Characterizing Macular Neovascularization in Myopic Macular Degeneration and Age-Related Macular Degeneration Using Swept Source OCTA

Abstract

Purpose

Visual prognosis and treatment burden for macular neovascularization (MNV) can differ between myopic macular degeneration (MMD) and age-related macular degeneration (AMD). We describe and compare MNV associated with MMD and AMD using swept-source (SS)-OCTA.

Patients and Methods

Adult patients with documented MNV associated with MMD or AMD were consecutively recruited. Qualitative and quantitative features were assessed from 6x6mm angiograms, including the MNV area and vessel density (VD). Descriptive statistics and linear regression analyses were carried out.

Results

Out of 75 enrolled eyes with diagnosed MNV (30 MMD-MNV and 45 AMD-MNV; mean age 55±19 and 75±8 years, respectively), 44 eyes had discernible MNV (11 MMD-MNV and 33 AMD-MNV) on SS-OCTA at the time of the study and were included in the analysis. The MMD-MNV group exhibited a three-fold smaller sized MNV (p=0.001), lower greatest linear dimension (p=0.009) and greatest vascular caliber (p<0.001) compared to AMD-MNVs, and had a higher prevalence of tree-in-bud pattern. Eyes with AMD showed a higher prevalence of type 1 MNVs with medusa pattern. There was no difference in the location of the MNV, shape’s regularity, margins, presence of core vessel, capillary fringe, peripheral loops, or perilesional dark halo (p>0.05) between both conditions. After adjustment, decreased MNV area and increased VD were associated with the tree-in-bud pattern, whereas the diagnosis did not significantly influence those parameters.

Conclusion

While larger studies are warranted, this study is the first to describe and compare MMD-MNV and AMD-MNV using SS-OCTA, providing relevant clinical insight on MNV secondary to MMD and AMD. These findings also further validate OCTA as a powerful tool to detect and characterize MNV non-invasively.

Keywords:

• macular neovascularization
• age-related macular degeneration
• high myopia
• swept source
• OCT angiography

Abbreviations

AMD, Age-related macular degeneration; BCVA, Best-corrected visual acuity; BMI, Body-mass index; D, Diopters; DBP, Diastolic blood pressure; FA, Fluorescein angiography; GLD, greatest linear dimension of macular neovascularization network; GVC, Greatest vascular caliber of macular neovascularization network; ICGA, Indocyanine green angiography; IOP, Intraocular pressure; IVI: Intravitreal injection; LogMAR, Logarithm of the minimum angle of resolution; MLS, Multilayer segmentation; MMD, Myopic macular degeneration; MNV, Macular neovascularization; OCTA, Optical coherence tomography angiography; ORCC, Outer-retina to choriocapillaris; PDT, Photodynamic therapy; RE, Refractive error; RPE, Retinal pigment epithelium; SBP, Systolic blood pressure; SS-OCTA, Swept-source optical coherence tomography angiography; VD, Vessel density; VEGF, Vascular endothelial growth factor.

Acknowledgments

This work was supported by the Lions International Fund [Grants 530125, 530869] Lions International Fund [Grants 530125, 530869] and the National Institutes of Health [Grant P30EY003790]. The funding organizations had no role in the design or conduct of this research.

The abstract of this paper was presented at the Association for Research in Vision and Ophthalmology (ARVO) Meeting as a poster presentation with interim findings. The poster’s abstract, titled “Characterizing Macular Neovascularization in Myopic Macular Degeneration and Age-related Macular Degeneration using Swept Source OCT Angiography” was published in “ARVO Annual Meeting Poster Abstracts” in Investigative Ophthalmology & Visual Science. (https://iovs.arvojournals.org/article.aspx?articleid=2779923).

Disclosure

C.A.L. has received financial support from the Ronald G. Michels Fellowship Foundation Award and the Heed Fellowship sponsored by the Society of Heed Fellows and has a patent pending related to a myopia control therapeutic. D.G.V. is a consultant for Valitor and Olix Pharmaceuticals and has received financial support from the National Eye Institute and by grants from the National Institutes of Health (R01EY025362 and R21EY0203079), Research to Prevent Blindness, Loeffler's Family Foundation, Yeatts Family Foundation, and Alcon Research Institute. J.W.M. is a consultant for Genentech/Roche, Sunovion, KalVista Pharmaceuticals, and ONL Therapeutics; received honorarium from Heidelberg Engineering; holds a patent through and has received financial support from ONL, Drusolv Therapeutics, Valeant Pharmaceuticals/Massachusetts Eye and Ear; has received financial support from Lowy Medical Research Institute, Ltd, and the National Eye Institute (R01EY03088); and holds stock options from Aptinyx and ONL Therapeutics, as well as equity from Ciendias. In addition, J.W.M. has a patent US 7,811,832 with royalties paid to ONL Therapeutics, patents US 5,798,349; US 6,225,303; US 6,610,679; CA 2,185,644; CA 2,536,069 with royalties paid to Valeant Pharmaceuticals. D.H. is a consultant for Allergan, Genetech, and Omeicos Therapeutics and has received financial support from the National Eye Institute, Lions VisionGift, Commonwealth Grant, Lions International, Syneos LLC, and the Macula Society. L.A.K. holds a patent (11229662) and has a patent pending (WO2019099595) related to ocular angiogenesis. L.A.K. also reports grants from CureVac, stock options from Ingenia Therapeutics and Pykus Therapeutics, outside the submitted work. N.A.P. is a consultant for Atheneum, Alcon, Allergan, Alimera, Eyepoint, Lifesciences, Guidepoint, and GLG. J.B.M. is a consultant for Alcon, Allergan, Carl Zeiss, Sunovion, Topcon, and Genentech. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.