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Fluorescein angiography, OCT measurements correlate with visual acuity in eyes with DME
Retina. 2010;30(10):1627-1637.
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Fluorescein angiography, optical coherence tomography and color fundus photography showed similar associations with visual acuity in eyes treated for diabetic macular edema, a study found.
The randomized multicenter clinical trial was the first to investigate associations between fluorescein angiography, fundus photography and OCT features in diabetic macular edema (DME), the study authors said.
The trial included 323 study eyes and 203 control eyes examined at 79 clinical centers. Investigators compared film and digital fluorescein angiographic images, color photographs, OCT images and visual acuity measurements at baseline and at 1 year.
Study results showed high inter-grader agreement in the identification of the presence or absence of fluorescein angiography leakage, capillary loss and cystoid abnormalities in digital and film images.
OCT showed the strongest baseline association with total macular volume, DME area and DME severity. Data showed no appreciable associations between baseline fluorescein leakage area and change in these variables from baseline.
Fluorescein angiography leakage was associated with reduced visual acuity, increased OCT measures of retinal thickness and volume, and color photographic measurements of retinal thickening, the authors reported.
"We did not identify any unique [fluorescein angiography] variables that had a stronger association with visual acuity than OCT measures of retinal thickness," the authors said.
Clinical trials routinely employ reading centers in an effort to quantify the results of ancillary testing and apply these results to the management of the disease under study. Clinical practice rarely, if ever, uses reading center interpretations of studies like optical coherence tomography (OCT) and fluorescein angiography (FA). Therefore direct clinical utility of the results of studies based on reading center data may not be applicable to clinical practice. Nevertheless, this study suggests that OCT is superior to FA in predicting visual acuity in patients with diabetic macular edema (DME) because of its ability to quantify macular thickening. The study also questions the widespread use of FA for future trials of DME.
– Jay S. Duker, MD
OSN Retina/Vitreous
Board Member
Disclosure: Dr. Duker receives research funding from Carl
Zeiss Meditec, Topcon and Optovue.