Abstract
Age-related macular degeneration (AMD) is one of the most common causes of severe visual loss in middle and old-age population, and often leads to serious deterioration in quality of life. Currently, the first-line treatment for neovascular AMD (nAMD) are intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications, including bevacizumab, ranibizumab, and aflibercept and also latest commercially available drug, brolucizumab. During initial examination and imaging and treatment follow-up for patients with nAMD, optical coherence tomography (OCT) is used to predict and assess the therapeutic response and guide the treatment. Several OCT-based biomarkers, including the central subfoveal thickness (CSFT), the presence of intraretinal cysts (IRCs) or subretinal fluid (SRF), and the presence of pigment epithelial detachment (PED), were found to influence baseline visual acuity or visual improvements. Recent analyses of large randomized control trials (RCTs) summarized the usefulness of these OCT-based biomarkers. However, many of these early studies relied on time-domain OCT to evaluate the retinal structures thus providing less precise evaluation of the retinal details. After introduction of spectral-domain OCT (SD-OCT) which provided high resolution images, recent studies offered new insights in specific morphological changes and their different impact on visual function in nAMD. For example, these advancement in resolution offered new classification of IRCs into degenerative and exudative which impacts treatment strategy and final outcome in the treatment of nAMD. Moreover, the recent data disclose a substantial difference between RCTs and real-world studies regarding the response to anti-VEGF therapy. In conclusions, IRCs and PED are associated with poor visual improvement in nAMD in a realworld setting. Both IRCs and SRF responded better than PED to anti-VEGF therapy. These observations mandate large longitudinal studies focusing on the usefulness of these high resolution SD-OCT biomarkers in real-world situations.
Highlights
Improving or maintaining visual acuity is the main target of treatment of neovascular age-related macular degeneration
Neovascular Age-related macular degeneration (AMD) is characterized by the presence of choroidal neovascularization (CNV), a pathologic form of angiogenesis resulting in leakage of fluid that accumulates in the retina, subretinally or below the retinal pigment epithelium (RPE); other features include the development of RPE tears, hard exudates, hemorrhage, or fibrous disciform scar tissue formation [7–9]
The results showed that arrangement of lacunas of the vascular plexus do not change after anti-vascular endothelial growth factor (VEGF), lacunarity may be an optical coherence tomography (OCT)-A parameter for neovascular age-related macular degeneration (nAMD) follow-up [85]
Summary
Improving or maintaining visual acuity is the main target of treatment of neovascular age-related macular degeneration (nAMD). Neovascular AMD is characterized by the presence of choroidal neovascularization (CNV), a pathologic form of angiogenesis resulting in leakage of fluid that accumulates in the retina, subretinally or below the retinal pigment epithelium (RPE); other features include the development of RPE tears, hard exudates, hemorrhage, or fibrous disciform scar tissue formation [7–9]. These clinical abnormalities in patients with nAMD lead to a gradual loss of retinal photoreceptors, resulting in decreased vision and even blindness if disease progression is not prevented [10]. Deleterious effect of vision loss on an individual’s quality of life mandates further development of effective treatment modalities and new molecules to treat nAMD
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