Macular fibrosis in neovascular AMD: inter-reader and intermodality variability across four imaging modalities

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Diseases

Background:

• Macular fibrosis is a key complication of neovascular age-related macular degeneration (AMD).
• Accurate quantification of macular fibrosis is crucial for monitoring disease progression and treatment response.
• Variability in imaging assessment can impact clinical decision-making.

Purpose of the Study:

• To evaluate inter-reader and intermodality variability in quantifying macular fibrosis.
• To compare four imaging modalities: color fundus photography (CFP), near-infrared reflectance (NIR), structural optical coherence tomography (OCT), and MultiColor imaging.
• To determine the most reliable imaging technique for fibrosis assessment in neovascular AMD.

Main Methods:

• A prospective, cross-sectional study included 30 eyes of 30 patients with neovascular AMD and macular fibrosis.
• Imaging was performed using CFP, NIR, structural OCT, and MultiColor modalities.
• Two masked graders assessed macular fibrosis size; inter-reader and intermodality variability were statistically analyzed.

Main Results:

• Structural OCT showed the highest inter-reader agreement (ICC=0.983) and lowest coefficient of variation (CV=0.04).
• Near-infrared reflectance (NIR) exhibited the lowest inter-reader agreement (ICC=0.461) and highest CV (0.26).
• Significant intermodality differences were found, with median fibrosis size ranging from 2.03 mm² (MultiColor) to 4.87 mm² (structural OCT).

Conclusions:

• Structural OCT is the most reliable modality for quantifying macular fibrosis in neovascular AMD.
• Significant variability exists between different imaging modalities.
• Standardized criteria are needed for fibrosis assessment to ensure consistent clinical interpretation and management.