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A Real-World Study

Roberts, Philipp K. MD*,†; Nesper, Peter L. BA*; Gill, Manjot K. MD*; Fawzi, Amani A. MD*

doi: 10.1097/IAE.0000000000001400
Original Study

Purpose: To perform a quantitative study of the vascular microstructure in actively treated choroidal neovascularization by optical coherence tomographic angiography.

Methods: Patients undergoing individualized anti–vascular endothelial growth factor therapy of minimum 12 months duration were included in this cross-sectional observational study and imaged using optical coherence tomographic angiography. En face optical coherence tomographic angiography images were analyzed for quantitative features, such as junction density, vessel length, and lacunarity using validated software (Angiotool). Patients were divided into 2 groups depending on their individualized treatment interval: “good responders, treated less frequently than 6 weeks” versus “poor responders, treated every 6 weeks or more frequently.” Nonparametric testing was used to assess differences between these groups.

Results: Twenty-five eyes of 23 consecutive patients with a median 58-month history of choroidal neovascularization, treated by median of 34 anti–vascular endothelial growth factor injections, were included in the analysis. There was no significant difference between any of the microvascular choroidal neovascularization features between the 2 groups (P > 0.05).

Conclusion: The semiautomated vessel segmentation software provides an objective and quantitative approach for choroidal neovascularization characterization. The consistently nonsignificant outcomes between the groups may provide evidence to support the “normalization hypothesis.” This would suggest that regardless of treatment interval, individualized therapy in these eyes established vessel stability.

In this study, the authors used optical coherence tomographic angiography to quantitatively analyze microvascular characteristics of choroidal neovascularization with poor and good response to treatment.

*Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and

Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

Reprint requests: Amani A. Fawzi, MD, Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue #440, Chicago, IL 60611; e-mail:

Research instrument support was provided by Optovue, Inc, Fremont, CA. This work was partly supported by NIH DP3DK108248 (AAF).

None of the authors has any conflicting interests to disclose.

© 2017 by Ophthalmic Communications Society, Inc.