Fluorescein angiographic lesion type frequency in neovascular age-related macular degeneration.
OBJECTIVE
To assess the frequency of lesion types using fluorescein angiography (FA) in neovascular age-related macular degeneration (nAMD).


METHODS
Cross-sectional study.


METHODS
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.


METHODS
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 (kappa).


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.
Olsen
Timothy W
TW
University of Minnesota, Department of Ophthalmology, Minneapolis, Minnesota 55455-0501, USA. olsen010@tx.umn.edu
Feng
Xiao
X
Kasper
Terrance J
TJ
Rath
Pamela P
PP
Steuer
Eric R
ER
D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000145:classification / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008268:Macular Degeneration / Q000145:classification / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014792:Visual Acuity