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Minimal VA loss, leakage associated with ‘early’ neovascular AMD
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WAILEA, Hawaii – Early choroidal neovascularization should be identified when small and extrafoveal, and should be associated with minimum visual acuity loss and other characteristics not previously thought of in early detection, Neil M. Bressler, MD, told colleagues at Retina 2015.
Neil M.
Bressler
“Many people’s concept of early is what we would call late,” Bressler said. For example, visual acuity loss of 20/80 or 20/100 would be a late indicator of CNV.
“We want to get these cases when [visual acuity] is 20/40 or better,” Bressler said, because the goal is minimal visual acuity loss from baseline.
The pattern on fluorescein angiography ideally should be occult, he said, before it becomes the classic pattern that presumably represents neovascularization that has proliferated beyond the pigment epithelium into the subretinal space with extensive fibrosis.
“We want to detect them before there is substantial leakage and fibrosis on fluorescein angiography,” he said.
Further early indicators would be thin lesions seen on OCT, minimal to no blood, little visible fibrosis and no rip of the retinal pigment epithelium.
Use of a home monitoring device and standard care between visits may enhance early diagnosis, he said.
“We want to get these [cases] when the baseline visual acuity and lesion size are relatively small because that predicts who is going to do the best,” Bressler said. “I hope we will change our way of detecting these. As we have with early macular holes, as we have with early diabetic macular edema, we need to do the same with macular degeneration. – by Patricia Nale
Disclosure: Bressler reports that his institution has received grant support from Notal Vision.