title: Retinal angiomatous proliferation.
abstract: Retinal angiomatous proliferation (RAP) is a unique variant of neovascular age-related macular degeneration. Published studies have estimated that up to 15% of patients with neovascular age-related macular degeneration have RAP. Clinical features frequently associated with RAP include bilateral disease, presence of pigment epithelial detachments, and reticular pseudodrusen. RAP is more frequently associated with the development of retinal pigment epithelial tears and geographic atrophy that can lead to severe vision loss. Recent advances in retinal and choroidal imaging technology have furthered our understanding of RAP. Although indocyanine green angiography remains the gold standard diagnostic tool, optical coherence tomography has improved the precision by which neovascular age-related macular degeneration with RAP lesions can be diagnosed, staged, and monitored. Anti-vascular endothelial growth factor therapy is currently the first line of treatment. Other treatment options including combination of photodynamic therapy with antiangiogenic agent intravitreal injections or corticosteroids may also achieve a reasonable therapeutic outcome; however, RAP may portend a more guarded visual prognosis than typical choroidal neovascularization because of variable treatment response and dependence on the disease stage. Future basic and clinical research is needed to clarify the pathophysiology, definition and classification, optimal treatment regimen, and long-term outcome of RAP.
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
authors.forename: Andrew S H
authors.initials: ASH
authors.lastname: Tsai
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
authors.forename: Ning
authors.initials: N
authors.lastname: Cheung
authors.affiliation: Singapore Eye Research Institute, Singapore.
authors.forename: Alfred T L
authors.initials: ATL
authors.lastname: Gan
authors.affiliation: Department of Ophthalmology, Duke University, Durham, North Carolina, USA.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Jaffe
authors.affiliation: NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
authors.forename: Sobha
authors.initials: S
authors.lastname: Sivaprasad
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore. Electronic address: wong.tien.yin@singhealth.com.sg.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
authors.forename: Chui Ming Gemmy
authors.initials: CMG
authors.lastname: Cheung
mesh_terms: D005451:Fluorescein Angiography / Q000379:methods*; D005654:Fundus Oculi; D014943:Global Health; D006801:Humans; D015994:Incidence; D012160:Retina / Q000473:pathology*; D015861:Retinal Neovascularization / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: age-related macular degeneration; anti-vascular endothelial growth factor; choroidal neovascularization; fundus fluorescein angiography; optical coherence tomography; photodynamic therapy; pigment epithelial detachment; retinal angiomatous proliferation