Color Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography in Diagnosing Polypoidal Choroidal Vasculopathy

Purpose To determine sensitivity and specificity of polypoidal choroidal vasculopathy (PCV) diagnosis using color fundus photography (CFP), optical coherence tomography (OCT), and fundus fluorescein angiography (FFA) without indocyanine green angiography (ICGA). Design Validity analysis. Methods Treatment-naive eyes with serous/serosanguinous maculopathy undergoing CFP, OCT, FFA, and ICGA imaging before treatment at a university hospital in Thailand (January 1, 2013 to June 30, 2015) were identified. Images of each subject were categorized into 4 sets (set A: CFP; set B: CFP+OCT; set C: CFP+FFA; set D: CFP+OCT+FFA). Six graders, 3 from Thailand (PCV endemic area) and 3 from the United States (nonendemic area), individually reviewed each set (without ICGA), and determined if the presumed diagnosis was PCV. In parallel, 2 other graders confirmed if each case had PCV or not using EVEREST criteria (including ICGA). Sensitivity and specificity of a PCV diagnosis with each set (without ICGA) were analyzed compared with diagnoses including ICGA. Results Of 119 study eyes (113 subjects, 57% male, mean age ± SD 59.9 ± 13.8 years), definite PCV diagnosis was 40.3%. Sensitivity of sets A, B, C, D: 0.63 (95% confidence interval [CI]: 0.47–0.76), 0.83 (95% CI: 0.69–0.92), 0.54 (95% CI: 0.39–0.68), 0.67 (95% CI: 0.51–0.79); specificities: 0.93 (95% CI: 0.84–0.97), 0.83 (95% CI: 0.72–0.91), 0.97 (95% CI: 0.89–0.99), 0.92 (95% CI: 0.82–0.97); accuracies: 0.81 (95% CI: 0.73–0.88), 0.83 (95% CI: 0.76–0.90), 0.79 (95% CI: 0.73–0.87), 0.82 (95% CI: 0.74–0.88). Discrepancies between Thai and US graders existed through sets A, C, and D. Conclusions These data suggest that without ICGA, fundus photography combined with OCT provides high sensitivity and high specificity to diagnose PCV; adding FFA does not improve accuracy.