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  • Eyes with subclinical MNV should be closely monitored for exudation

    Retina/Vitreous

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    In this prospective analysis, swept source optical coherence tomography angiography (SS-OCTA) was used to study the prevalence, incidence and natural history of subclinical macular neovascularization (MNV) in eyes with dry AMD in 1 eye and exudative AMD in the fellow eye.

    Study design

    Investigators imaged 227 patients using 3x3 mm and 6x6 mm SS-OCTA scans. Subclinical macular neovascularization (MNV) was detected using an en face slab imaged from the outer retina to choriocapillaris. Included patients had exudative AMD in 1 eye and nonexudative AMD in the fellow eye; the nonexudative eyes were prospectively followed and reported on in this study. Patients could have either intermediate AMD or AMD with geographic atrophy. Exudation was evaluated by OCT B-scans looking for intraretinal or subretinal fluid. A pigment epithelial detachment was not considered evidence of exudation.

    Study design

    At baseline, 30 eyes (13.2%) had subclinical MNV at first imaging. Over the course of the study, an additional 12 eyes (8.9%) developed subclinical MNV. Of the 191 patients who returned to clinic at least once, 19 developed exudation; 14 of these eyes had pre-existing subclinical MNV.

    The relative risk of exudation after detection of the subclinical MNV was 13.6 times greater than in the absence of subclinical MNV. Of the 191 eyes, approximately two-thirds had intermediate AMD and one-third had geographic atrophy.

    Limitations

    Patients did not have regular and consistent follow-up, which ranged from 1 to 47 months with a mean of 22 months. With this follow-up variability, more patients may have developed MNV that were not detected. The irregular follow-up period may have also limited the detection of subclinical exudation prior to the patient noticing change in their vision.

    Clinical significance

    The study found subclinical MNV in approximately 10% of eyes with intermediate or late dry AMD. Eyes with this finding are at higher risk of developing exudative AMD which then could ultimately benefit from treatment. However, as a portion of patients with MNV did not develop exudation during the follow-up period of this study, regular close observation may be more prudent rather than treating eyes with MNV that do not have evidence of exudation.