SD-OCT AND OCTA: Distinct or Additional Information on Neovascular Activity? The COCTAEYL Study

This study aimed to compare exudative recurrence features detected by optical coherence tomography angiography (OCTA) with those identified by spectral domain optical coherence tomography (SD-OCT), considered the gold standard, and to characterize OCTA-derived profiles predictive of recurrence in patients with macular neovascularization (MNV) secondary to neovascular age-related macular degeneration (nAMD) treated with aflibercept.

In this prospective observational cohort study, 49 patients were enrolled, yielding data from 686 examinations for concordance analysis between SD-OCT and OCTA. After a loading phase of three-monthly intravitreal injections of 2 mg aflibercept, patients were monitored monthly. Both SD-OCT and OCTA were performed at each visit, with intravitreal injections administered bimonthly (fixed regimen) for up to 12 months.

OCTA demonstrated a sensitivity of 72%, specificity of 27%, positive predictive value (PPV) of 59%, and negative predictive value (NPV) of 40% for detecting exudative activity. The area under the ROC curve (AUC) for OCTA-defined recurrence was 0.49, with an odds ratio (OR) of 0.95 for predicting neovascular activity in the next month ( P = 0.87). The net benefit (NB) was 0.13 for OCTA versus 0.19 for a general approach strategy. Relying on OCTA for recurrence detection instead of SD-OCT did not reduce unnecessary intravitreal injections.

OCTA and SD-OCT provide complementary information, with OCTA focusing on flow remodeling and SD-OCT highlighting exudative features. OCTA provides complementary vascular flow information to the structural data acquired with SD-OCT, allowing a more comprehensive assessment of neovascular activity, although no modification in management was observed in this cohort.