Detection of Nonexudative Choroidal Neovascularization and Progression to Exudative Choroidal Neovascularization Using OCT Angiography

Steven Bailey, O. Thaware, Jie Wang, Ahmed M. Hagag, X. Zhang, Christina Flaxel, Andreas (Andy) Lauer, Thomas Hwang, Phoebe Lin, David Huang, Jia Yali

Research output: Contribution to journalArticle

Abstract

Purpose: To detect nonexudative choroidal neovascularization (CNV) in age-related macular degeneration (AMD) with OCT angiography (OCTA) and determine the risk of exudative CNV developing compared with eyes without nonexudative CNV. Design: Prospective, longitudinal, observational study. Participants: Consecutive patients with drusen and pigmentary changes in the study eye and exudative neovascular AMD in the fellow eye. Methods: In this prospective observational study, participants underwent spectral-domain OCTA (AngioVue; Optovue, Inc, Fremont, CA), clinical examination, and structural OCT at baseline and 6-month intervals for 2 years. OCT angiography images were exported for custom processing to remove projection artifact and calculate CNV vessel area. Main Outcome Measures: Rate of developing exudation in eyes with and without nonexudative CNV as detected by OCTA on regular follow-up. Results: Sixty-three study participants were followed up every 6 months and 48 completed the 2-year study. Mean age was 78 years and 60.3% were female. On the baseline visit, 5 eyes (7.9%) were found to have nonexudative CNV by OCTA, and 3 of them demonstrated exudation. Of 58 eyes with a normal OCTA on baseline visit, 5 eyes developed nonexudative CNV during a follow-up visit. All 5 of these nonexudative CNV went on to develop exudation in subsequent visits. Overall, 8 of the 10 eyes with nonexudative CNV developed exudation with a mean time of 8 months and mean CNV area growth rate of 20% per month (P = 0.014, exponential model). Initiation of antiangiogenic treatment halted their growth. In comparison, exudation occurred in only 6 of the 53 eyes (11%) that lacked a precursor nonexudative CNV. Cox proportional hazard analysis showed that having nonexudative CNV detected was associated with an 18.1-fold increase in the rate of exudation subsequently developing (P < 0.0001). Conclusions: Nonexudative CNV frequently is detected by OCTA in the fellow eyes of those with exudative CNV. These lesions carry a high risk of exudation developing within the first year after detection and could benefit from close monitoring. The high risk of progression may justify prophylactic treatment; further studies are needed.

Original languageEnglish (US)
Pages (from-to)629-636
Number of pages8
JournalOphthalmology Retina
Volume3
Issue number8
DOIs
StatePublished - Aug 1 2019

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Choroidal Neovascularization
Angiography
Macular Degeneration
Observational Studies
Growth
Artifacts
Longitudinal Studies

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{2e354dd88a0c4933b0c7cd67f9077777,
title = "Detection of Nonexudative Choroidal Neovascularization and Progression to Exudative Choroidal Neovascularization Using OCT Angiography",
abstract = "Purpose: To detect nonexudative choroidal neovascularization (CNV) in age-related macular degeneration (AMD) with OCT angiography (OCTA) and determine the risk of exudative CNV developing compared with eyes without nonexudative CNV. Design: Prospective, longitudinal, observational study. Participants: Consecutive patients with drusen and pigmentary changes in the study eye and exudative neovascular AMD in the fellow eye. Methods: In this prospective observational study, participants underwent spectral-domain OCTA (AngioVue; Optovue, Inc, Fremont, CA), clinical examination, and structural OCT at baseline and 6-month intervals for 2 years. OCT angiography images were exported for custom processing to remove projection artifact and calculate CNV vessel area. Main Outcome Measures: Rate of developing exudation in eyes with and without nonexudative CNV as detected by OCTA on regular follow-up. Results: Sixty-three study participants were followed up every 6 months and 48 completed the 2-year study. Mean age was 78 years and 60.3{\%} were female. On the baseline visit, 5 eyes (7.9{\%}) were found to have nonexudative CNV by OCTA, and 3 of them demonstrated exudation. Of 58 eyes with a normal OCTA on baseline visit, 5 eyes developed nonexudative CNV during a follow-up visit. All 5 of these nonexudative CNV went on to develop exudation in subsequent visits. Overall, 8 of the 10 eyes with nonexudative CNV developed exudation with a mean time of 8 months and mean CNV area growth rate of 20{\%} per month (P = 0.014, exponential model). Initiation of antiangiogenic treatment halted their growth. In comparison, exudation occurred in only 6 of the 53 eyes (11{\%}) that lacked a precursor nonexudative CNV. Cox proportional hazard analysis showed that having nonexudative CNV detected was associated with an 18.1-fold increase in the rate of exudation subsequently developing (P < 0.0001). Conclusions: Nonexudative CNV frequently is detected by OCTA in the fellow eyes of those with exudative CNV. These lesions carry a high risk of exudation developing within the first year after detection and could benefit from close monitoring. The high risk of progression may justify prophylactic treatment; further studies are needed.",
author = "Steven Bailey and O. Thaware and Jie Wang and Hagag, {Ahmed M.} and X. Zhang and Christina Flaxel and Lauer, {Andreas (Andy)} and Thomas Hwang and Phoebe Lin and David Huang and Jia Yali",
year = "2019",
month = "8",
day = "1",
doi = "10.1016/j.oret.2019.03.008",
language = "English (US)",
volume = "3",
pages = "629--636",
journal = "Ophthalmology Retina",
issn = "2468-7219",
publisher = "Elsevier Inc.",
number = "8",

}

TY - JOUR

T1 - Detection of Nonexudative Choroidal Neovascularization and Progression to Exudative Choroidal Neovascularization Using OCT Angiography

AU - Bailey, Steven

AU - Thaware, O.

AU - Wang, Jie

AU - Hagag, Ahmed M.

AU - Zhang, X.

AU - Flaxel, Christina

AU - Lauer, Andreas (Andy)

AU - Hwang, Thomas

AU - Lin, Phoebe

AU - Huang, David

AU - Yali, Jia

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Purpose: To detect nonexudative choroidal neovascularization (CNV) in age-related macular degeneration (AMD) with OCT angiography (OCTA) and determine the risk of exudative CNV developing compared with eyes without nonexudative CNV. Design: Prospective, longitudinal, observational study. Participants: Consecutive patients with drusen and pigmentary changes in the study eye and exudative neovascular AMD in the fellow eye. Methods: In this prospective observational study, participants underwent spectral-domain OCTA (AngioVue; Optovue, Inc, Fremont, CA), clinical examination, and structural OCT at baseline and 6-month intervals for 2 years. OCT angiography images were exported for custom processing to remove projection artifact and calculate CNV vessel area. Main Outcome Measures: Rate of developing exudation in eyes with and without nonexudative CNV as detected by OCTA on regular follow-up. Results: Sixty-three study participants were followed up every 6 months and 48 completed the 2-year study. Mean age was 78 years and 60.3% were female. On the baseline visit, 5 eyes (7.9%) were found to have nonexudative CNV by OCTA, and 3 of them demonstrated exudation. Of 58 eyes with a normal OCTA on baseline visit, 5 eyes developed nonexudative CNV during a follow-up visit. All 5 of these nonexudative CNV went on to develop exudation in subsequent visits. Overall, 8 of the 10 eyes with nonexudative CNV developed exudation with a mean time of 8 months and mean CNV area growth rate of 20% per month (P = 0.014, exponential model). Initiation of antiangiogenic treatment halted their growth. In comparison, exudation occurred in only 6 of the 53 eyes (11%) that lacked a precursor nonexudative CNV. Cox proportional hazard analysis showed that having nonexudative CNV detected was associated with an 18.1-fold increase in the rate of exudation subsequently developing (P < 0.0001). Conclusions: Nonexudative CNV frequently is detected by OCTA in the fellow eyes of those with exudative CNV. These lesions carry a high risk of exudation developing within the first year after detection and could benefit from close monitoring. The high risk of progression may justify prophylactic treatment; further studies are needed.

AB - Purpose: To detect nonexudative choroidal neovascularization (CNV) in age-related macular degeneration (AMD) with OCT angiography (OCTA) and determine the risk of exudative CNV developing compared with eyes without nonexudative CNV. Design: Prospective, longitudinal, observational study. Participants: Consecutive patients with drusen and pigmentary changes in the study eye and exudative neovascular AMD in the fellow eye. Methods: In this prospective observational study, participants underwent spectral-domain OCTA (AngioVue; Optovue, Inc, Fremont, CA), clinical examination, and structural OCT at baseline and 6-month intervals for 2 years. OCT angiography images were exported for custom processing to remove projection artifact and calculate CNV vessel area. Main Outcome Measures: Rate of developing exudation in eyes with and without nonexudative CNV as detected by OCTA on regular follow-up. Results: Sixty-three study participants were followed up every 6 months and 48 completed the 2-year study. Mean age was 78 years and 60.3% were female. On the baseline visit, 5 eyes (7.9%) were found to have nonexudative CNV by OCTA, and 3 of them demonstrated exudation. Of 58 eyes with a normal OCTA on baseline visit, 5 eyes developed nonexudative CNV during a follow-up visit. All 5 of these nonexudative CNV went on to develop exudation in subsequent visits. Overall, 8 of the 10 eyes with nonexudative CNV developed exudation with a mean time of 8 months and mean CNV area growth rate of 20% per month (P = 0.014, exponential model). Initiation of antiangiogenic treatment halted their growth. In comparison, exudation occurred in only 6 of the 53 eyes (11%) that lacked a precursor nonexudative CNV. Cox proportional hazard analysis showed that having nonexudative CNV detected was associated with an 18.1-fold increase in the rate of exudation subsequently developing (P < 0.0001). Conclusions: Nonexudative CNV frequently is detected by OCTA in the fellow eyes of those with exudative CNV. These lesions carry a high risk of exudation developing within the first year after detection and could benefit from close monitoring. The high risk of progression may justify prophylactic treatment; further studies are needed.

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U2 - 10.1016/j.oret.2019.03.008

DO - 10.1016/j.oret.2019.03.008

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