New findings from a study published in the American Journal of Ophthalmology have revealed data on the risk of progression from non-exudative macular neovascularization (MNV) in patients with exudative age-related macular degeneration (nAMD).
Talk about this research.
Investigators conducted a systematic review of 10 literature databases for any clinical studies with patients diagnosed with treatment-naïve non-exudative MNV in AMD.
What was being measured?
The primary outcome was time from diagnosis to exudative progression among AMD patients, as measured by the prevalence of exudative progression at 1 and 2 years via meta-analyses.
To note the investigators stratified individual participant data from the studies to conduct a meta-analysis for each patient to examine exudative progression (via a time-to-event curve).
And how many studies were identified?
A total of 16 studies fit the necessary criteria, with a collective 384 eyes—all with non-exudative MNV—included.
So … how prevalent was exudative progression?
Among the 16 studies, year 1 progression was observed in 20.9% (95% confidence interval [CI]: 13.1 - 29.8) of eyes.
By year 2, 30.7% (95% CI: 21.8 - 40.4%) of eyes had exudative progression occur.
What about in the individual meta-analyses?
The data was similar, with 18.9% and 31.3% of eyes showing exudative progression at Year 1 and Year 2, respectively.
Just out of curiosity … how does this compare to neovascular AMD progression?
Very close, actually. Per the investigators, prior research found that the rate of nAMD progressed from 15.9% to 26.4% of patients (Year 1) and 23.8% to 38.8% (Year 2).
While similar, the study authors noted that, “(Optical coherence tomography-angiography) OCT-A studies that distinguish between eyes with and without non-exudative MNV highlight a clear clinically and statistically significant difference.”
Gotcha. Back to this study: What were the risk factors?
Based on the analysis data, risk factors for a fast exudative progression included:
- Presence of subretinal lipid globules
- Large MNV areas
- Rapid MNV growth
- Growth in pigment epithelial detachment (PED) height / width
- Appearance of a branching pattern
- Development of hyporeflective halo (around the MNV)
Conclusions?
The study authors concluded that the presence of non-exudative MNVs indicates a high risk of exudative progression in AMD patients.
Any recommendations for reducing this risk?
The authors recommend that, by recognizing these lesions (MNVs), eye care practitioners (ECPs) may be able to develop better individualized followed-up management plans for AMD patients, “in which closer monitoring may facilitate earlier diagnosis of exudative progression.”