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Abstract
Intravitreal antivascular endothelial growth factor drugs represent the current standard of care for neovascular age-related macular degeneration (nAMD). Individualized treatment regimens aim at obtaining the same visual benefits of monthly injections with a reduced number of injections and follow-up visits, and, consequently, of treatment burden. The target of these strategies is to timely recognize lesion recurrence, even before visual deterioration. Early detection of lesion activity is critical to ensure that clinical outcomes are not compromised by inappropriate delays in treatment, but questions remain on how to effectively monitor the choroidal neovascularization (CNV) activity. To assess the persistence/recurrence of lesion activity in patients undergoing treatment for nAMD, an expert panel developed a decision algorithm based on the morphological features of CNV. After evaluating all current retinal imaging techniques, the panel identified optical coherent tomography as the most reliable tool to ascertain lesion activity when funduscopy is not obvious.
Highlights
Neovascular age-related macular degeneration is a complex and progressive disease characterized by choroidal neovascularization (CNV)
An English-language literature search using the PubMed Library was initially performed, focusing on specific topics inherent to the AMD, using the following keywords: ‘‘grading,’’ ‘‘histology,’’ ‘‘fluorescein angiography,’’ ‘‘indocyanine green angiography,’’ ‘‘spectral domain optical coherent tomography (OCT),’’ ‘‘OCT angiography,’’ and ‘‘anti-VEGF.’’ This was followed by a manual search of references cited in selected articles published in peer-reviewed journals
The imaging tools currently used for the diagnosis and follow-up of Neovascular age-related macular degeneration (nAMD) patients comprise color fundus photography (CFP), fluorescein angiography (FA) and indocyanine green angiography (ICGA), and OCT and OCT angiography (OCT-A)
Summary
Neovascular age-related macular degeneration (nAMD) is a complex and progressive disease characterized by choroidal neovascularization (CNV). The prevalence of AMD, which is the most common cause of irreversible blindness in Western Countries, is expected to increase with the progressive aging of the population.[1,2,3,4] In a recent metaanalysis, Wong et al.[5] estimated that the number of people with AMD would rise to 196 million in 2020 and to 288 million in 2040. Intravitreal antivascular endothelial growth factor (antiVEGF) drugs limit moderate and severe vision loss in most nAMD patients and improve visual acuity (VA), representing the first-line treatment. The monthly regimen used in the MARINA and ANCHOR trials showed clear efficacy, despite the elevated treatment burden that such a schedule would entail.[11,12]
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