Nascent Geographic Atrophy as a Predictor of Type 3 Macular Neovascularization Development

Abstract

To investigate the association of nascent geographic atrophy (GA) preceding the development of exudative type 3 macular neovascularization (MNV) in patients with age-related macular degeneration (AMD). Retrospective longitudinal study. AMD patients diagnosed with treatment-naïve exudative type 3 MNV in one or both eyes were evaluated. Inclusion criteria included serial tracked structural optical coherence tomography (OCT) examinations for ≥ 2 years prior to the detection of exudative type 3 MNV. Clinical characteristics and retinal imaging including structural OCT at baseline and at each follow-up examination were analyzed. Eyes showing the presence of nascent GA during the follow-up were selected for analysis of prevalence, and clinical characteristics at the site of subsequent type 3 MNV development. Description of prevalence and clinical characteristics of nascent GA at the site of subsequent type 3 MNV development. Ninety-seven eyes affected by type 3 MNV meeting inclusion criteria were analyzed. Of 97 eyes (71 patients), 22 eyes of 21 patients (mean age 82±9 years) showed nascent GA preceding exudative type 3 MNV. The observed prevalence of nascent GA preceding exudative type 3 MNV was 22.7% (95% CI: 14.4-31.0%). Exudative Type 3 MNV developed a mean of 9±6 months following detection of nascent GA. The presence of reticular pseudodrusen in the study eye did not significantly influence the timing of exudative type 3 MNV development after the observation of nascent GA (p>0.1 in all analyses). Reduced BCVA was recorded at the exudative type 3 stage in comparison to the nascent GA stage (p=0.003). As nascent GA may precede the development of exudative type 3 MNV, the detection of nascent GA in eyes with AMD may warrant closer surveillance in order to identify early exudative type 3 MNV warranting treatment.