Prevalence and progression of non-exudative macular neovascularization in age-related macular degeneration

To determine the prevalence of non-exudative macular neovascularization (neMNV) in age-related macular degeneration (AMD) and to identify potential markers for activation and disease progression using findings from optical coherence tomography angiography (OCTA).

This retrospective longitudinal study included patients with treatment-naïve neMNV secondary to AMD who presented to a tertiary retina clinic between January 2021 and July 2024. Patients were evaluated using OCT and OCTA at each visit, with a definitive diagnosis of neMNV established using OCTA. Exclusion criteria included prior anti-VEGF therapy, pachychoroid spectrum diseases, vitreoretinal surgery, chorioretinal conditions, and unreliable OCTA images. Parameters assessed included best-corrected visual acuity (BCVA), and lens status.

neMNV was identified in 186 out of 3119 patients (5.96%). The mean age was 72.73±8.60 years, with a mean follow-up of 22.11±7.51 months. Transition from the non-exudative to the exudative form occurred in 34 (18.3%) patients, with an average activation duration of 14.71±8.42 months. BCVA improved significantly in neMNV eyes over time (P<0.01) but remained stable in fellow eyes. No significant correlations were found between activation time and age, gender, or laterality. The prevalence of exudative MNV in fellow eyes was 67%.

neMNV is relatively common among AMD patients, with a prevalence of 5.96%. Regular monitoring using OCTA is essential for early detection and management, given the significant potential for these lesions to progress to an exudative state. Future research should focus on identifying specific biomarkers and imaging characteristics predictive of neMNV activation.