Distinguishing Central Serous Chorioretinopathy From Neovascular Age-Related Macular Degeneration: A Prospective Study

2020 ◽  
Vol 4 (4) ◽  
pp. 293-299
Author(s):  
Parampal S. Grewal ◽  
Steven R.J. Lapere ◽  
Christopher J. Rudnisky ◽  
Rizwan Somani ◽  
Matthew T.S. Tennant
Keyword(s):  
Decision Making ◽  
Macular Degeneration ◽  
Central Serous Chorioretinopathy ◽  
Choroidal Thickness ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Age Related Macular Degeneration ◽  
Subfoveal Choroidal Thickness ◽  
Pigment Epithelial ◽  
Age Related

Purpose: This article identifies clinical features that differentiate central serous chorioretinopathy (CSR) from neovascular age-related macular degeneration (nAMD) and uses this information to develop a diagnostic tool. Methods: A prospective observational study was conducted of patients with a new diagnosis of CSR, nAMD, or indeterminate presentation. All patients underwent clinical assessment, axial length measurement, enhanced-depth imaging–optical coherence tomography, and intravenous fluorescein angiography. A final consensus diagnosis was derived following review of these factors. Results: A total of 56 eyes of 56 patients were enrolled (CSR = 34; nAMD = 22). The subfoveal choroidal thickness was greater in the CSR group (421 ± 106 µm) than the nAMD group (219 ± 91 µm, P < .001). The following odds ratio of CSR reached statistical significance: age 70 and younger (72.00, 95% CI: 11.99-432.50), subfoveal choroidal thickness greater than or equal to 300 µm (33.92, 95% CI: 4.06-283.18), dome-shaped neurosensory detachment (13.24, 95% CI: 3.22-54.45), retinal pigment epithelial changes (0.31, 95% CI: 0.10-0.97), subretinal hyperreflective material (0.11, 95% CI: 0.03-0.42), and fibrovascular pigment epithelial detachment (0.05, 95% CI: 0.01-0.47). A stepwise CSR vs nAMD clinical decision-making algorithm is proposed. Conclusions: Choroidal thickness is increased in CSR when compared with nAMD. The presented odds ratios and the CSR vs nAMD clinical decision-making tool can be applied to distinguish CSR from nAMD.

scholarly journals Evaluation of a clinical decision-making aid for nutrition advice in age-related macular degeneration

2017 ◽  
Vol 35 (3) ◽  
pp. 185-196 ◽  
Author(s):  
Rebekah Stevens ◽  
Hannah Bartlett ◽  
Richard Cooke
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Central Area ◽  
Clinical Decision ◽  
Age Related Macular Degeneration ◽  
Preliminary Evaluation ◽  
Eye Care ◽  
Eligibility Criteria ◽  
Age Related ◽  
Clinical Scenarios

Age-related macular disease (AMD) is a multifactorial degenerative condition affecting the central area of the retina. Patients with AMD report that eye care practitioners are not giving consistent advice regarding nutrition and reported confusion as to what advice, if any, to follow. The aim of this study was to design and conduct a preliminary evaluation of a flowchart to support eye care practitioners in providing accurate, evidence-based nutritional advice to their patients. A flowchart was designed to take practitioners through a decision-making process that would determine whether a patient matched the Age-Related Eye Disease Study (AREDS) 2 eligibility criteria for supplementation. The flowchart was evaluated using a qualified and student optometrist cohort, with both cohorts completing confidence scales and students completing clinical scenarios. Qualified participants showed a significant increase in confidence scores from the initial survey ( M = 69.7%, standard deviation [ SD] = 16.2%) to the second survey after use of the flowchart for 2 weeks ( M = 82.1%, SD = 11.6%; t(45) = 7.33, p < .001; rs = .61, p < .001). The student participants also increased confidence scored after receiving the flowchart ( M of first survey = 41.7, SD = 14.6; M of second survey = 69.1, SD = 1.7; t(25) = 7.92, d = .81, p < .001) and increased the number of correct answers on five clinical scenarios. Overall, the flowchart has proved to be useful in boosting the self-efficacy of both qualified practitioners and student practitioners, as well as improving clinical decisions made by student practitioners.

Subfoveal choroidal thickness as a prognostic factor in exudative age-related macular degeneration

2018 ◽  
Vol 103 (7) ◽  
pp. 918-921 ◽  
Author(s):  
Jaya B Kumar ◽  
Karen M Wai ◽  
Justin P Ehlers ◽  
Rishi P Singh ◽  
Aleksandra V Rachitskaya
Keyword(s):  
Prognostic Factor ◽  
Macular Degeneration ◽  
Choroidal Thickness ◽  
Age Related Macular Degeneration ◽  
Intravitreal Injections ◽  
Imaging Biomarkers ◽  
Exudative Amd ◽  
Subfoveal Choroidal Thickness ◽  
Age Related ◽  
The Mean

AimsTo investigate the relationship between subfoveal choroidal thickness (SFCT), visual acuity (VA), optical coherence tomography (OCT) features and total anti-vascular endothelial growth factor (VEGF) treatments to determine whether SFCT serves as a prognostic factor in age-related macular degeneration (AMD).MethodsThis is a retrospective case series of 62 consecutive treatment-naive patients with exudative AMD followed for 1 year and treated with treat-and-extend or pro re nata anti-VEGF protocols. SFCT was measured at three locations using Cirrus HD-OCT (the foveal centre and 500 um nasal and temporal to the fovea) at presentation, 3, 6 and 12 months. Demographic characteristics, OCT imaging biomarkers and VA were recorded.ResultsMean SFCT at baseline was 187 µm (range: 70–361 µm). There was a trend of decreasing SFCT at 1 year (173 µm) compared with 3 months (175 µm) and baseline (188 µm) (p=0.2). There was no correlation between baseline SFCT and presence of subretinal fluid (p=0.2), intraretinal fluid (p=0.6) or subretinal hyper-reflective material (p=0.4) at baseline. The mean number of injections at 1 year was 6.6 (range: 2–12). Increased SFCT at baseline showed statistically significant correlation with a higher number of intravitreal injections at 1 year (p=0.004). Eyes with SFCT>1 SD above the mean required 50% more injections compared with others. There was no association between SFCT on presentation with baseline and 1 year VA (p=0.7 and p=0.2).ConclusionsSFCT in naïve patients with exudative AMD may be an important prognostic tool in determining treatment burden. Patients with thicker subfoveal choroid may require increased intravitreal injections.

Sign in / Sign up

Export Citation Format

Share Document