Indocyanine green angiography can be used to diagnose polypoidal choroidal vasculopathy (PCV), a common cause of vision loss in Asian and African patients. However, it’s expensive, invasive and not always available. Therefore, it is important to know of certain features that can be detected using fundus photography, optical coherence tomography (OCT) and fluorescein angiography (FA) so that eye care providers can diagnose PCV without relying on indocyanine green angiography.

Researchers recently found fundus and OCT features such as notched or hemorrhagic pigment epithelial detachment provide high sensitivity and specificity for a diagnosis of PCV, especially when at least two of four highly suggestive signs are present.

De-identified fundus, OCT and FA images were graded by three retina specialists for potential diagnostic features of PCV. These grades were then compared with the grades of two other retina specialists who had access to all imaging modalities. Specialists graded images of 124 eyes of 120 patients presenting between January  2013 and December 2016 with newly identified serous or serosanguinous maculopathy who had undergone multiple imaging studies before treatment at a large referral eye center in Thailand.

The team found that the diagnosis was PCV for 65 eyes (52.4%), central serous chorioretinopathy for 45 eyes (36.3%) and neovascular age-related macular degeneration for 12 eyes (9.7%). They note that potential diagnostic features for PCV were notched or hemorrhagic pigment epithelial detachment with the use of fundus photography and pigment epithelial detachment notch, sharply peaked pigment epithelial detachment and a hyperreflective ring imaged with OCT. When at least two of these four signs were present, sensitivity was 0.95, specificity was 0.95, the positive predictive value was 0.92 and the negative predictive value was 0.95.

Chaikitmongkol V, Kong J, Khunsongkiet P, et al. Sensitivity and specificity of potential diagnostic features detected using fundus photography, optical coherence tomography and fluorescein angiography for polypoidal choroidal vasculopathy. JAMA Ophthalmol. April 11, 2019. [Epub ahead of print].