News and Announcements

Last year, Dr. Amani Fawzi’s group published an innovative study to examine a phenomenon that they were the first to recognize – they observed an unusual, multi-layered pattern of abnormal neovascularization in some patients with wet age-related macular degeneration (AMD). Their goal was to understand whether the unusual and complex phenotype of these membranes had any implications with respect to the response to anti-VEGF therapy. They discovered that these complex neovascular lesions were harder to treat than the ones that were simple, and single-layered. Dr. Fawzi believes this finding provides a framework for the development of a method to prognosticate the outcomes of anti-VEGF treatment. Based on these findings, eyes that harbor these complex three-dimensional vascular lesions are likely to require more frequent anti-VEGF injections compared to eyes that have simpler monolayer neovascular membranes. This provides important guidance to clinicians and patients and may allow us to simplify the treatment algorithm for patients that have more responsive (less complex) neovascular lesions.

To do this study, a talented MD/PhD student, Brian Soetikno, adapted a recently described algorithm to remove the vascular artifacts from the OCT angiography images. This algorithm allowed the removal of all extraneous signals that do not originate within the neovascular lesions, including the normal overlying retinal vasculature that would otherwise appear to artifactually be within these neovascular lesions. Once Dr. Fawzi’s group was able to obtain an unadulterated image of the neovascular lesions without the extraneous artifacts, they were able to analyze their thickness as well as the number of vascular layers within them.

The investigators divided their patient population into those that required monthly anti-VEGF injections for optimal control of their neovascularization and those that were able to remain quiescent with extension of their treatment intervals beyond 6 weeks. Using this approach, they found that eyes needing frequent anti-VEGF therapy were more likely to have the complex multilayered neovascular lesions. As shown in this video, these lesions are quite intricate and definitely more complex than those with a single layer of vasculature, suggesting these complex vessels were more aggressively proliferating and therefore more leaky. Dr. Fawzi believes that sticky and stiff proteins leak and accumulate around this vasculature forming the necessary “scaffolds” for these vascular layers to extend.

This research is now publically available, as open access, as

Nesper, Soetikno, Treister and Fawzi. Volume-Rendered Projection-Resolved OCT Angiography: 3D Lesion Complexity Is Associated With Therapy Response in Wet Age-Related Macular Degeneration. Investigative Ophthalmology & Visual Science April 2018, Vol.59, 1944-1952. doi:10.1167/iovs.17-23361

The volume-rendered videos are available at this LINK, under supplementary material.