HOME OPTICAL COHERENCE TOMOGRAPHY-GUIDED MANAGEMENT OF TYPE 3 MACULAR NEOVASCULARIZATION

To explore the impact of home optical coherence tomography (OCT)-guided treatment personalization for type 3 macular neovascularization in age-related macular degeneration.

A prospective home OCT trial of a patient with a 1-month history of type 3 macular neovascularization under antiangiogenic treatment (2 "loading" injections). During the 23.4-week study period, the patient's treatment regimen was managed through regular self-imaging, enabling continuous monitoring of retinal fluid dynamics.

During the observation period, the patient performed 143 home OCT measurements (mean 6.1 per week, SD 1), which prompted 3 in-office visits where 3 antiangiogenic injections were delivered at the discretion of the investigator. The mean individualized treatment intervals established through home OCT were 8 weeks, with the patient maintaining stable visual acuity at 20/20 Snellen. Complete resolution of intraretinal fluid was noted between injections. Notably, home OCT revealed unexpected fluctuations in retinal fluid measured as hyporeflective spaces in the absence of treatment. Two out of 3 injections were administered after the retinal fluid volume had decreased by more than half within 2 and 8 days after an initial transient spike.

The neovascular subtype as defined by the Consensus Nomenclature for Reporting Neovascular AMD Data may serve as a useful management framework when approaching home OCT-guided treatment decisions. In type 3 disease, home OCT-guided management demonstrates significant potential for optimizing treatment. Further research is warranted to elucidate the dynamics of retinal fluid variations in different macular neovascularization subtypes.