Occult choroidal neovascularization in age-related macular degeneration - A natural history study

Objective: To explore morphological and vision changes in untreated eyes with subfoveal choroidal neovascularization (CNV) that have poorly demarcated boundaries. Design: Analysis of photographs of untreated patients with poorly demarcated occult CNV participating in a prospective clinical trial evaluating laser treatment compared with observation. Setting: Two tertiary retinal referral centers. Patients: Symptomatic individuals with poorly demarcated subfoveal occult CNV associated with age-related macular degeneration. Main Outcome Measures: Change in size of lesion, development of classic CNV, change in vision, and development of subretinal fibrosis. Results: During follow-up (9-12 months), 32% of the occult choroidal neovascular lesions more than doubled their original size. Classic CNV developed in 52% of eyes that started without it. The median loss in visual acuity was 2.5 lines. Eyes with classic CNV or subretinal blood or both at baseline developed subretinal fibrosis more frequently and lost more visual acuity, but not to a statistically significant degree. Conclusions: The morphological changes of eyes with subfoveal occult CNV in which the boundaries are poorly demarcated is variable; the presence of subretinal blood or a component of classic CNV may influence the prognosis for further loss of vision.