Related Experiment Video
Updated: Sep 19, 2026
Characterization of Vascular Morphology of Neovascular Age-Related Macular Degeneration by Indocyanine Green Angiography
Published on: August 11, 2023
Macular neovascularisation subtype determines visual consequences of early fibro-atrophic remodelling in neovascular
Livia Faes1,2,3, Syed Kubravi4, Kimberly Spooner1,5,6
1NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK.
Purpose:
To evaluate whether baseline well-delineated hyperreflective material (wdHRM) is associated with short-term visual outcome in treatment-naïve neovascular age-related macular degeneration (nAMD), whether this association differs by macular neovascularisation (MNV) subtype, and how wdHRM relates to atrophy-related OCT biomarkers.
Methods:
Multicentre observational analysis of 2036 treatment-naïve eyes (PRECISE cohort) completing three monthly aflibercept 2 mg injections. Best-corrected visual acuity (BCVA) at Visit 4 (V4) was modelled against baseline wdHRM using adjusted multivariable linear regression. Secondary analyses assessed subtype interaction and eye-level association with atrophy-related OCT biomarkers.
Results:
Mean BCVA improved from 58.0 to 62.6 letters by V4. Baseline wdHRM was present in 14.6% of eyes, and foveal-involving wdHRM independently predicted lower V4 BCVA (β =-6.60 letters, 95%confidence interval [CI]-8.18 to -5.02; p < 0.001). Foveal-involving baseline choroidal hypertransmission (HTM) showed a stronger adverse association (β =-8.98, 95%CI-10.97 to -6.98; p < 0.001). The wdHRM association differed by subtype (interaction p = 0.016), with adjusted BCVA reductions of -10.6 letters in Type 3 MNV, -4.8 in Type 2/mixed MNV, -4.1 in Type 1 MNV, and -1.0 in polypoidal choroidal vasculopathy. By V4, wdHRM increased to 21.0% and was associated with HTM and greater outer retinal disruption.
Conclusions:
In treatment-naïve nAMD, baseline wdHRM is independently associated with poorer short-term visual outcome, particularly in Type 3 MNV. Short-term visual outcome should be interpreted in relation to both fibrosis-related and atrophy-related OCT biomarkers.
