Original article
The Incidence of Neovascular Subtypes in Newly Diagnosed Neovascular Age-Related Macular Degeneration

https://doi.org/10.1016/j.ajo.2014.07.006Get rights and content

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.

Section snippets

Methods

This retrospective cohort study design was approved by the Western Institutional Review Board (Olympia, Washington, USA). It complied with the Health Insurance Portability and Accountability Act of 1996 and followed the tenets of the Declaration of Helsinki.

Results

A total of 374 patients with treatment-naïve neovascular AMD in at least 1 eye treated with anti-VEGF therapy were identified. Among these 374 patients, 232 patients (266 eyes) met the eligibility criteria. The mean age was 86.3 ± 8.1 years; 67.7% of eyes (180/266) were from female patients and 95.5% (254/266) from white patients, followed by 2.6% (7/266) Hispanic, 1.5% (4/266) Asian, and 0.4% (1/266) African-American.

Using the FA classification system, the distribution of neovascular subtypes

Discussion

The identification of neovascular AMD lesion subtypes and their relative frequencies in newly diagnosed eyes have been assessed by FA alone with the occasional addition of indocyanine green angiography (ICG).23, 24, 25, 26, 27, 28, 29, 30 To our knowledge, the present study is the first to determine lesion frequencies using both an FA-based and an anatomic classification using both FA and OCT.

The anatomic classification of NV is accomplished by using both FA and OCT to define the location of

Jesse J. Jung received his BA in biology and psychology at Washington University in St. Louis and his MD at Emory University School of Medicine. After completing a transitional year internship at Emory University School of Medicine, he completed his Ophthalmology residency and was Chief Resident during his final year of residency at New York University School of Medicine/Manhattan Eye, Ear, and Throat Hospital. He is currently a second year vitreoretinal fellow at the Edward S. Harkness Eye

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    Jesse J. Jung received his BA in biology and psychology at Washington University in St. Louis and his MD at Emory University School of Medicine. After completing a transitional year internship at Emory University School of Medicine, he completed his Ophthalmology residency and was Chief Resident during his final year of residency at New York University School of Medicine/Manhattan Eye, Ear, and Throat Hospital. He is currently a second year vitreoretinal fellow at the Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons/Vitreous Retina Macula Consultants of New York/Manhattan Eye, Ear, and Throat Hospital under the mentorship of Drs. Stanley Chang and Lawrence Yannuzzi.

    K. Bailey Freund, MD is a Clinical Professor of Ophthalmology at New York University School of Medicine and a senior partner at Vitreous Retina Macula Consultants of New York. Dr Freund is on the Editorial Board of the journal Retina. He has authored over 170 peer-reviewed scientific manuscripts and numerous book chapters. He is a recipient of the Young Investigator Award from the Macula Society.

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