Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article

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.

Keywords: antivascular endothelial growth factor; choroidal neovascularization; lesion activity; morphologic criteria; neovascular age-related macular degeneration.

FIG. 1.

Flow chart for clinical follow-up based on morphological features of CNV in patients undergoing treatment for neovascular age-related macular degeneration. CNV, choroidal neovascularization; IRF, intraretinal fluid; OCT, optical coherence tomography; RPE, retinal pigment epithelium; sPED, serous pigment epithelium detachment; SRF, subretinal fluid.