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Editorial
Fluid-based prognostication in n-AMD: Type 3 macular neovascularisation needs an analysis in isolation
  1. Ashish Sharma1,
  2. Nikulaa Parachuri1,
  3. Nilesh Kumar1,
  4. Francesco Bandello2,
  5. Baruch D Kuppermann3,
  6. Anat Loewenstein4,
  7. Carl Regillo5,
  8. Usha Chakravarthy6
  1. 1 Lotus Eye Hospital and Institute, Coimbatore, TN, India
  2. 2 University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
  3. 3 Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
  4. 4 Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
  5. 5 The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
  6. 6 Center for Public Health, Queen's University of Belfast, Belfast, USA, USA
  1. Correspondence to Dr Ashish Sharma, Lotus Eye Hospital and Institute, Coimbatore 641014, TN, India; drashish79{at}hotmail.com

https://doi.org/10.1136/bjophthalmol-2020-318128

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    The antivascular endothelial growth factor agents have brought a paradigm shift in the treatment strategy of neovascular age-related macular degeneration (nAMD) by making the approach more interventional. Optical coherence tomography (OCT) is the critical clinical tool used for assessing the lesion activity and the need for therapy, and the presence of fluid is the key biomarker. We have noticed that there has been a lot of discussion and analysis to understand the fluid seen on spectral-domain OCT (SD-OCT) in the recent past. Most of the data and interpretation are based on the post hoc analysis of the Comparison of Age-Related Macular Degeneration Treatment Trials and VIEW 2 trials.1 2 Understanding the tolerance towards subretinal fluid (SRF) was demonstrated by the FLUID trial.3 The recent post hoc analysis of HARBOR trial measured the artificial intelligence-based fluid volume (IRF and SRF) and its prognostic value.4

    Common interpretation and perception on the basis of evidences described above say that intraretinal fluid (IRF) either at baseline or at any stage of the treatment is a sign of poor visual prognosis in the long term. On the contrary, some amount of SRF can be tolerated. Subretinal pigment epithelial (sub-RPE) fluid can also be carefully monitored if associated with good visual acuity. However, this may not be completely true for the entire spectrum of nAMD.

    Jung et al 5 reported the incidence of the three subtypes of neovascularisation in AMD with the use of SD-OCT. They found that type 3 macular neovascularisation (MNV) comprised 28%–34% of eyes with neovascular AMD which is much higher than what was …

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    Footnotes

    • Twitter @Dr Ashish Sharma, @tweet2nilesh

    • Contributors AS: conception, analysis, drafting, integrity check, final approval. NP, NK, FB, BDK, AL, CR and UC: drafting, revision, analysis, integrity check.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests AS—consultant: Novartis India, Allergan Global, Intas India, Bayer India. NP: none. NK: none. FB—consultant: Allergan, Bayer, Boehringer Ingelheim, Fidia Sooft, Hoffmann-La Roche, Novartis, NTC Pharma, Sifi, ThromboGenics, Zeiss. BDK—clinical research: Alcon, Alimera, Allegro, Allergan, Apellis, Clearside, Genentech, GSK, Ionis, jCyte, Novartis, Regeneron, ThromboGenics; consultant: Alimera, Allegro, Allergan, Cell Care, Dose, Eyedaptic, Galimedix, Genentech, Glaukos, Interface Biologics, jCyte, Novartis, Ophthotech, Regeneron, Revana, Theravance Biopharma. Dr Kuppermann acknowledges an unrestricted grant from Research to Prevent Blindness to the Gavin Herbert Eye Institute at the University of California, Irvine. AL—consultant: Allergan, Novartis, Roche, Notal Vision, FiorSightsLabs, Beyeonics, Bayer Healthcare. CR—consultant: Allergan, Chengdu Kanghong, Genentech/Roche, Novartis, Kodiak, Notal, Merck, Shire-Takeda, Adverum, Graybug, Eyepoint; research support: Allergan, Chengdu Kanghong, Genentech/Roche, Novartis, Kodiak, Iveric, Adverum. UC has received grants from the National Institute for Health Research and Novartis; personal fees from Allergan, Bayer, Novartis, and Roche; and is a data safety and monitoring board member for Bayer.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.