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S.H. Sinclair, W. Li, P. Presti; Effect on High Contrast Discriminated Target Central Fields of Photodynamic Therapy With Verteporphyrin for CNVM Due to AMD . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2141.
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© ARVO (1962-2015); The Authors (2016-present)
Vision outcomes from CNVM treatment due to AMD have been previously evaluated using visual acuity with severe limitations. Central visual field tested for discriminated targets appears to offer significant advantages.
In this cohort, 20 eyes of 17 patients undergoing PDT for AMD CNVM underwent IVFA, BCVA by ETDRS, and testing of central 20deg using high contrast discriminated targets (MAVES) prior to and at 6 month intervals. Angiograms were assessed for CNVM type, and graded for amount and change of subretinal fluid, exudates, hemorrhage, leakage severity, amount of RPE atrophy. Correlations were drawn between these and visual field alterations.
Average duration of treatment and follow–up was 18.5 +/–6.5 months. Among 20 eyes, 8 demonstrated complete involution with variable fibrosis and RPE atrophy, but no significant residual leakage, 8 partial decrease in size or leakage, 2 no response, and in 2 worsening of leakage or increased CNVM size. Among those 16 with complete or partial regression, significant improvement in VA (>/= 3 lines) occurred in none, but in 3 the VA decreased (>/= 3 lines), best central macular acuity improved but global macular acuity did not (final BMA 20/235+/– 277, final GMA 20/321+/– 265) . Among 16 with complete or partial CNVM involution, discriminated target central fields demonstrated shrinkage of central scotoma size in 10, stabilization in 2, enlargement in 4. Improvement in central scotoma density was noted in 8. Greatest improvement was observed following treatment with intravitreal triamcinolone and PDT. Improved scotoma size/density correlated with less RPE atrophy and less residual fluid/exudates/hemorrhage
/leakage. Extensive fibrosis or atrophy produced corresponding dense scotomas, but smaller fibrotic areas with hardened edges were associated with improved paraxial field.
Central visual field testing with discriminated targets offers improved understanding of retinal pathology and resulting vision for eyes undergoing CNVM AMD treatment.
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