The incidence of neovascular subtypes in newly diagnosed neovascular age-related macular degeneration.

Abstract

PURPOSE:

To determine the frequency of neovascularization subtypes as determined by fluorescein angiography (FA) alone vs FA and optical coherence tomography (OCT) grading in age-related macular degeneration (AMD).

DESIGN:

Retrospective cohort.

METHODS:

participants: Newly diagnosed neovascular AMD patients who initiated intravitreal anti-vascular endothelial growth factor therapy by 1 physician from October 1, 2005 to December 1, 2012. interventions: Two independent graders classified the baseline lesions using FA alone and FA+OCT. main outcome measures: Analysis of the frequency of lesion subtypes by FA alone or FA+OCT and agreement between both classification systems was performed.

RESULTS:

A total of 232 patients (266 eyes) fit the inclusion criteria. Mean age was 86.3 years; 67.7% of eyes (180/266) were from female patients, and 95.5% (254/266) were from white patients. The distribution using FA alone was 49.6% (132/266), 12.0% (32/266), 28.6% (76/266), and 9.8% (26/266) among occult, classic, retinal angiomatous proliferation, and mixed choroidal neovascularization, respectively. With FA+OCT, 39.9% (106/266), 9.0% (24/266), 34.2% (91/266), and 16.9% (45/266) were type 1 (sub-retinal pigment epithelium), type 2 (subretinal), type 3 (intraretinal), and mixed neovascularization (NV), respectively. The κ statistic was 0.65 (standard error ±0.37, P < .001) between the 2 classification systems, representing good agreement.

CONCLUSION:

With both FA-alone and FA+OCT grading, we found a higher incidence of type 3 NV in eyes with newly diagnosed neovascular AMD than that reported in prior studies. The κ statistic between the 2 classification systems showed "good" agreement. The discrepancies are likely attributable to the identification of a higher frequency of type 3 and mixed NV and a lower frequency of type 1 NV with the aid of OCT.

• Authors: Jesse J Jung, Christine Y Chen, Sarah Mrejen, Roberto Gallego-Pinazo, Luna Xu, Marcela Marsiglia, Sucharita Boddu, K Bailey Freund
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 158 Issue 4 Pg. 769-779.e2 (Oct 2014) ISSN: 1879-1891 [Electronic] United States
• PMID: 25034111 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Angiogenesis Inhibitors
• VEGFA protein, human
• Vascular Endothelial Growth Factor A

Topics

• Aged, 80 and over
• Angiogenesis Inhibitors (therapeutic use)
• Choroidal Neovascularization (classification)
• Female
• Fluorescein Angiography
• Humans
• Incidence
• Male
• Retrospective Studies
• Tomography, Optical Coherence
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Visual Acuity
• Wet Macular Degeneration (classification, diagnosis, drug therapy)