Summary: diagnosis

The AAO Preferred Practice Pattern describes diagnosis based on history (metamorphopsia, decreased vision, scotoma), examination including stereoscopic biomicroscopy of the macula, and imaging. Optical coherence tomography (OCT) is described as important for detecting subretinal and intraretinal fluid and for monitoring response to therapy; fluorescein angiography is indicated to detect and characterize macular neovascularization, and OCT angiography had a pooled sensitivity of 0.87 and specificity of 0.97 for detecting macular neovascularization in a meta-analysis cited by the guideline.

Initial evaluation: history and examination

“The initial evaluation of a patient with signs and symptoms suggestive of AMD includes all features of the comprehensive adult medical eye evaluation,274 with particular attention to those aspects relevant to AMD.” (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)

Optical coherence tomography

“Optical coherence tomography is important in diagnosing and managing AMD, particularly with respect to determining the presence of subretinal and intraretinal fluid and in documenting the degree of retinal thickening.” (opens the source at this quote in a new tab)
“It may reveal the presence of fluid that is not apparent on biomicroscopy alone. It also helps in evaluating the response of the retina and RPE to therapy by allowing structural changes to be followed accurately.” (opens the source at this quote in a new tab)

Optical coherence tomography angiography

“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)

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)
“If MNV is suspected on the basis of new symptoms or ocular findings, fluorescein angiography should be performed and interpreted expeditiously by an individual experienced in managing patients with neovascular AMD.” (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)

Multimodal imaging: role of fluorescein angiography and OCT

“Although ophthalmoscopy might be sufficient for a basic diagnosis of AMD, fluorescein angiography is the gold standard for detecting and differentiating MNV. Furthermore, OCT imaging is particularly suitable for monitoring the disease, especially in the context of anti-VEGF therapy.” (opens the source at this quote in a new tab)
“On OCT, exudative activity typically presents with intraretinal and/or subretinal fluid.” (opens the source at this quote in a new tab)

Patient-facing description of diagnostic testing

“Eye doctors can check for AMD as part of a comprehensive dilated eye exam.” (opens the source at this quote in a new tab)
“Your doctor may also recommend doing a test called optical coherence tomography (OCT).” (opens the source at this quote in a new tab)

Duravyu (vorolanib intravitreal insert)

Diagnosis