Characteristics of Choroidal Neovascularization in the Complications of Age-Related Macular Degeneration Prevention Trial
Presented in part at: the Association for Research in Vision and Ophthalmology Meeting, April 24–29, 2004, Fort Lauderdale, Florida, and the Macula Society Meeting, February 23–26, 2005, Key Biscayne, Florida.
Received 2 November 2007; received in revised form 21 February 2008; accepted 29 February 2008. published online 16 May 2008.
Objective
To describe the characteristics of incident choroidal neovascularization (CNV) in observed and treated eyes in the Complications of Age-related Macular Degeneration Prevention Trial (CAPT).
Design
Cross-sectional descriptive study within a multicenter, randomized clinical trial.
Participants
Patients who developed CNV during CAPT follow-up.
Methods
Inclusion criteria for CAPT specified bilateral large drusen (≥10 drusen at least 125 μ), visual acuity ≥20/40 in each eye, and age ≥50. Exclusion criteria included CNV and geographic atrophy >1 Macular Photocoagulation Study (MPS) disc area or within 500 μ of the foveal center. One eye of each person was selected randomly for low-intensity laser treatment and the contralateral eye was observed. Fluorescein angiography was performed at baseline, annually for ≥5 years, and whenever there were symptoms of CNV. Trained readers at the CAPT Photograph Reading Center assessed color stereo photographs and angiogram negatives to identify CNV.
Main Outcome Measures
Choroidal neovascularization was classified by type (predominantly classic CNV, minimally classic CNV, occult only CNV, or scar), location, and area. Visual acuity was measured by certified examiners. Symmetry of characteristics between eyes of bilaterally affected patients was examined.
Results
Choroidal neovascularization developed in 282 eyes of 225 patients. At the time of detection, 192 (68%) of the lesions were occult only, 153 (54%) were subfoveal, and 157 (56%) were ≤2 MPS disc areas. Visual acuity was ≥20/40 in 123 (69%) of 179 eyes with visual acuity measured at the time of detection. Choroidal neovascularization developed in both eyes in 57 patients (25%) during CAPT follow-up. Lesions in eyes of bilaterally affected patients were no more similar to each other than affected eyes in 2 different patients.
Conclusions
When patients are monitored closely, many CNV lesions can be detected outside of the fovea and when they are relatively small. Early detection may lead to improved long-term visual acuity.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
Available online: May 16, 2008.
Department of Ophthalmology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Correspondence: CAPT Coordinating Center, University of Pennsylvania, 3535 Market Street, Suite 700, Philadelphia, PA 19104-3309
Manuscript no. 2007-1427.
Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
Supported by grants EY012211, EY012261, and EY012279, from the National Eye Institute, National Institutes of Health, Department of Health and Human Services.
† A listing of the Complications of Age-related Macular Degeneration Prevention Trial (CAPT) Research Group appeared in Appendix 1 in “Complications of Age-Related Macular Degeneration Prevention Trial Research Group. Laser treatment in patients with bilateral large drusen: The Complications of Age-related Macular Degeneration Prevention Trial (CAPT).” Ophthalmology 2006;113:1974-86.
ABSTRACT