Detection of Nonexudative Choroidal Neovascularization in Age-Related Macular Degeneration With Optical Coherence Tomography Angiography

In Brief Purpose: To evaluate eyes with age-related macular degeneration and high-risk characteristics for choroidal neovascularization (CNV) with optical coherence tomographic (OCT) angiography to determine whether earlier detection of CNV is possible. Methods: Eyes with drusen, pigmentary changes, and with CNV in the fellow eye were scanned with a 70-kHz spectral domain OCT system (Optovue RTVue-XR Avanti). The split-spectrum amplitude-decorrelation angiography (SSADA) algorithm was used to distinguish blood flow from static tissue. Two masked graders reviewed scans for CNV, defined as flow in the outer retinal/sub-RPE slab. Choroidal neovascularization flow area repeatability and between-grader reproducibility were calculated. Results: Of 32 eyes, 2 (6%) were found to have Type 1 CNV with OCT angiography. The lesions were not associated with leakage on fluorescein angiography or fluid on OCT. One case was followed for 8 months without treatment, and the CNV flow area enlarged slightly without fluid buildup on OCT or vision loss. Between-grader reproducibility of the CNV flow area was 9.4% (coefficient of variation) and within-visit repeatability was 5.2% (pooled coefficient of variation). Conclusion: Optical coherence tomographic angiography can detect the presence of nonexudative CNV, lesions difficult to identify with fluorescein angiography and OCT. Further study is needed to understand the significance and natural history of these lesions. Thirty-two eyes with nonneovascular age-related macular degeneration with high-risk characteristics were screened with optical coherence tomography angiography. Optical coherence tomography angiography detected 2 cases of Type 1 choroidal neovascularization. In both cases, fluorescein angiography revealed no leakage, and no fluid was present on optical coherence tomography. Optical coherence tomography angiography has the potential to detect choroidal neovascularization without exudation.