Exudative AMD subtypes and eligibility for treatment with ranibizumab

To ascertain the proportion of patients with neovascular age-related macular degeneration (AMD) eligible for intravitreal treatment with monoclonal antibodies to vascular endothelial growth factor, on the basis of inclusion criteria used in pivotal clinical trials.

We scrutinised an imaging database and extracted all fluorescein angiograms (FAs) captured between 1 January and 31 December 2001. Of the 1083 FA, we found 184 where features of AMD in one or both eyes that were observed. In 130 eyes with neovascular AMD, we measured the area of choroidal neovascularisation (CNV) and retinal angiomatous proliferation (RAP). If contiguous to the area of neovascularisation, any areas of blood, exudate, blocked fluorescence, fibrosis, and atrophy were also measured. Descriptive statistics on lesion location, size, and composition were generated and chi2-tests were used to test for associations.

Of 130 eyes with neovascular AMD, a subfoveal CNV was present in over 75%. Overall, 24.6% were wholly or predominantly classic, and the remainder minimally classic or occult. Of this latter group, RAPs constituted nearly a third and were significantly associated with co-existent pigment epithelial detachment (PED). Using MARINA and ANCHOR study criteria, less than 50% would have been eligible for clinical trials for antiangiogenic therapy.

The majority of CNV were ineligible for treatment with antiangiogenic therapies when assessed solely on angiographic features. RAPs accounted for some one-third of lesions classified as minimally classic or occult at presentation, and the majority of these would have been ineligible for inclusion in the pivotal randomized control trials.