Fig. 29.1
Choroidal neovascularization with associated hemorrhages. For further figures, see Agerelated macular degeneration – exudative and Macular edema.
Additional tests Fluorescein angiography is used to diagnose CNV and to direct treatment, as discussed above. Indocyanine green (ICG) angiography may further assist assessment.
Laser treatment Argon laser treatment is mainly used for extrafoveal CNV, to avoid affecting vision. Verteporfin photodynamic treatment (PDT) is most often used for subfoveal, predominantly classic CNV.
Injection Choroidal neovascularization may be treated with repeated doses of anti-angiogenic drugs: Anecortave acetate is delivered by periocular injection and pegaptanib sodium by intravitreal injection. Most recently Ranibizumab (Lucentis) and Bevacizumab (Avastin) have produced improved vision in some patients.
Oral medication and diet The risk of development of CNV in AMD is reduced
with vitamin supplementation, daily fruit consumption and cessation of smoking. The patient’s general vascular status should be reviewed in relation to systemic conditions.
Review Patients at risk of CNV may be reviewed annually, but encouraged to attend immediately if signs of reduced vision or distortion are noted. They may be provided with an Amsler (grid) chart for home use to self-assess the vision in each eye for distortion.
Refractive correction or low vision aids If bilateral low vision results, then low vision aids may be required such as high reading addition power, telescopes, hand magnifiers and closed circuit TV magnification systems.