Occult Subretinal New Vessels in Age-related Macular Degeneration. Natural History and Early Laser Treatment

Little information is available on the natural history and no data have been published on laser treatment for occult neovascularization in age-related macular degeneration. The visual and angiographic outcomes were analyzed in 156 patients (82 untreated eyes; 81 treated eyes) with occult neovascularization who were followed for 1 to 8 years. Early laser treatment decreased visual acuity to less than 20/200 in 31 of the treated eyes (38%) compared with 20 of the untreated eyes (25%). Three years after the onset of symptoms, 24 treated eyes (29%) and 31 eyes untreated eyes (38%) retained 20/50 visual acuity or better, whereas their respective initial visual acuities were not statistically different. Severe loss of vision (6 or more lines of visual acuity) occurred in 43 treated eyes (53%) and in 33 untreated eyes (40%) at the end of follow-up (range, 12-84 months). A slow and gradual increase of the disciform lesion was demonstrated on fluorescein angiography in 60 untreated eyes, with subfoveal involvement noted in 39 eyes at the end of follow-up. In the treated group, subfoveal involvement occurred in 53 eyes, after a relatively short time (mean, 4 months). Only 28 of the 81 treated eyes had successful anatomic results. These findings suggested that laser treatment of occult neovascularization immediately after the onset of symptoms should not be recommended.