Retinal angiomatous proliferation or retinal anastomosis to the lesion

Much debate exists within the literature with respect to the variant of neovascular age-related macular degeneration (AMD) known as retinal angiomatous proliferation (RAP). We prefer the term retinal anastomosis to the lesion (RAL), as we believe that the choroidal neovascularization (CNV) lesion precedes the development of an anastomosing retinal vessel to this lesion. Natural history data surrounding RAP lesions are available through analysis of the eyes with subfoveal occult CNV within the placebo arm of the Verteporfin in Photodynamic Therapy (VIP) trial. Although many reports ascribe a poor prognosis to RAP lesions, the data suggest that the true natural history of RAP lesion may be highly variable and similar to that of other CNV lesions. Information from clinical trials suggests that the response of RAP lesions to CNV treatments may also be similar to that of other variants of neovascular AMD.