Age-related macular degeneration: using morphological predictors to modify current treatment protocols

Area of Science:

• Ophthalmology
• Medical Research
• Regenerative Medicine

Background:

• Neovascular age-related macular degeneration (AMD) is a leading cause of vision loss.
• Anti-vascular endothelial growth factor (anti-VEGF) therapies are standard treatments.
• Predicting treatment response is crucial for optimizing patient outcomes.

Purpose of the Study:

• To identify prognostic indicators for treatment response in neovascular AMD.
• To develop a patient-centric treatment algorithm based on predictive factors.
• To guide personalized anti-VEGF therapy regimens.

Main Methods:

• Systematic literature search of PubMed, EMBASE, and Web of Science.
• Inclusion of prospective and retrospective studies with >1-year follow-up and predefined treatment criteria.
• Analysis of morphological and demographic factors predicting visual outcomes and injection frequency.

Main Results:

• Smaller choroidal neovascularization (CNV) size, subretinal fluid (SRF), and early positive response predict good outcomes.
• Larger CNV, older age, pigment epithelial detachment (PED), intraretinal cysts (IRC), and vitreomacular adhesion (VMA) are associated with poorer gains.
• VMA/VMT necessitates more intensive treatment; PVD with SRF allows less frequent injections.

Conclusions:

• Morphological and demographic factors significantly predict anti-VEGF therapy response in neovascular AMD.
• Tailored treatment algorithms can be developed based on prognostic indicators.
• Personalized regimens, including Treat-and-Extend (TAE), can optimize visual outcomes and manage treatment intensity.