Optical coherence tomography for the diagnosis of neovascular age-related macular degeneration: a systematic review

Mayret M. Castillo, Graeme Mowatt, Noemi Lois, Andrew Elders, Cynthia Fraser, Winfried Amoaku, Jennifer Burr, Andrew Lotery, Craig Ramsay, Augusto Azuara-Blanco

Research output: Contribution to journalArticle


The purpose is to study the diagnostic performance of optical coherence tomography (OCT) and alternative diagnostic tests for neovascular age-related macular degeneration (nAMD). Methods employed are as follows:- systematic review and meta-analysis; Index test: OCT including time-domain (TD-OCT) and the most recently developed spectral domain (SD-OCT); comparator tests: visual acuity, clinical evaluation (slit lamp), Amsler chart, colour fundus photographs, infra-red reflectance, red-free images/blue reflectance, fundus autofluorescence imaging (FAF), indocyanine green angiography (ICGA), preferential hyperacuity perimetry (PHP), and microperimetry; reference standard: fundus fluorescein angiography. Databases searched included MEDLINE, MEDLINE In Process, EMBASE, Biosis, SCI, the Cochrane Library, DARE, MEDION, and HTA database. Last literature searches: March 2013. Risk of bias assessed using QUADAS-2. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic (HSROC) curves. Twenty-two studies (2 abstracts and 20 articles) enrolling 2124 participants were identified, reporting TD-OCT (12 studies), SD-OCT (1 study), ICGA (8 studies), PHP (3 studies), Amsler grid, colour fundus photography and FAF (1 study each). Most studies were considered to have a high risk of bias in the patient selection (55%, 11/20), and flow and timing (40%, 8/20) domains. In a meta-analysis of TD-OCT studies, sensitivity and specificity (95% CI) were 88% (46–98%) and 78% (64–88%), respectively. There was insufficient information to undertake metaanalysis for other tests. TD-OCT is a sensitive test for detecting nAMD, although specificity was only moderate. Data on SD-OCT are sparse. Diagnosis of nAMD should not rely
solely on OCT.
Original languageEnglish
Pages (from-to)1399-1406
Number of pages7
Publication statusPublished - Sep 2014



  • Optical coherence tomography
  • age-related macular degeneration
  • systematic review
  • vision science research

Cite this

Castillo, M. M., Mowatt, G., Lois, N., Elders, A., Fraser, C., Amoaku, W., Burr, J., Lotery, A., Ramsay, C., & Azuara-Blanco, A. (2014). Optical coherence tomography for the diagnosis of neovascular age-related macular degeneration: a systematic review. Eye, 28, 1399-1406. https://doi.org/10.1038/eye.2014.214