Subthreshold Exudative Choroidal Neovascularization Associated With Age-Related Macular Degeneration Identified by...

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Diseases

Background:

• Age-related macular degeneration (AMD) is a leading cause of vision loss.
• Exudative choroidal neovascularization (CNV) is a common complication of AMD, often leading to significant vision impairment.
• Subthreshold exudative CNV presents a diagnostic challenge with traditional imaging modalities.

Purpose of the Study:

• To describe the clinical and multimodal imaging characteristics of subthreshold exudative choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD).
• To evaluate the utility of various imaging techniques, including OCT angiography (OCTA), in identifying subtle CNV.
• To assess the natural history and optimal management strategies for this specific subtype of AMD-associated CNV.

Main Methods:

• Retrospective analysis of 3773 patients with AMD.
• Identification of 8 eyes (6 patients) with the specific clinical phenotype.
• Utilized dilated fundus examinations, color fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and OCT angiography (OCTA).

Main Results:

• OCT revealed irregular pigment epithelial detachment with subretinal fluid (SRF).
• Traditional FA and ICGA failed to detect definitive leakage or neovascular networks.
• OCTA successfully visualized CNV within the pigment epithelial detachment in all cases.
• Seven out of eight eyes showed stable visual acuity over 1-10 years without anti-VEGF treatment.

Conclusions:

• OCTA is superior to FA and ICGA for detecting subthreshold CNV in AMD.
• A subset of AMD patients with SRF and confirmed CNV on OCTA may represent an indolent form and can be managed by observation.
• This finding challenges the routine use of anti-VEGF injections in all cases with fluid and CNV, suggesting a potential for watchful waiting.