To develop consensus terminology in the setting of polypoidal choroidal vasculopathy (PCV) and to develop and validate a set of diagnostic criteria not requiring indocyanine green angiography (ICGA) for differentiating PCV from typical neovascular age-related macular degeneration (nAMD) based on a combination of OCT and color fundus photography findings. Evaluation of diagnostic test results. Panel of retina specialists. As part of the Asia-Pacific Ocular Imaging Society, an international group of experts surveyed and discussed the published literature regarding the current nomenclature and lesion components for PCV, and proposed an updated consensus nomenclature that reflects our latest understanding based on imaging and histologic reports. The workgroup evaluated a set of diagnostic features based on OCT images and color fundus photographs for PCV that may distinguish it from typical nAMD and assessed the performance of individual and combinations of these non-ICGA features, aiming to propose a new set of diagnostic criteria that does not require the use of ICGA. The final recommendation was validated in 80 eyes from 2 additional cohorts. Consensus nomenclature system for PCV lesion components and non-ICGA-based criteria to differentiate PCV from typical nAMD. The workgroup recommended the terms polypoidal lesion and branching neovascular network for the 2 key lesion components in PCV. For the diagnosis of PCV, the combination of 3 OCT-based major criteria (sub-retinal pigment epithelium [RPE] ring-like lesion, en face OCT complex RPE elevation, and sharp-peaked PED) achieved an area under the receiver operating characteristic curve of 0.90. Validation of this new scheme in a separate subset 80 eyes achieved an accuracy of 82%. We propose updated terminology for PCV lesion components that better reflects the nature of these lesions and is based on international consensus. A set of practical diagnostic criteria applied easily to spectral-domain OCT results can be used for diagnosing PCV with high accuracy in clinical settings in which ICGA is not performed routinely.

To determine the inter-reader agreement for incomplete and complete retinal pigment epithelium and outer retinal atrophy (iRORA and cRORA respectively) and their related features in age-related macular degeneration (AMD). Inter-reader agreement study. Twelve readers from six reading centers. Following formal training, readers qualitatively assessed 60 optical coherence tomography (OCT) B-scans from 60 eyes with AMD for nine individual features associated with early atrophy and performed seven different annotations to quantify the spatial extent of OCT features within regions-of-interests. The qualitative and quantitative features were used to derive the presence of iRORA and cRORA, and also in an exploratory analysis to examine if agreement could be improved using different combinations of features to define OCT atrophy. Inter-reader agreement based on Gwet's first-order agreement coefficient (AC1) for qualitatively graded OCT features and classification of iRORA and cRORA, and smallest real difference (SRD) for quantitatively graded OCT features. Substantial or better inter-reader agreement was observed for all qualitatively graded OCT features associated with atrophy (AC1=0.63-0.87), except for retinal pigment epithelium attenuation (AC1=0.46) and disruption (AC1=0.26). The lowest SRD for the quantitatively graded horizontal features was observed for the zone of choroidal hypertransmission (±190.8μm). There was moderate agreement for a three-category classification of no atrophy, iRORA and cRORA (AC1=0.53). Exploratory analyses suggested a significantly higher level of agreement for a three-category classification using (i) no atrophy, (ii) presence of inner nuclear layer and outer plexiform layer subsidence, or a hyporeflective wedge-shaped band as a less severe atrophic grade and (iii) the latter plus an additional requirement of choroidal hypertransmission ≥250μm for a more severe atrophic grade (AC1=0.68; P=0.013). Assessment of iRORA and cRORA, and most of their associated features, can be performed relatively consistently and robustly. A refined combination of features to define early atrophy could further improve inter-reader agreement.

Background/aims To describe the morphological features of choroidal neovascularisation (CNV) and to report the ability of optical coherence tomography angiography (OCT-A) to detect the presence of myopic CNV by means of this new technique. Methods Myopic CNV cases were individuated from a pool of patients with pathological myopia consecutively presenting between October 2015 and March 2016. OCT-A images were assessed for classification of morphological features, and to estimate sensitivity and specificity. Results Thirty-six eyes of 28 consecutive patients with myopic CNV were included. In 4 out of 36 eyes it was not possible to classify the CNV ‘shape’, ‘core’, ‘margin’ and ‘appearance’ because the vascular network was not clearly visualised due to the poor quality of the examination. CNV shape on OCT-A was rated as circular in 9 eyes and irregular in 23 eyes. CNV core was visible in 11 eyes. CNV margin was considered as well defined in 16 eyes and poorly defined in 16 eyes. CNV appearance showed an ‘interlacing’ aspect in 16 eyes and a ‘tangled’ aspect in the other 16 eyes. A total of 11 CNVs were defined as active, 9 of which (81.8%) were interlacing, while a total of 21 were inactive, 14 of which (66.7%) were tangled. OCT-A sensitivity turned out to be 90.48% and specificity was 93.75%. Conclusions We describe the OCT-A features of myopic CNV secondary to pathological myopia and demonstrate its high sensitivity and specificity for neovascular detection. Qualitative evaluation of OCT-A characteristics may allow one to recognise different patterns, possibly corresponding to different degrees of neovascular activity.