alexa Fluorescein angiographic lesion type frequency in neovascular Age-Related macular degeneration


Journal of Clinical & Experimental Ophthalmology

Author(s): Olsen TW, Feng X, Kasper TJ, Rath PP, Steuer ER

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Objective To assess the frequency of lesion types using fluorescein angiography (FA) in neovascular age-related macular degeneration (nAMD). Design Cross-sectional study. Participants Two hundred cases of nAMD. Methods Fluorescein angiograms from 908 patients (university-based, tertiary retinal referral practice [UP] = 478; comprehensive, community-based eye clinic [CC] = 430) were reviewed to identify 200 cases of nAMD (100 from each center). Two graders evaluated the frequency of angiographic subtypes. Main outcome measures Identifying (1) the frequency of subfoveal nAMD lesions that meet the definition of “predominantly classic,” “minimally classic,” “occult with no classic”; (2) lesion location, size, and subtype; and (3) the intergrader agreement (κ). Results There was little difference in the frequency of lesion type between the UP and the CC. Most nAMD lesions were subfoveal (78.5%, 157 of 200), and of these, 20% (32 of 157) were predominantly classic; whereas 73% (114 of 157) were occult with no classic, and 7% (11 of 157) were minimally classic. Of the 200 angiograms, 33 (16.5%) were juxtafoveal, and 10 (5%) were extrafoveal. Twenty of the 43 juxtafoveal and extrafoveal lesions (47%) were predominantly classic. Classic with no occult subfoveal lesions were smaller than minimally classic or occult with no classic (1.7 vs. 3.7 and 2.8 mm; P = 0.001 and 0.01, respectively). Of 114 subfoveal occult with no classic lesions, 54 (47%) had both smaller lesion size ≤4 disc areas (DA) and lower visual acuity <20/50, whereas 107 (94%) had a smaller lesion or lower visual acuity. Conclusions Most angiographic lesions of patients who undergo FA for nAMD are subfoveal and occult. We estimate that 20% of subfoveal lesions are predominantly classic. Approximately half of the juxtafoveal and extrafoveal lesions are predominantly classic. Nearly 30% of all nAMD lesions have both small occult lesions (size ≤4 DA) and a visual acuity less than 20/50. We found minimal difference in lesion type between a UP and a CC.

This article was published in Ophthalmology and referenced in Journal of Clinical & Experimental Ophthalmology

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