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Angela Tsuang, Michelle Y. Cho, Quan V. Hoang, Joel M. Solomon, Shantan Reddy; Visual Acuity and Clinical Findings as Assessed by Resident Physicians as Indicators of Choroidal Neovascularization in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2011;52(14):103.
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To determine the effect of baseline visual acuity and clinical exam findings on the perception of visual symptoms and the presence of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).
117 eyes from 67 patients with AMD examined by resident-level physicians and suspected to have new or recurrent CNV, and had fluorescein angiograms (FA)s read by attending physicians at an academic center between January 2008 and October 2010 were reviewed. Eyes were grouped based on their prior clinic visit ("baseline") best-corrected visual acuity (BCVA) as group 1 (20/20 to 20/40, n = 44), group 2 (20/50 to 20/80, n = 32) and group 3 (< 20/80, n = 41). Univariate logistic regression was used to assess for an association between CNV and subjective visual symptoms or objective clinical exam/OCT findings.
Mean baseline BCVA was 20/30 Snellen (0.18 +/- 0.02 logMAR, mean +/- standard deviation) in group 1, 20/62 (0.49 +/- 0.01) in group 2, and 20/384 (1.28 +/- 0.09) in group 3. Drop in BCVA Snellen lines from baseline to the time of active CNV was greater in groups 1 (4.9 +/- 0.9) and 2 (3.5 +/- 0.7), than group 3 (0.6 +/- 0.2).There was a strong association between reported subjective visual symptoms (ie. decreased vision, metamorphopsia and/or scotomas) and FA-evident active CNV in groups 1 (OR 4.77, p = 0.024) and 2 (OR 16.5, p = 0.014), but not in group 3 (p = 0.61). Additionally, a drop in BCVA of > 3 lines (OR 10.29, p < 0.0001) and subretinal hemorrhage (OR 5.75, p < 0.0001) as reported on clinical exam by a resident physician were strongly associated with active CNV found on FA, as read by an attending physician. Clinical reports of subretinal fluid, subretinal fibrosis, retinal pigment epithelial detachment and lipid exudation were not found to be accurate predictors of CNV (all p > 0.52). Subretinal fluid evidenced by OCT was strongly associated with CNV diagnosis (OR 7.75, p < 0.0001).
Visual symptoms are a fair indicator of active CNV in patients with a baseline best-corrected visual acuity of ≥ 20/80. Active CNV was also accurately predicted by resident physician-reported findings of a decrease in BCVA of > 3 lines, subretinal hemorrhage by clinical exam and subretinal fluid by OCT.
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