Macular neovascularization biomarkers seen on OCT-A may include central feeder vessel, no capillary fringe, hyporeflective halo and mature MNV phenotype. Photo: National Eye Institute. Click image to enlarge.

To guide treatment decisions for neovascular age-related macular degeneration (nAMD), physicians rely on various clinical assessment factors including anatomical features such as macular neovascularization (MNV) activity on structural OCT. The literature suggests that another imaging modality, OCT angiography (OCT-A), may yield additional information on MNV. To learn more, researchers recently examined patients with treated stable MNV in nAMD. They reported several features of disease activity and associated MNV phenotypes.

In the prospective study, 32 eyes of 32 patients with nAMD underwent OCT-A imaging. All patients were receiving aflibercept on a treat-and-extend regimen out to 12 weeks. The researchers observed no macular hemorrhage and no markers of active MNV at the index 12-week treatment extension visit. They noted that 31 eyes were gradable without significant imaging artifacts.

Regarding MNV, mean size was 3.6mm² and 87.1% of patients had detectable MNV blood flow. The researchers reported that 93.5% of patients had MNV with mature phenotypes (10 non-specific, 10 tangle and three deadtree). In 58.1% and 61.3% of patients the researchers observed MNV halo and MNV central feeder vessel, respectively. One subject (3.2%) had MNV capillary fringe.

The researchers concluded that in treated stable nAMD, the following biomarkers may be seen on OCT-A: mature MNV phenotypes, central feeder vessel, absence of capillary fringe and hyporeflective halo. “We hope that further description of neovascular complexes with OCT-A technology can help to inform our understanding of nAMD and be used to create new paradigms for treatment decisions with anti-VEGF agents,” they wrote in their paper.

Hanumunthadu D, Saleh A, Florea D, et al. Biomarkers of macular neovascularization activity using optical coherence tomography angiography in treated stable neovascular age related macular degeneration. BMC Ophthalmol. February 14, 2023. [Epub ahead of print].