Recommendations for OCT Angiography Reporting in Retinal Vascular Disease: A Delphi Approach by International Experts

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Vascular Diseases

Background:

• Optical Coherence Tomography Angiography (OCTA) is crucial for diagnosing retinal vascular diseases.
• Standardized nomenclature for OCTA findings is lacking, hindering consistent interpretation and reporting.
• Retinal vascular diseases like diabetic retinopathy and retinal vein occlusion require precise diagnostic criteria.

Purpose of the Study:

• To establish a consensus nomenclature for reporting OCT Angiography (OCTA) findings in retinal vascular diseases.
• To standardize the definition of wide-field (WF) OCTA parameters and flow measurements.
• To develop guidelines for OCTA in the management and staging of retinal vascular diseases.

Main Methods:

• A Delphi-based survey involving 25 international experts in retinal vascular disease and OCTA imaging.
• Two rounds of online questionnaires followed by a virtual face-to-face meeting.
• Consensus was defined by agreement levels: strong consensus (≥85%), consensus (80-84%), and near consensus (70-79%).

Main Results:

• Consensus reached on a ≥30% change in absolute imaged area of flow signal defining meaningful change on WF-OCTA.
• Agreed on defining a "large area" of reduced flow signal on WF-OCTA as ≥30% of the absolute imaged area.
• Recommendations for incorporating new vessels, intraretinal microvascular abnormalities, foveal avascular zone parameters, and no-flow areas for diabetic retinopathy staging were established.

Conclusions:

• This study provides international consensus recommendations for reporting OCTA findings in retinal vascular diseases.
• The developed nomenclature aims to enhance the interpretability and description of OCTA in clinical practice and trials.
• Further validation and ongoing efforts will address unresolved questions in OCTA reporting.