OCT: Optical coherence tomography for the diagnosis, monitoring, and guiding of treatment for neovascular age-related macular degeneration: a systematic review and economic evaluation


This NIHR HTA-funded project sought to determine the optimal role of Optical coherence tomography (OCT) in: (i) the diagnosis of people newly presenting with suspected neovascular age-related macular degeneration (nAMD) and (ii) in monitoring those previously diagnosed with the disease. Both the more recently introduced spectral domain OCT (SD-OCT) and the time domain OCT (TD-OCT) were assessed against a reference standard of fundus fluorescein angiography (FFA). Based on a small body of evidence of variable quality, OCT had high sensitivity and moderate specificity for diagnosis, and relatively high sensitivity but low specificity for monitoring.  For the diagnosis of newly suspected nAMD cases, the pooled sensitivity and specificity estimates for TD-OCT were 88% (95% CI; 46% to 98%) and 78% (95% CI; 64% to 85%) respectively. For the monitoring of those previously diagnosed with nAMD, the pooled sensitivity and specificity estimates for TD-OCT and SD-OCT combined were 85% (95% CI; 72% to 93%) and 48% (95% CI; 30% to 67%) respectively.  The findings suggest that although OCT is a reasonable sensitive test, using it as the only test for monitoring patients with nAMD would, potentially, result in a substantial proportion of patients with inactive disease receiving treatment unnecessarily, due to its low specificity. In the economic modelling, strategies using OCT test results alone to make diagnosis and/or monitoring treatment decisions were unlikely to be a cost-effective use of resources. The most cost-effective strategy was FFA alone, interpreted by an ophthalmologist, for diagnosis combined with a nurse or technician-led stepwise approach for monitoring. For further information see: www.nets.nihr.ac.uk/projects/hta/105722


Miriam Brazzelli; m.brazzelli@abdn.ac.uk




In preparation