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Al-Sheikh, Mayss MD*,†; Iafe, Nicholas A. MD; Phasukkijwatana, Nopasak MD, PhD†,‡; Sadda, SriniVas R. MD*; Sarraf, David MD‡,§

doi: 10.1097/IAE.0000000000001628
Original Study

Purpose: To study the qualitative and quantitative features of choroidal neovascular (NV) membranes in age-related macular degeneration using optical coherence tomography angiography in patients with active and quiescent NV lesions before and after treatment with anti–vascular endothelial growth factor.

Methods: Macular optical coherence tomography angiography images were obtained using RTVue XR Avanti with AngioVue. Morphologic features and quantitative measurements of the NV lesion were analyzed using en face projection images. The NV lesion was subdivided into inner segment and outer fringe for further fractal dimension analysis.

Results: In a series of 31 eyes, 11 eyes with active NV lesions at baseline and after consecutive follow-up after treatment with anti–vascular endothelial growth factor therapy and 20 eyes with quiescent NV lesions were included in this study. Morphologically, all the quiescent NV lesions versus 63.6% of the active NV lesions demonstrated a prominent central vessel and active leasions demonstrated a greater rate of small vessels branching (82%) and peripheral arcades (82%) than quiescent lesions (30% and 40% respectively) and this was statistically significant. The lesion area and vessel density was not statistically significantly different after treatment or versus quiescent lesions although the latter lesions were reduced in area. Lesion pattern complexity measured by the fractal dimension was statistically significantly lower in the inner part of the lesion after treatment and statistically significantly lower in the total lesion of the quiescent NV compared with the active NV.

Conclusion: Optical coherence tomography angiography is a new, noninvasive imaging modality that can be used to perform qualitative and quantitative analyses of NV lesions. In the future, OCT angiography may provide biomarkers of activity and guide the evaluation and treatment and monitoring of neovascularization in age-related macular degeneration.

The authors evaluated the structural features of active neovascularization before and after treatment versus inactive or quiescent neovascularization secondary to age-related macular degeneration using qualitative and quantitative OCT angiography. Active lesions showed similar morphologic and quantitative features before and after treatment but quiescent lesions differed qualitatively and quantitatively compared with active neovascularization.

*Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California;

Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California;

Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; and

§Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.

Reprint requests: David Sarraf, MD, Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, UCLA, 100 Stein Plaza, Los Angeles, CA 90095; e-mail:

D. Sarraf is a consultant and speaker for Optovue and consultant for Bayer and Genentech and receives research support from Allergan, Heidelberg, Regeneron, Genentech, and Optovue. S. R. Sadda is a consultant for Optos, Carl Zeiss Meditec, Allergan, Genentech, Regeneron, Bayer, Novartis, Iconic and receives research support from Optos, Carl Zeiss Meditec, Allergan, and Genentech. The remaining authors have no financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.