Optic Disc Neovascularization Research Articles

The Spectrum of Presumed Tubercular Uveitis in a Referral Eye Clinic in Qatar

ABSTRACT Purpose To analyze the clinical spectrum of patients with presumed tubercular uveitis in a referral eye clinic in Qatar. Methods We retrospectively reviewed the clinical records of 50 patients (80 eyes) diagnosed with presumed ocular tuberculosis who presented to the uveitis clinic, department of Ophthalmology Hamad Medical Corporation, Qatar, from January 2014 till December 2019. Results Mean age at presentation was 34.5 ± 9.3 years. Forty one patients were males (82%) and 30 patients had bilateral involvement (60%). Forty eyes (50%) had posterior uveitis, 21 eyes (26.3%) intermediate uveitis, 11 eyes (13.7%) panuveitis, and 8 eyes (10%) anterior uveitis. Ocular findings included vitritis in 82.5% of eyes, retinal vasculitis in 46.3% (92% of which were occlusive in nature), multifocal choroiditis in 18.8%, serpiginous-like choroiditis in 11.3%, Most common complications at presentation or during follow-up included macular edema in 32 eyes (40%), preretinal or optic disc neovascularization in 29 eyes (36.3%) and vitreous hemorrhage in 17 eyes (21.3%). Anti-tubercular treatment was provided to 46 patients (92%). Systemic corticosteroids and corticosteroid sparing agents were associated, respectively, in 39 patients (78%) and 14 patients (28%). After 1 year of follow up, inflammation was controlled, with a significant improvement in visual acuity (p < 0.0001). Conclusions In Qatar, tubercular uveitis has a broad spectrum of ocular features, with posterior and intermediate uveitis being the most common anatomic forms. Vitritis, multifocal choroiditis without or with a serpiginous-like pattern, and occlusive retinal vasculitis are the most common ocular findings. Main sight-threatening ocular complications are macular edema, posterior segment neovascularization, and vitreous hemorrhage.

The Spectrum of Presumed Tubercular Uveitis in a Referral Eye Clinic in Qatar

ABSTRACT Purpose To analyze the clinical spectrum of patients with presumed tubercular uveitis in a referral eye clinic in Qatar. Methods We retrospectively reviewed the clinical records of 50 patients (80 eyes) diagnosed with presumed ocular tuberculosis who presented to the uveitis clinic, department of Ophthalmology Hamad Medical Corporation, Qatar, from January 2014 till December 2019. Results Mean age at presentation was 34.5 ± 9.3 years. Forty one patients were males (82%) and 30 patients had bilateral involvement (60%). Forty eyes (50%) had posterior uveitis, 21 eyes (26.3%) intermediate uveitis, 11 eyes (13.7%) panuveitis, and 8 eyes (10%) anterior uveitis. Ocular findings included vitritis in 82.5% of eyes, retinal vasculitis in 46.3% (92% of which were occlusive in nature), multifocal choroiditis in 18.8%, serpiginous-like choroiditis in 11.3%, Most common complications at presentation or during follow-up included macular edema in 32 eyes (40%), preretinal or optic disc neovascularization in 29 eyes (36.3%) and vitreous hemorrhage in 17 eyes (21.3%). Anti-tubercular treatment was provided to 46 patients (92%). Systemic corticosteroids and corticosteroid sparing agents were associated, respectively, in 39 patients (78%) and 14 patients (28%). After 1 year of follow up, inflammation was controlled, with a significant improvement in visual acuity (p < 0.0001). Conclusions In Qatar, tubercular uveitis has a broad spectrum of ocular features, with posterior and intermediate uveitis being the most common anatomic forms. Vitritis, multifocal choroiditis without or with a serpiginous-like pattern, and occlusive retinal vasculitis are the most common ocular findings. Main sight-threatening ocular complications are macular edema, posterior segment neovascularization, and vitreous hemorrhage.

A deep learning system for the detection of optic disc neovascularization in diabetic retinopathy using optical coherence tomography angiography images

A deep learning system for the detection of optic disc neovascularization in diabetic retinopathy using optical coherence tomography angiography images

Unilateral Optic Disc Neovascularization in a Patient with Optic Disc Pit Depending on Proliferative Diabetic Retinopathy

Unilateral Optic Disc Neovascularization in a Patient with Optic Disc Pit Depending on Proliferative Diabetic Retinopathy

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Background: Diabetic retinopathy is differentiated into two main types. They are non-proliferative and proliferative diabetic retinopathy. The presence or absence of aberrant new blood vessels is the differentiating characteristic between these two groups (retinal or optic disc neovascularization). The ischemic retina secretes vascular endothelial growth factor (VEGF). We conducted a study to evaluate the diabetic changes in the retina in type 1 diabetes mellitus (T1DM) after 15 to 20 years of its diagnosis using Fundus Fluorescein Angiography & Optical Coherence Tomography Angiography & Optical Coherence Tomography. Methods: The study was designed as a retrospective cohort clinical study conducted on T1DM patients. Results & Conclusion: The most frequent FFA finding was Microaneurysms (51.7%), followed by Cystoid macular edema (CME) (24.1%), while the least frequent findings were an artifact, neovascularization elsewhere (NVE), and branch retinal vein occlusion (BRVO) (3.4% for each). The most frequent OCTA finding was mean FAZ(0.32±0.09mm2) while mean SVD(46.2±4.6%) while mean DVD (46.1±5.6%).The most frequent OCT finding was epi-retinal membrane (16.7%), followed by exudate (13.3%) and intraretinal cyst (10.0%), while the least frequent finding was parafoveal macular edema (3.3%).

Алгоритмы искусственного интеллекта для диагностики признаков диабетической ретинопатии, диабетического макулярного отека, возрастной макулярной дегенерации, аномалий витреомакулярного интерфейса

Purpose. Development of artificial intelligence (AI) algorithms for diagnosing of diabetic retinopathy (DR), diabetic macular edema (DME), age-related macular degeneration (AMD), vitreomacular interface abnormalities (VMA) through the analysis of OCT scans and fundus images. Material and methods. Fundus images of patients with DR and DME, OCT scans of patients with DME, AMD and VMA were used as training and validation databases. The volume of training databases was 3600 fundus images and 10 000 OCT scans, the volume of validation databases was 400 fundus images and 1000 OCT scans. For fundus images analysis algorithms accuracy, sensitivity, specificity, AUROC were calculated for the following structures: microaneurysms, intraretinal hemorrhages, hard exudates, soft exudates, retinal and optic disc neovascularization, preretinal hemorrhages, epiretinal fibrosis, laser coagulates. For OCT scan analysis algorithms, these metrics were calculated for the features: intraretinal cysts, subretinal fluid, pigment epithelium detachment, subretinal hyperreflective material, drusen, epiretinal membrane, full thickness macular hole, lamellar macular hole, vitreomacular traction. Results. For fundus images analysis algorithms, accuracy exceeded 93% for all features except soft exudates (88.3%) and neovascularization (88.0%), sensitivity exceeded 90% for all features except neovascularization (80.2%) and epiretinal fibrosis (72.5%), specificity exceeded 91% for all features except microaneurysms (80.5%), hard exudates (83.5%) and soft exudates (88.7%), AUROC exceeded 0.90 for all signs except epiretinal fibrosis (0.88), neovascularization (0.87), preretinal hemorrhages (0.89). For OCT analysis algorithms, accuracy exceeded 93% for all features, sensitivity exceeded 90% for all features except lamellar macular hole (87.22%), specificity exceeded 93% for all features, AUROC exceeded 0.93 for all features. Conclusion. An algorithm for high precision segmentation of pathological signs has been developed. Based on these AI algorithms, the Retina.AI ophthalmological platform was developed, which allows automated analysis of OCT scans and fundus images and diagnosing of DR, DME, AMD and VMA. The platform is available for testing at https://www.screenretina.com/ Keywords: artificial intelligence, ophthalmic screening, diabetic retinopathy, diabetic macular edema, age-related macular degeneration, vitreomacular interface abnormalities

Optic nerve head perfusion changes in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab or photocoagulation: a randomized controlled trial.

Proliferative diabetic retinopathy (PDR) is a serious sight-threatening disease, and half of the patients with high-risk PDR can develop legal blindness within 5 years, if left untreated. This study was aimed at comparing panretinal photocoagulation (PRP) and intravitreal ranibizumab injections in terms of radial peripapillary capillary (RPC) density on optical coherence tomography angiography (OCTA) in patients with treatment-naive PDR. This open-label, prospective, randomized clinical trial included 50 patients with treatment-naive PDR with optic disc neovascularization and randomized them into two groups: group 1, with patients undergoing two sessions of PRP 2 weeks apart, and group 2, with patients received three intravitreal ranibizumab injections (0.5 mg) 1 month apart for 3 consecutive months. Patients underwent a full ophthalmological examination, including best-corrected distance visual acuity (BCDVA) measurement in the logarithm of minimal angle of resolution (logMAR) notation and OCTA before intervention and monthly after the last laser session or the first intravitreal ranibizumab injection for 3 months of follow-up. Visual field (VF) was tested at the beginning and end of 3 months. Forty-two (84%) eyes completed the 3-month follow-up, including 22 eyes in the PRP group (88%) and 20 (80%) eyes in the ranibizumab group. The two groups were comparable in terms of demographic characteristics, diabetes duration, baseline BCDVA, glycated hemoglobin level, OCTA parameters, VF indices, and intraocular pressure (all P > 0.05). The RPC density change from baseline to the 3-month follow-up was significantly lower in the PRP group than in the ranibizumab group (mean difference in RPC density change: - 3.61%; 95% confidence interval: - 5.57% to - 1.60%; P = 0.001). The median (interquartile range) logMAR change from baseline to the 3-month follow-up (0.0 [0.2]) was significantly higher in the PRP group than in the ranibizumab group (- 0.15 [0.3]; P < 0.05). The median changes in central foveal thickness from baseline to the 3-month follow-up differed significantly between the two groups (P = 0.001). In eyes with PDR and neovascularization of the disc RPC density on OCTA increased in the ranibizumab group and decreased in the PRP group. Visual acuity gain was higher in the ranibizumab group than in the PRP group. Future multicenter trials addressing our limitations are required to verify the findings of this study.

A rare case of unilateral traumatic peripheral retinal arteriolar occlusions and neovascularization of optic disc

A young adult Asian Indian male presented to us with a 1-month history of trauma to the right eye (RE) with a tennis ball. He had intraocular pressure (IOP) of 32 mmHg while on three topical antiglaucoma drugs and oral acetazolamide, with uncontrolled inflammation in the anterior chamber (AC) and arteriolar occlusions in the periphery. His best corrected visual acuity was 20/20 in RE. Fluorescein angiography of the RE showed the presence of neovascularization of disc (NVD). Magnetic resonance angiography of the head and neck, and blood investigations ruled out the embolic origin of arteriolar occlusion and systemic causes for inflammation. Intra ocular pressure (IOP) and inflammation were controlled with appropriate treatment. NVD resolved with photocoagulation treatment (PRP) for capillary non-perfusion areas in 4 weeks. This case documents the occurrence of arteriolar occlusion, with neovascularization after arteriolar occlusion post blunt trauma, and successful adjunct use of topical cyclosporine in the management of AC inflammation and high IOP.

Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report

<i>Background</i>: The intraocular manifestations of leukemia are diverse. The retina is the most common ophthalmic involvement site. The most common retinal manifestations of acute lymphoblastic leukemia (ALL) include dilated and tortuous vessels, serous retinal detachment (SRD), intraretinal hemorrhages as well as roth spots. Optic nerve infiltration and retinal neovascularization are unusual, especially in complete clinical remission of ALL. However, neovascularization in optic disk has not been observed in ALL during complete clinical remission. <i>Objective</i>: To report clinical characteristics of a bilateral optic disk neovascularization associated with relapse of ALL. <i>Method</i>: A 31-year-old male with ALL after having reached complete remission from chemotherapy complained about a vision loss in both eyes. First examination showed that best corrected visual acuity (BCVA) was 20/200 for his right eye and 20/160 for his left eye, respectively. Fundus examination revealed bilateral profound optic disk edema with multiple yellow-white exudates and retinal hemorrhages. Optical coherence tomography (OCT) showed bilateral optic disk edema and SRD in both maculas. Fundus fluorescein angiography (FFA) showed bilateral optic disk neovascularization. All these changes were present in remission. The patient received intravitreal Conbercept injection 0.5 mg (10 mg/ml) in both eyes for once on June 29, 2019. Optic disk neovascularization resolved three weeks after treatment. BCVA improved to 20/200 in his right eye, but still light perception in his right eye. No optic disk neovascularization recurrence was observed in 3-month follow-up. BCVA of the right eye maintained 20/200 at the latest follow-up. After intravitreal injection for 4 months the patient suffered from cerebral hemorrhage. He received bone marrow biopsy and cerebrospinal fluid sampling. The results showed relapse in hemogram and lymphocytes in central nervous system (CNS). Therefore, the chemotherapy treatment did not cause a new remission of the disease and the patient failed to recover. <i>Conclusion</i>: Optic disk neovascularization may appear as a sign of extramedullary relapse of ALL months in advance of the hematologic relapse. Intravitreal injection of conbercept could be beneficial and safe in treating this neovascularization.

Optic disc neovascularization in panuveitis and the role of optical coherence tomography angiography in diagnosis and follow-up

Optic disc neovascularization in panuveitis and the role of optical coherence tomography angiography in diagnosis and follow-up

Long-term success treating inflammatory epiretinal neovascularization with immunomodulatory therapy.

This study aims to report the long-term outcomes of uveitis-associated optic disc and epiretinal neovascularization (NV) treated with immunomodulatory therapy alone. This is a retrospective, multi-center chart review conducted at Northwestern University (Chicago, IL) and San Raffaele Scientific Institute (Milan, Italy) from 2014 to 2021 of patients with optic disc and/or retinal neovascularization associated with uveitis. The data collected included age at the time of NV detection, gender, medications, and follow-up period. Imaging was reviewed if available. Eight eyes of six patients were identified. The mean age was 22years (range 10-52years); the median follow-up was 3years (range 6months to 7years). All eyes presented with active NV at the time of uveitis onset; 7 eyes were treatment-naïve. None had clinical or angiographic evidence of retinal ischemia. All patients received a variable combination of local steroids, systemic steroids, and systemic immunosuppression. Complete resolution of uveitic NV occurred in all eyes within a median of 8weeks (ranging 2-20weeks) from initiating treatment. No NV recurrence was noted. Immunomodulatory therapy alone may be successful in achieving long-term control of uveitis-associated NV, without the use of destructive measures.

Pattern and distribution of neovascularization in proliferative diabetic retinopathy on fundus fluorescein angiography: A growing paradigm

BackgroundThe objective of this study was to evaluate pattern and distribution of neovascularization of optic disc (NVD) and elsewhere (NVE) in proliferative diabetic retinopathy (PDR). MethodsA cross-sectional study was conducted among freshly detected cases of PDR. Fundus fluorescein angiographic images of 61 eyes were assessed. Parameters studied for NVD were their number and location and for NVE were their number, location, type of leak, and distance from center of optic disc. ResultsOf 61 eyes, 29 eyes (47.5%) had NVD with a total of 49 leaks. Of these 49 NVD leaks, the maximum was concentrated in the superotemporal quadrant with 21 leaks (42.9%; 95%CI 28.8–57.8%). Of 61 eyes, 50 eyes (82%) had NVE with 97 leaks. Of 97 NVE leaks, 41 were found in the superotemporal quadrant (42.3%; 95%CI 32.3–52.7%). Maximum NVE was found within the circle of radius 3–6 mm centered on optic disc (p value = 0.001) with no leaks in central macula. Of 29 eyes with NVD, only 7 eyes had >1/3 area of disc involvement. Also, of 18 eyes with concurrent NVD and NVE, only 2 eyes had >1/3 area of disc involvement which is a high-risk characteristic of PDR. ConclusionNeovascular lesions have a predilection for superotemporal part for both NVD and NVE. NVE leaks were almost double the number of NVD leaks. Maximum NVE leaks were found at posterior pole with no central macular involvement. This study provides comprehensive data and further adds to knowledge of neovascularization for early diagnosis and management of PDR.

Acquired unilateral visual deterioration: More to ischemia than meets the eye

A 56-year-old woman presented with visual loss in the right eye with best-corrected visual acuity of 20/40. Funduscopic examination revealed neovascularization of the disk with peripapillary preretinal hemorrhages and leakage on fluorescein angiography. Cerebral arteriography demonstrated stenosis of the major cerebral vessels with classic collaterals configuring as “puff of smoke.” A diagnosis of moyamoya-related ocular ischemic syndrome manifesting with optic disk neovascularization was made.

Diabetic Optic Neuropathy and Its Risk Factors in Chinese Patients With Diabetic Retinopathy.

To investigate diabetic optic neuropathy (DON) prevalence and risk factors in Chinese diabetic retinopathy (DR) patients. This retrospective study included 1067 eyes (550 patients) that underwent ocular imaging. The diabetes duration, systolic blood pressure (SBP), hemoglobin A1c (HbA1c), and high-density lipoprotein (HDL) were also recorded simultaneously. A total of 410 eyes with DON and 657 eyes without DON were included (38.4% DON prevalence). DON eyes were classified as having diabetic papillopathy (DP), optic disc neovascularization (NVD), anterior ischemic optic neuropathy (AION), or optic atrophy (OA). Proliferative DR eyes had a higher DON prevalence than nonproliferative DR eyes (P < 0.001). Diabetes duration, SBP, and HbA1c were higher in DON patients than in non-DON patients (all P < 0.001). Additionally, HDL was lower in patients with DON (0.74 ± 0.13 mM) than in those without DON (1.00 ± 0.24 mM, P < 0.001). HbA1c levels were greater in AION patients (10.00 ± 1.53% [85.76 ± 16.71 mmol/mol]) than in DP patients (8.78 ± 1.97% [72.45 ± 21.55 mmol/mol], P = 0.017); central foveal thickness (CFT) significantly varied among groups (P < 0.001). Increased age, diabetes duration, SBP, CFT, and DR severity were risk factors for DON; and increased HbA1c was a risk factor for NVD, AION, and OA (all P < 0.05). Our study results strengthen the argument that increased age, diabetes duration, SBP, CFT, DR severity, and HbA1c are all risk factors for DON in patients with DR.

TIME COURSE OF CHANGES IN OPTIC DISK NEOVASCULARIZATION AFTER A SINGLE INTRAVITREAL BEVACIZUMAB INJECTION.

To evaluate the longitudinal changes in optic disk neovascularization (NVD) after intravitreal bevacizumab injection using optical coherence tomography angiography. In this prospective, interventional, case series, eyes with NVD secondary to diabetic retinopathy were enrolled. En face optical coherence tomography angiographic images were obtained from the optic disks before and 3 hours, 6 hours, 24 hours, 7 days, and 30 days after intravitreal bevacizumab injection. The size and flow area of the neovascularization were measured by two graders. Eleven eyes of 9 patients with a mean age of 52.11 ± 9.48 years were included. The reduction in the NVD size and flow area was statistically significant at 24 hours, 7 days, and 30 days after injections compared with the baseline measurements (all P < 0.05). The decremental regression in the NVD size and flow area continued during the study course. The changes were not statistically significant in 3-hour and 6-hour measurements (all P > 0.05). In this study, statistically significant regression in the NVD size and flow area was observed as early as 24 hours after a single intravitreal bevacizumab injection, with a continued decreasing trend for at least a 1-month period.

Efficacy of panretinal laser in ischemic central retinal vein occlusion: A systematic review.

The aim of the present systematic review was to assess the efficacy of laser therapy for ischemic central retinal vein occlusion (CRVO). Relevant studies were retrieved by searching the PubMed, Embase, Chinese Biomedical Literature Database and, Chinese Science and Technology Periodicals databases using a combination of key words, including 'central retinal vein obstruction', 'CRVO', 'laser' and 'panretinal photocoagulation'. The titles, abstracts and full texts were screened by two independent reviewers and studies were selected according to specific inclusion criteria. Data were extracted and the quality of each study was graded using the Grading of Recommendations, Assessment, Development and Evaluation or Methodological Index for Non-Randomized Studies (MINORS) criteria. A total of 1,187 abstracts were retrieved, and finally, 11 clinical studies were selected, including 534 cases of CRVO. Of these, 8 studies compared the efficacy of laser therapy with other treatments for CRVO, two studies compared the efficacy of laser therapy and drug treatment for CRVO and one study compared the efficacy of early laser therapy with standard laser therapy (regular examinations and laser therapy performed as soon as neovascularization was identified) for CRVO. Among them, the results of five studies demonstrated that panretinal photocoagulation (PRP) for the prevention of iris neovascularization and neovascular glaucoma is inefficient regarding the improvement of visual acuity. A total of 10 studies indicated that laser therapy achieved better outcomes in neovascularization of the retina, optic disc neovascularization and iris neovascularization, neovascular glaucoma, vitreous hemorrhage, changes in the visual field, macular edema, macular thickness and intraocular pressure. Of note, it was indicated that laser photocoagulation prevents the severe vascular complications of CRVO. In addition, in the eyes of patients receiving PRP for the treatment of ischemic CRVO, significant reductions in corneal sub-basal nerve plexus parameters and average peripapillary retinal nerve fiber layer thickness were observed. Furthermore, laser photocoagulation was able to increase retinal blood flow in eyes with ischemic CRVO.

This issue of ACTA

This issue of ACTA

Observation of optic disc neovascularization using OCT angiography in proliferative diabetic retinopathy after intravitreal conbercept injections

This study reports the short-term efficacy and safety of intravitreal conbercept injections for neovascularization at the disc (NVD) in patients with proliferative diabetic retinopathy (PDR). Conbercept is a recombinant fusion protein with a high affinity for all isoforms of vascular endothelial growth factor (VEGF)-A, placental growth factor and VEGF-B. A prospective case series study was conducted in 15 patients (15 eyes). Patients had complete ocular examinations and received a 0.5 mg intravitreal conbercept injection followed by supplemental pan-retinal photocoagulation (PRP). Optical coherence tomography angiography (OCTA) was performed before and after treatment. Before treatment, the mean NVD area was 1.05 ± 0.33 mm2, and it decreased to 0.56 ± 0.17 mm2 after an interval of 7.5 d (p = 0.000). One eye required vitrectomy during follow-up. Recurrent NVD was observed in 2 eyes, which resolved after repeated injections. The remaining 12 eyes were stable over a mean follow-up period of 8.3 months. The mean area of the NVD in 14 patients without vitrectomy was 0.22 ± 0.11 mm2 (p = 0.000) at the last visit. Intravitreal conbercept injections combined with intensive PRP are an effective and safe treatment for PDR with NVD. Quantitative information on NVD can be obtained with OCTA, which may be clinically useful in evaluating the therapeutic effect.

Inflammatory optic disc neovascularisation managed with oral steroids/immunosuppressants and intravitreal ranibizumab

Inflammatory optic disc neovascularisation (NVD) has been treated with periocular or systemic steroids, immunosuppressants, panretinal photocoagulation and bevacizumab. However, the role of intravitreal ranibizumab in inflammatory NVD has not been...

Idiopathic retinal vasculitis, arteriolar macroaneurysms and neuroretinitis (IRVAN): case series of three patients with multimodal imaging

PurposeTo describe the clinical presentation, disease progression, treatment and complications of IRVAN.MethodsRetrospective review of three patients with a diagnosis of IRVAN seen at the Birmingham and Midland Eye Centre between 2010 and 2017. Multimodal imaging investigations included wide‐field fluorescein angiography, optical coherence tomography, and indocyanine green angiography.ResultsA total of 6 eyes from 3 patients with bilateral disease were included. All six eyes were treated with panretinal photocoagulation (PRP). One eye received a dexamethasone implant for refractory macular oedema and exudation. One eye was treated with Avastin injections for persistent optic disc neovascularization. All 3 patients were treated with oral steroids at some point in the course of their disease and one was subsequently immunosuppressed with mycophenolate mofetil. Visual outcomes varied. One patient maintained excellent visual acuity of 6/6 in both eyes at 72‐months follow‐up. The second patient experienced progressive visual loss from 6/9 right eye, 6/6 left eye at presentation; to 6/18 right eye, 6/60 left eye at 12 months follow‐up due to macular exudation despite aggressive PRP and intravitreal Ozurdex. The third patient deteriorated from 6/5 right eye, 6/4 left eye at presentation to 6/60 right eye at 6 months, despite aggressive PRP. He had recurrent vitreous haemorrhages in the right eye secondary to NVD despite further interventions with Avastin injections; seven years after presentation, vision remained at 6/60 right eye and 6/18 left eye.ConclusionsThe cadence of progression of IRVAN can vary greatly, despite aggressive treatment with PRP, intravitreal steroids, and anti‐VEGF agents. We observed variation in disease progression both among patients as well as within the same individual, supporting an individualized approach to therapy.