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Which of the following technologies do you prefer (and use primarily) for detecting new-onset choroidal neovascularization?
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K. Bailey Freund
Among the individual aspects that give an overall picture of a patient at risk for CNV — symptoms, visual acuity testing on the day of the visit, clinical examination, OCT — I would say that a good-quality spectral-domain OCT is probably the most sensitive way of picking up early findings, in particular, subretinal fluid. Sometimes OCT detects subretinal fluid before symptoms develop or before any clinical findings would otherwise raise suspicion. It is not uncommon for patients who are coming in for injections in one eye to have a conversion to wet AMD detected by OCT in the fellow eye. Without regular follow-up, the conversion might not be detected until much later, possibly after some degree of irreversible vision loss. These patients who are diagnosed early are the patients who end up doing the absolute best. They are the patients whose vision is still at baseline when OCT shows fluid. In those cases, you have the opportunity to treat the patient before any permanent structural damage develops.
K. Bailey Freund, MD
Disclosure: Freund is on the scientific advisory board for DigiSight and consults for Heidelberg Engineering.
Jonathan Prenner
It is tempting to rely solely on spectral-domain optical coherence tomography, but I try to remind myself that CNV has a long differential diagnosis. Because of that, I typically use fluorescein angiography, autofluorescence imaging, and may use ICG angiography as well during the initial investigation of new-onset CNV.
Jonathan Prenner, MD
Disclosure: Prenner has a financial interest in Ophthotech, Neurotech, Genentech, Regeneron and Panoptica.
Michael Singer
Our practice uses spectral-domain optical coherence tomography to see if there is fluid, because it is a very easy test that is very quick. In terms of clinic flow, many technicians in our practice are able to perform it, and it does not disrupt the flow of patients in a given day. If our doctors see fluid on OCT or blood on the fundus exam, we get an FA to rule out wet AMD. In this way, we are able to screen people much more quickly; FA is more time intensive and requires more specialized technical staff. Using OCT prevents a potential logjam that would happen if we did FA on every patient.
Michael Singer, MD
Disclosure: Singer has no relevant financial disclosures.