Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 May;263(5):1197-1212.
doi: 10.1007/s00417-024-06721-5. Epub 2025 Apr 14.

Simultaneous GA and CNV/MNV: incidence, characteristics, and treatments

Keiko Kataoka  1 , Richard Gale  2 , Xiaoxin Li  3 , Figen Şermet  4 , Cynthia X Qian  5 , Chui Ming Gemmy Cheung  6   7 , Miltiadis K Tsilimbaris  8 , Igor Kozak  9   10
Affiliations
Review

Simultaneous GA and CNV/MNV: incidence, characteristics, and treatments

Keiko Kataoka et al. Graefes Arch Clin Exp Ophthalmol. 2025 May.

Abstract

Purpose: Understanding the clinical characteristics and underlying mechanisms of simultaneous geographic atrophy (GA) and choroidal neovascularization (CNV)/macular neovascularization (MNV) is necessary for the long-term management of late age-related macular degeneration (AMD) in clinical practice.

Methods: The authors reviewed the literature on the incidence, risk factors, and clinical characteristics of simultaneous GA and CNV/MNV and developed consensus recommendations for the diagnosis, assessment, and management of simultaneous GA and CNV/MNV in clinical practice.

Results: The incidence rate of CNV/MNV in eyes with GA is reported as 7.4% per patient-year or 13.8% in 4.1 years, while that of macular atrophy (MA) subsequent to CNV/MNV is reported as 24.4% to 37% in 24 months. Recent studies using optical coherence tomography angiography (OCT-A) revealed the presence of subclinical CNV/MNV in 11% to 16% of eyes with GA. Fundus autofluorescence is used to detect MA; optical coherence tomography (OCT) and OCT-A are useful for detecting MA, especially around the fovea, with OCT-A offering high sensitivity and specificity in the detection of both MA and CNV/MNV. GA and CNV/MNV share the genetic risk factors of HTRA1, complement factor H, complement factors 3 and 2, and ARMS2, and clinical risk factors of large drusen, cuticular drusen, intraretinal hyperreflective foci, and subretinal drusenoid deposits, suggesting that simultaneous GA and CNV/MNV represents a continuum of AMD. Anti-vascular endothelial growth factor therapy for CNV/MNV is reported to have no impact on the speed or magnitude of MA development or enlargement. An association has been observed between CNV subtype and MA progression, with the latter being slower in the presence of type 1 CNV/MNV.

Conclusions: These findings suggest there is a high probability of coexistence of GA and CNV/MNV and that they should not be considered separately. Future clinical studies should assess the two conditions simultaneously using OCT and OCT-A.

Key messages: What is known Owing to differences in their clinical characteristics, geographic atrophy (GA) and choroidal neovascularization (CNV)/macular neovascularization (MNV) have historically been regarded as two separate entities; however, several cases of coexistent GA and CNV/MNV have been reported recently in the published literature. What is new The findings of this review confirm that GA and CNV/MNV share common genetic risk factors and clinical characteristics, and suggest that these two entities are part of a continuum of late-stage age-related macular degeneration (AMD). The potential for GA and CNV/MNV to coexist should be considered in any discussion of the long-term management of late AMD; moreover, clinicians should assess for CNV/MNV in patients with GA, and for GA in those with CNV/MNV, using multimodal imaging.

Keywords: Age-related macular degeneration; Choroidal neovascularization; Geographic atrophy; Macular neovascularization.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical approval: This article does not report any studies involving human or animal participants performed by any of the authors. Conflict of interest: Keiko Kataoka received personal fees from Bayer, Boehringer Ingelheim, Canon MedTech, Chugai, OMC, Otsuka, Novartis, Santen, and Senju. Richard Gale is a consultant for AbbVie, Allergan, Apellis, Bayer, Biogen, Boehringer Ingelheim, Notal, Novartis, Roche, and Santen, and has received research grants from Bayer, Novartis, and Roche. Xiaoxin Li is a consultant for Kanghong, Novartis, and Ocumension, and has received research grants from Bayer. Figen Şermet is a consultant for AbbVie, Bayer, Novartis, Roche, and Thea. Cynthia X. Qian is a consultant for AbbVie, Apellis, Bayer, Boehringer Ingelheim, Novartis, and Roche. Chui Ming Gemmy Cheung has received consultant fees, speaker fees, and grant funding from Avirmax, Bayer, Boehringer Ingelheim, Iveric, Janssen, Novartis, Roche, Topcon, and Zeiss. Miltiadis K. Tsilimbaris has received personal fees from AbbVie, Bayer Hellas, Mavrogenis, and Novartis Hellas, and has received grants from Alcon, Bayer, Johnson & Johnson, and Novartis. Igor Kozak is a consultant for Alcon, Alimera, Allergan, Bayer, Roche, and Novartis.

Similar articles

See all similar articles

References

    1. Ferris FL III, Wilkinson CP, Bird A et al (2013) Clinical classification of age-related macular degeneration. Ophthalmology 120:844–851. 10.1016/j.ophtha.2012.10.036 - PMC - PubMed
    1. Spaide RF, Jaffe GJ, Sarraf D et al (2020) Consensus nomenclature for reporting neovascular age-related macular degeneration data: consensus on neovascular age-related macular degeneration nomenclature study group. Ophthalmology 127:616–636. 10.1016/j.ophtha.2019.11.004 - PMC - PubMed
    1. Sadda SR, Guymer R, Holz FG et al (2018) Consensus definition for atrophy associated with age-related macular degeneration on OCT: Classification of Atrophy Report 3. Ophthalmology 125:537–548. 10.1016/j.ophtha.2017.09.028 - PMC - PubMed
    1. Chakravarthy U, Bailey CC, Johnston RL et al (2018) Characterizing disease burden and progression of geographic atrophy secondary to age-related macular degeneration. Ophthalmology 125:842–849. 10.1016/j.ophtha.2017.11.036 - PubMed
    1. Hwang CK, Agrón E, Domalpally A et al (2021) Progression of geographic atrophy with subsequent exudative neovascular disease in age-related macular degeneration: AREDS2 Report 24. Ophthalmol Retina 5:108–117. 10.1016/j.oret.2020.10.008 - PMC - PubMed

MeSH terms

Substances

LinkOut - more resources