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A. Nestler, P. Gäbler, D.C. Trost, M.B. Reichel, S. Wolf; Two Year Follow-up of Natural History of Occult Choroidal Neovascularization in Patients with Age-related Macular Degeneration: Changes in Visual Acuity . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1779.
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Purpose:Treatment of occult CNV secondary to ARMD is recommended in patients who have recent disease progression. This includes visual loss or growth of the lesion within the last 3 months. We have assessed the changes in visual acuity and lesion size in patients with occult choroidal neovascularization over a period of two years. Methods:In a prospective study we included patients with occult CNV secondary to ARMD. Inclusion criteria were visual acuity of 20/80 or better, presence of exudative ARMD with an occult CNV and no other ocular disease. Examinations included ETDRS visual acuity, binocular ophthalmoscopy, fluorescein and ICG angiography with a scanning laser ophthalmoscope (HRA, Heidelberg Engineering GmbH, Germany) and color fundus photography. From the fluorescein angiograms the size of the occult lesion was assessed using the tracking tool of the Heidelberg Eye Explorer. All examinations were performed at baseline, 6 weeks, 3, 6, 12, 18 months and 24 months thereafter. Results:. Sixty patients (32 female, 28 male) were included into the "natural history study of occult CNV". Age ranged from 52-88 years (mean: 71 ± 8 years). Visual acuity ranged from 20/80 to 20/20 at baseline. Within 24 months 13 patients experienced a moderate visual loss (≥ 3 ETDRS lines), 17 patients a severe visual loss (≥ 6 ETDRS lines). In 14 patients the visual acuity remained without a significant change (±2 ETDRS lines). Lesion size was increased (at least 20%) in 33 patients at the 24 months visit. The correlation between visual loss and increase of lesion size was r = 0.41. Conclusions:This prospective study indicates that moderate or severe visual loss in patients with occult CNV secondary to ARMD occurs in about 50% of patients. The coefficient of correlation between visual loss and lesion size suggests that only 17% of visual loss can be explained by growth of the lesion.
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