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Based on the success of intravitreal therapies targeting vascular endothelial growth factor,1–3 some of which suggested efficacy independent of lesion subtype,3 we investigated the benefit and safety of pegaptanib sodium in patients with early neovascular age-related macular degeneration (NV-AMD) versus those with established lesions.4
PERSPECTIVES (NCT00327470) was a 102-week, open-label trial. Participants aged ≥50 years with evidence of NV-AMD in at least one eye, clear ocular media and a visual acuity >25 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters, and a lesion <12 disc areas were eligible (see supplemental data, figure 1). Using an algorithm reflecting function and morphology, we characterised lesions as early when (a) the baseline visual acuity was ≥54 ETDRS letters and (b) on angiography with neovascularisation classified as occult with no classic or occult with classic consisting of <50% of lesion area, with no retinal haemorrhage, lipid exudation, or retinal pigment epithelial (RPE) detachment. Lesions were classified as established when classic neovascularisation comprised ≥50% of lesion area or if retinal haemorrhage, lipid exudation, or RPE detachment were present even if classic constituted <50% of lesion area.