Nonexudative Macular Neovascularization in Age-Related Macular Degeneration

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Diseases

Background:

• Nonexudative macular neovascularization (neMNV) is a risk factor for exudation in fellow eyes of patients with unilateral exudative age-related macular degeneration (AMD).
• Accurate estimation of neMNV prevalence is crucial for clinical trial sample size calculations.
• The double-layer sign (DLS) on optical coherence tomography (OCT) is often considered a surrogate for neMNV.

Purpose of the Study:

• To assess the prevalence of neMNV on OCT angiography (OCT-A) in fellow eyes with DLS on OCT among patients with unilateral new-exudative AMD.
• To determine if DLS on OCT is a reliable surrogate for neMNV in this patient population.

Main Methods:

• Prospective observational cohort multicenter study in the UK (January 2021-June 2025).
• Included 550 eyes with OCT and OCT-A within 30 days of anti-VEGF therapy initiation in the fellow eye.
• Prevalence of DLS and neMNV assessed using logistic regression models.

Main Results:

• Among 550 eyes, 20.4% had DLS and 8.5% had neMNV at baseline.
• Neovascularization was present in 40% of eyes with DLS (47/112).
• Prevalence of neMNV was significantly higher in eyes with thick DLS (48%) compared to thin DLS (16.2%).

Conclusions:

• DLS on OCT in fellow eyes of patients with new-onset exudative AMD is not a good surrogate for neMNV.
• A significant proportion of eyes with DLS do not exhibit neMNV, highlighting the need for OCT-A for accurate diagnosis.
• Findings impact the design of clinical trials and patient management strategies for AMD.