PurposeTo assess OCT angiography (OCTA) effectiveness at detecting choroidal neovascularization (CNV) in cases of suspected neovascular age related macular degeneration (nAMD), chronic central serous retinopathy (cCSR) and pathological myopia compared to FFA and how it compares to a multimodal approach (OCT, FFA and ICGA) for detecting the vascular network.MethodsThis was a retrospective observational cohort study of patients who had clinical and/or OCT findings suggestive of CNV, having further investigation with FFA, with or without ICG, and had same day OCTA using the Heidelberg Spectralis OCT2 beta angiography module. Multimodal imaging interpretation was compared to OCTA images. OCTA images were also analysed for inter-rater reliability (using kappa statistic). The diagnostic accuracy of OCTA was compared to FFA (using Cochran's Q, p<0.05). OCTA was also compared to a multimodal approach in defining a vascular network.ResultsOverall sensitivity of OCTA compared to FFA was 71% and specificity of 81% (p=0.108). Subgroup analysis for OCTA vs FFA for detecting classic nAMD/type II CNV sensitivity was 100% and specificity of 76% (p<0.05). OCTA vs FFA for detecting occult nAMD/type-I CNV sensitivity was 47% and specificity of 76%, (p=0.248). OCTA was better than FFA at defining a vascular network overall, when OCT was suspicious (59% vs 49%).ConclusionsOCTA was better at detecting classic nAMD/type II CNV compared to FFA and for defining a vascular network in nAMD compared to FFA and ICGA. It was able to aid in making the diagnosis in cases where evidence of CNV was uncertain following FFA/ICGA.