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Relative yield of retinal imaging versus clinical exam in following neovascular exudative age related macular degeneration

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Abstract

Purpose

To compare therapeutic decisions between 3 diagnostic protocols and to assess the need for in-person physical doctor–patient encounter in follow up and treatment of neovascular exudative age-related macular degeneration (AMD).

Methods

Analysis of 88 eyes of 88 unique patients with neovascular AMD who were routinely followed at our medical retina clinic. A retinal specialist reviewed all images in advance and wrote his decisions. He later attended an in-person encounters with all patients and documented his decisions. Masking was done by not exposing any identifying information to the specialist and by randomizing patient’s images order before the in-person encounter. Therapeutic decisions regarding intravitreal injections intervals and agent selection were made based on three protocols: (1) optic coherence tomography (OCT); (2) OCT/Ultra-widefield (UWF) color image; (3) OCT/UWF/full clinical exam. Visual acuity (VA) was incorporated into all protocols.

Results

We found an agreement of 93% between those protocols regarding the intervals of injections, and of 100% regarding injection agent selection. When comparing OCT, OCT/UWF and OCT/UWF/clinical exam guided decision making, there were no discrepancies between OCT and OCT/UWF. There were 6 out of 88 discrepancies (7%) between OCT/UWF and OCT/UWF/clinical exam. Of those 6 discrepancies, all were regarding intervals (Bland–Altman bias = − 0.2386). All discrepancies between OCT/UWF and OCT/UWF/Clinical exam were due to patients’ preferences, socioeconomic issues and fellow eye considerations, addressed during the face-to-face encounter with patients. Physical examination itself did not affect decision making.

Conclusions

Neovascular exudative AMD follow up and treatment decisions can be guided by VA and OCT, with UWF adding important information regarding macula and peripheral retina, but rarely affecting decision making. However, decision making may also be driven by patients’ preferences and other considerations that are being made only during the face-to-face visit and discussion. Thus, every approach supporting imaging only decision making, must take these factors into account.

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Data availability

Data is available and can be accessed via authors’ PC. Patient’s anonymity is protected.

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Acknowledgements

This research was conducted as part of the requirements for MD degree in the School of Medicine, Hebrew University of Jerusalem.

Funding

None.

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Author notes

  1. Shilo Voichanski and Netanel Weinshtein have contributed equally to this work.

Authors and Affiliations

  1. Shaare Zedek Medical Center, Jerusalem, Israel

    Shilo Voichanski & Joel Hanhart

  2. School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Netanel Weinshtein

Authors
  1. Shilo Voichanski
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  2. Netanel Weinshtein
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  3. Joel Hanhart
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Contributions

Shilo Voichanski and Netanel Weinshtein analyzed and interpreted the patient data and wrote the manuscript. Yoel Hanhart contributed to writing the manuscript and reviewing tables and figures. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shilo Voichanski.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study protocol was reviewed and approved Helsinki IRB committee, Shaare Zedek Medical Center, Approval Number 0117–21-SZMC.

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Written informed consent from participants was not required in accordance with local guidelines.

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Voichanski, S., Weinshtein, N. & Hanhart, J. Relative yield of retinal imaging versus clinical exam in following neovascular exudative age related macular degeneration. Int Ophthalmol 44, 126 (2024). https://doi.org/10.1007/s10792-024-03072-2

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