An international panel of retina experts suggests new diagnostic criteria for polypoidal choroidal vasculopathy (PCV) using a combination of SD-OCT and color fundus photography. Their study, published online in Ophthalmology, reports their approach offers a quick, practical and noninvasive method for differentiating PCV from typical wet AMD, especially in clinical settings and in practices that do not have access to indocyanine green angiography (ICGA).
The panel, which was part of the Asia-Pacific Ocular Imaging Society, recommended revising the terms “polyp” and “branching vascular network” which are based on ICGA appearance, to “polypoidal lesion” and “branching neovascular network,” respectively, as these terms capture advances in the understanding of these two key lesion components of PCV based on multimodal imaging and histological studies.
Using a combination of three OCT-based major criteria (sub-RPE ring-like lesion, en face OCT complex RPE elevation and sharp-peaked PED), the noninvasive diagnostic technique achieved an area under the receiver operating characteristic curve of 0.90. In a validation subset, 110 eyes achieved an accuracy of 82%.
The final recommendation was validated in 80 eyes from two additional cohorts.
Although the study recommends a set of diagnostic criteria that can be used to screen for PCV in eyes with macular neovascularization due to AMD, the researchers note that ICGA remains the best-validated method for confirmation of PCV and will likely remain the standard.
“Nonetheless our validation exercise based on a moderately sized sample shows that the criteria selected by the international expert committee has the potential to be equivalent to ICGA in diagnostic accuracy,” the researchers wrote in their paper.
The 82% accuracy result, which was applied by both residents and specialists, offers support that clinicians can forego ICGA under most conditions, the investigators added.
Gemmy Cheung CM, Lai TYY, Teo K, et al. Polypoidal choroidal vasculopathy: consensus nomenclature and non-ICGA diagnostic criteria from the Asia-Pacific Ocular Imaging Society (APOIS) PCV Workgroup. Ophthalmology. August 11, 2020. [Epub ahead of print].