitivity: 91.7 (85.2-95.6); specificity: 87.8 (83.8-90.9)”

Optical coherence tomography versus fluorescein angiography: systematic review

“Twenty-two studies (2 abstracts and 20 articles) enrolling 2124 participants were identified” (opens the source at this quote in a new tab)
“In a meta-analysis of TD-OCT studies, sensitivity and specificity (95% CI) were 88% (46-98%) and 78% (64-88%), respectively.” (opens the source at this quote in a new tab)
“Diagnosis of nAMD should not rely solely on OCT.” (opens the source at this quote in a new tab)

Optical coherence tomography angiography versus fluorescein angiography: meta-analyses

“The total population included in the meta-analysis comprised 553 eyes, with a cumulative sensitivity and specificity of 85.9% (95% CI 81.9-89.3%) and 89% (95% CI 83.5-93.2%), respectively” (opens the source at this quote in a new tab)
“The evidence obtained does not demonstrate the superiority of OCTA over FA.” (opens the source at this quote in a new tab)

“We found a pooled sensitivity of 0.90 (95% confidence intervals (CIs): 0.82-0.95) and a pooled specificity of 0.97 (95% CI: 0.89-0.99).” (opens the source at this quote in a new tab)

Detection of new-onset MNV in high-risk fellow eyes: AMD DOC study

“The sensitivity of each modality for detecting CNV was: OCT 0.40 (95% confidence interval [CI], 0.16-0.68), supervised Amsler grid 0.42 (95% CI, 0.15-0.72), and PHP 0.50 (95% CI, 0.23-0.77).” (opens the source at this quote in a new tab)
“Among fellow eyes of individuals with unilateral CNV, FA remains the best method to detect new-onset CNV.” (opens the source at this quote in a new tab)

Home monitoring for earlier detection: HOME study

“Seven hundred sixty-three participants were randomized to device monitoring and 757 participants were randomized to standard care and were followed up for a mean of 1.4 years between July 2010 and April 2013.” (opens the source at this quote in a new tab)
“The primary analysis achieved statistical significance, with the participants in the device arm demonstrating a smaller decline in visual acuity with fewer letters lost from baseline to CNV detection (median, -4 letters; interquartile range [IQR], -11.0 to -1.0 letters) compared with standard care (median, -9 letters; IQR, -14.0 to -4.0 letters; P = 0.021), resulting in better visual acuity at CNV detection in the device arm.” (opens the source at this quote in a new tab)

AAO Preferred Practice Pattern: self-monitoring and prompt evaluation of new symptoms

“Patients with a high-risk AMD phenotype are at increased risk of progression to advanced AMD and should be educated about methods of detecting new symptoms of MNV, including self-monitoring.” (opens the source at this quote in a new tab)
“Electronic monitoring devices are now available to aid in the detection of neovascularization at an early stage.” (opens the source at this quote in a new tab)

Polypoidal choroidal vasculopathy: OCT-based diagnostic criteria without indocyanine green angiography

“For the diagnosis of PCV, the combination of 3 OCT-based major criteria (sub-retinal pigment epithelium [RPE] ring-like lesion, en face OCT complex RPE elevation, and sharp-peaked PED) achieved an area under the receiver operating characteristic curve of 0.90. Validation of this new scheme in a separate subset 80 eyes achieved an accuracy of 82%.” (opens the source at this quote in a new tab)

Diagnosis in US practice: ICD-10 coding of active choroidal neovascularization

“The nAMD diagnosis was based on the International Classification of Diseases, Tenth Revision, codes of H35.3211, H35.3221, H35.3231, and H35.3291.” (opens the source at this quote in a new tab)