Neovascular age-related macular degeneration presenting at extremities of age: a comparative study
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Neovascular age-related macular degeneration presenting at extremities of age: a comparative study Alexander Rubowitz 1,2 & Saleh Esa 1 & Maayan Fradkin 1 & Elad Moisseiev 1,2 Received: 16 May 2020 / Revised: 16 July 2020 / Accepted: 10 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To compare the characteristics and response to treatment between patients with NVAMD presenting at the extremities of the AMD age spectrum. Methods Fifty-four eyes of 47 patients were included in this retrospective study, divided by age at NVAMD presentation under 65 (n = 15) or over 85 (n = 39) years. All patients were initially treated with 3 monthly bevacizumab injections, followed by a PRN protocol. Clinical parameters and OCT characteristics were recorded and analyzed at presentation, after the initial 3 monthly injections and at 1 year. Results At presentation, patients in the young group had significantly higher rates of subretinal fluid (p = 0.005), a polypoidal choroidal vasculopathy–like pattern (p < 0.01) and a history of smoking (p = 0.004). Submacular hemorrhage and pigment epithelial detachments were more common in young patients, and intraretinal fluid was more common in elderly patients (all with borderline statistical significance). VA improved significantly more in the younger patients at 3 months and 1 year (p = 0.001 and 0.002, respectively), despite similar treatment protocols and mean number of injections. Bilateral involvement at baseline was more common in elderly patients (p = 0.008). The differences in OCT characteristics between groups remained throughout the study period. Conclusion There are considerable differences in the clinical manifestations and response to treatment between NVAMD patients at the extremities of the AMD age spectrum. Different pathophysiological, systemic, and genetic factors may play a role in such patients. Keywords Age-related macular degeneration . Elderly. Extremities of age . Neovascular . Presentation . Young
Introduction Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the population over 50 years of age [1], and neovascular AMD (NVAMD) is responsible for up to 90% of severe vision loss due to AMD [2, 3]. The incidence of AMD rises with age, and the disease affects more than 30% of the population over 75 years of age [4]. As the global trends of population growth and aging continue to increase, the number of patients with AMD is expected to rise
* Elad Moisseiev [email protected] 1
Department of Ophthalmology, Meir Medical Center, 59 Tshernichovsky St., 4428164 Kfar Saba, Israel
2
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
by 15% or more over the next 20 years, making this condition a significant health burden [5, 6]. Although considered a disease of the aging population, it still affects patients in a wide age spectrum, spanning the decades from 50 to over 100 years of age. Relatively few prior works have focused on the differences between
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