eMedicine Specialties > Ophthalmology > Retina

ARMD, Exudative: Differential Diagnoses & Workup

Author: Grant M Comer, MD, Vitreoretinal Service, Clinical Ophthalmologist, Kellogg Eye Center, University of Michigan
Coauthor(s): Thomas Ciulla, MD, Associate Professor, Department of Ophthalmology, Indiana University School of Medicine; Mark H Criswell, PhD, Director of Retina Service Research Laboratories, Assistant Research Professor, Department of Ophthalmology, Indiana University School of Medicine; Alon Harris, PhD, Lois Letzter Professor, Director of Glaucoma Research and Diagnostic Center, Department of Ophthalmology, Indiana University School of Medicine
Contributor Information and Disclosures

Updated: Jun 25, 2008

Differential Diagnoses

Angioid Streaks
Neovascular Membranes, Subretinal
ARMD, Nonexudative
Neovascularization, Choroidal
Chorioretinopathy, Central Serous
Presumed Ocular Histoplasmosis Syndrome
Choroidal Rupture
Retinal Detachment, Exudative
Melanoma, Choroidal
Multifocal Choroidopathy Syndromes

Other Problems to Be Considered

Myopic degeneration
Polypoidal choroidal vasculopathy
Basal laminar drusen with vitelliform macular detachment
Parafoveal telangiectasis

Workup

Laboratory Studies

No laboratory studies assist in the diagnosis of AMD.

Imaging Studies

After a thorough dilated examination of the fundus with slit lamp biomicroscopy, stereo color photography of the fundus, rapid-sequence fluorescein angiography (FA), and optical coherence tomography (OCT) are performed on many patients with signs and symptoms of exudative AMD.

FA is an office-based procedure to help identify and confirm the source of the CNV. During the procedure, fluorescein dye is injected intravenously and serial photographs of the retina are taken to document the progression of the dye through the choroidal and retinal vasculature. Abnormalities are identified in areas where the dye collects (hyperfluorescence) or is absent (hypofluorescence).

Findings on FA consistent with exudative AMD include the following: increasing hyperfluorescence secondary to dye leakage from the CNV and hypofluorescent blockage from subretinal hemorrhage. Additional findings consistent with any form of AMD include the following: hyperfluorescence of drusen and RPE atrophy and hypofluorescence from RPE hypertrophy. A disciform scar, which is the end stage of exudative AMD, is hyperfluorescent from fluorescein staining.

  • Depending on the distance from the foveal avascular zone, the leakage is classified as subfoveal, juxtafoveal (1-199 µm), or extrafoveal (200-250 µm).
  • CNV is sometimes defined as classic or occult based on the FA leakage pattern.
    • Classic CNV results in discrete and early hyperfluorescence with late leakage of fluorescein dye into the surrounding interstitial spaces.
    • Occult CNV is categorized into 2 basic forms, as follows: late leakage of undetermined source or fibrovascular PED. Both forms manifest as a region of ill-defined leakage in the early and late frames without a distinct source of leakage.
  • When a treatment other than a vascular endothelial growth factor (VEGF) inhibitor is planned, angiography is customarily performed within 72 hours of treatment because the morphology and resulting treatment parameters can evolve rapidly.

Indocyanine green (ICG) angiography can be performed as an adjunctive study in patients with subretinal hemorrhage, suspected retinal angiomatous proliferation, or polypoidal choroidal vasculopathy.

  • The near-infrared light (795-810 nm) absorbed by ICG tends to penetrate hemorrhage and RPE better than the shorter wavelength that is absorbed by fluorescein.
  • Unlike fluorescein, ICG is strongly bound to plasma proteins, which prevents diffusion of the compound through the normally fenestrated choroidal capillaries and improves delineation of choroidal detail.

Optical coherence tomography (OCT) is a useful noninvasive adjunct for identifying retinal and subretinal pathology secondary to CNV.

  • OCT provides a cross-sectional view of the retina with an axial resolution of about 10 µm. (Newer versions report a resolution to about 4 µm with 3-D capabilities.)
  • OCT can identify soft drusen, RPE detachments, subretinal and intraretinal fluid, CNV, and cystoid macular edema.36,37,38
  • OCT is useful for monitoring the therapeutic response to photodynamic therapy (PDT) and anti-VEGF therapy.39,38,40

More on ARMD, Exudative

Overview: ARMD, Exudative
Differential Diagnoses & Workup: ARMD, Exudative
Treatment & Medication: ARMD, Exudative
Follow-up: ARMD, Exudative
Multimedia: ARMD, Exudative
References
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References

  1. Kahn HA, Leibowitz HM, Ganley JP, Kini MM, Colton T, Nickerson RS, et al. The Framingham Eye Study. I. Outline and major prevalence findings. Am J Epidemiol. Jul 1977;106(1):17-32. [Medline].

  2. Attebo K, Mitchell P, Smith W. Visual acuity and the causes of visual loss in Australia. The Blue Mountains Eye Study. Ophthalmology. Mar 1996;103(3):357-64. [Medline].

  3. Klaver CC, Wolfs RC, Vingerling JR, Hofman A, de Jong PT. Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study. Arch Ophthalmol. May 1998;116(5):653-8. [Medline].

  4. Tielsch JM, Javitt JC, Coleman A, Katz J, Sommer A. The prevalence of blindness and visual impairment among nursing home residents in Baltimore. N Engl J Med. May 4 1995;332(18):1205-9. [Medline].

  5. Friedman DS, O'Colmain BJ, Munoz B, Tomany SC, McCarty C, de Jong PT, et al. Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol. Apr 2004;122(4):564-72. [Medline].

  6. Bird AC, Bressler NM, Bressler SB, Chisholm IH, Coscas G, Davis MD, et al. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol. Mar-Apr 1995;39(5):367-74. [Medline].

  7. Davis MD, Gangnon RE, Lee LY, Hubbard LD, Klein BE, Klein R, et al. The Age-Related Eye Disease Study severity scale for age-related macular degeneration: AREDS Report No. 17. Arch Ophthalmol. Nov 2005;123(11):1484-98. [Medline].

  8. Klein R, Peto T, Bird A, Vannewkirk MR. The epidemiology of age-related macular degeneration. Am J Ophthalmol. Mar 2004;137(3):486-95. [Medline].

  9. Edwards AO, Ritter R 3rd, Abel KJ, Manning A, Panhuysen C, Farrer LA. Complement factor H polymorphism and age-related macular degeneration. Science. Apr 15 2005;308(5720):421-4. [Medline].

  10. Haines JL, Hauser MA, Schmidt S, Scott WK, Olson LM, Gallins P, et al. Complement factor H variant increases the risk of age-related macular degeneration. Science. Apr 15 2005;308(5720):419-21. [Medline].

  11. Hageman GS, Anderson DH, Johnson LV. A common haplotype in the complement regulatory gene factor H (HF1/CFH) predisposes individuals to age-related macular degeneration. Proc Natl Acad Sci USA. 2005;102:7227-32.

  12. Jakobsdottir J, Conley YP, Weeks DE, Mah TS, Ferrell RE, Gorin MB. Susceptibility genes for age-related maculopathy on chromosome 10q26. Am J Hum Genet. Sep 2005;77(3):389-407. [Medline].

  13. Gold B, Merriam JE, Zernant J. Variation in factor B (BF) and complement component 2 (C2)genes is associated with age-related macular degeneration. Nat Genet. 2006;38:458-62.

  14. Johnson LV, Leitner WP, Staples MK, Anderson DH. Complement activation and inflammatory processes in Drusen formation and age related macular degeneration. Exp Eye Res. Dec 2001;73(6):887-96. [Medline].

  15. Esparza-Gordillo J, Soria JM, Buil A, Almasy L, Blangero J, Fontcuberta J. Genetic and environmental factors influencing the human factor H plasma levels. Immunogenetics. May 2004;56(2):77-82. [Medline].

  16. Sepp T, Khan JC, Thurlby DA, Shahid H, Clayton DG, Moore AT, et al. Complement factor H variant Y402H is a major risk determinant for geographic atrophy and choroidal neovascularization in smokers and nonsmokers. Invest Ophthalmol Vis Sci. Feb 2006;47(2):536-40. [Medline].

  17. Bressler NM, Bressler SB, Congdon NG, Ferris FL 3rd, Friedman DS, et al. Potential public health impact of Age-Related Eye Disease Study results: AREDS report no. 11. Arch Ophthalmol. Nov 2003;121(11):1621-4. [Medline].

  18. Thylefors B. A global initiative for the elimination of avoidable blindness. Am J Ophthalmol. Jan 1998;125(1):90-3. [Medline].

  19. Brody BL, Gamst AC, Williams RA, et al. Depression, visual acuity, comorbidity, and disability associated with age-related macular degeneration. Ophthalmology. Oct 2001;108(10):1893-900; discussion 1900-1. [Medline].

  20. Casten RJ, Rovner BW, Tasman W. Age-related macular degeneration and depression: a review of recent research. Curr Opin Ophthalmol. Jun 2004;15(3):181-3. [Medline].

  21. Coleman AL, Stone K, Ewing SK, Nevitt M, Cummings S, Cauley JA, et al. Higher risk of multiple falls among elderly women who lose visual acuity. Ophthalmology. May 2004;111(5):857-62. [Medline].

  22. Dong LM, Childs AL, Mangione CM, Bass EB, Bressler NM, Hawkins BS, et al. Health- and vision-related quality of life among patients with choroidal neovascularization secondary to age-related macular degeneration at enrollment in randomized trials of submacular surgery: SST report no. 4. Am J Ophthalmol. Jul 2004;138(1):91-108. [Medline].

  23. Sommer A, Tielsch JM, Katz J, Quigley HA, Gottsch JD, Javitt JC, et al. Racial differences in the cause-specific prevalence of blindness in east Baltimore. N Engl J Med. Nov 14 1991;325(20):1412-7. [Medline].

  24. Cruickshanks KJ, Klein R, Klein BE. Sunlight and age-related macular degeneration. The Beaver Dam Eye Study. Arch Ophthalmol. Apr 1993;111(4):514-8. [Medline].

  25. Das BN, Thompson JR, Patel R, Rosenthal AR. The prevalence of eye disease in Leicester: a comparison of adults of Asian and European descent. J R Soc Med. Apr 1994;87(4):219-22. [Medline].

  26. Miyazaki M, Nakamura H, Kubo M, Kiyohara Y, Oshima Y, Ishibashi T, et al. Risk factors for age related maculopathy in a Japanese population: the Hisayama study. Br J Ophthalmol. Apr 2003;87(4):469-72. [Medline].

  27. Klein R, Klein BE, Linton KL. Prevalence of age-related maculopathy. The Beaver Dam Eye Study. Ophthalmology. Jun 1992;99(6):933-43. [Medline].

  28. Klein R, Rowland ML, Harris MI. Racial/ethnic differences in age-related maculopathy. Third National Health and Nutrition Examination Survey. Ophthalmology. Mar 1995;102(3):371-81. [Medline].

  29. Kini MM, Leibowitz HM, Colton T, Nickerson RJ, Ganley J, Dawber TR. Prevalence of senile cataract, diabetic retinopathy, senile macular degeneration, and open-angle glaucoma in the Framingham eye study. Am J Ophthalmol. Jan 1978;85(1):28-34. [Medline].

  30. Leibowitz HM, Krueger DE, Maunder LR, Milton RC, Kini MM, Kahn HA, et al. The Framingham Eye Study monograph: An ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975. Surv Ophthalmol. May-Jun 1980;24:335-610. [Medline].

  31. Klein R, Klein BE, Jensen SC, Meuer SM. The five-year incidence and progression of age-related maculopathy: the Beaver Dam Eye Study. Ophthalmology. Jan 1997;104(1):7-21. [Medline].

  32. Seddon JM, Cote J, Davis N, Rosner B. Progression of age-related macular degeneration: association with body mass index, waist circumference, and waist-hip ratio. Arch Ophthalmol. Jun 2003;121(6):785-92. [Medline].

  33. Seddon JM, Ajani UA, Mitchell BD. Familial aggregation of age-related maculopathy. Am J Ophthalmol. Feb 1997;123(2):199-206. [Medline].

  34. Seddon JM, Willett WC, Speizer FE, Hankinson SE. A prospective study of cigarette smoking and age-related macular degeneration in women. JAMA. Oct 9 1996;276(14):1141-6. [Medline].

  35. Christen WG, Glynn RJ, Manson JE, Ajani UA, Buring JE. A prospective study of cigarette smoking and risk of age-related macular degeneration in men. JAMA. Oct 9 1996;276(14):1147-51. [Medline].

  36. Hee MR, Baumal CR, Puliafito CA, Duker JS, Reichel E, Wilkins JR, et al. Optical coherence tomography of age-related macular degeneration and choroidal neovascularization. Ophthalmology. Aug 1996;103(8):1260-70. [Medline].

  37. Ting TD, Oh M, Cox TA, Meyer CH, Toth CA. Decreased visual acuity associated with cystoid macular edema in neovascular age-related macular degeneration. Arch Ophthalmol. Jun 2002;120(6):731-7. [Medline].

  38. Sahni J, Stanga P, Wong D, Harding S. Optical coherence tomography in photodynamic therapy for subfoveal choroidal neovascularisation secondary to age related macular degeneration: a cross sectional study. Br J Ophthalmol. Mar 2005;89(3):316-20. [Medline].

  39. Rogers AH, Martidis A, Greenberg PB, Puliafito CA. Optical coherence tomography findings following photodynamic therapy of choroidal neovascularization. Am J Ophthalmol. Oct 2002;134(4):566-76. [Medline].

  40. Rosenfeld P, Rich RM, Lalwani GA. Ranibizumab: Phase II clinical trial results. Ophthalmology Clinics of North America. 2006;19:361-72.

  41. MPS Group. Macular Photocoagulation Study Group. Argon laser photocoagulation for senile macular degeneration. Results of a randomized clinical trial. Arch Ophthalmol. Jun 1982;100(6):912-8. [Medline].

  42. MPS Group. Macular Photocoagulation Study Group. Argon laser photocoagulation for neovascular maculopathy. Three-year results from randomized clinical trials. Arch Ophthalmol. May 1986;104(5):694-701. [Medline].

  43. MPS Group. Argon laser photocoagulation for neovascular maculopathy. Five-year results from randomized clinical trials. Macular Photocoagulation Study Group. Arch Ophthalmol. Aug 1991;109(8):1109-14. [Medline].

  44. MPS Group. Macular Photocoagulation Study Group. Five-year follow-up of fellow eyes of patients with age-related macular degeneration and unilateral extrafoveal choroidal neovascularization. Arch Ophthalmol. Sep 1993;111(9):1189-99. [Medline].

  45. Freund KB, Yannuzzi LA, Sorenson JA. Age-related macular degeneration and choroidal neovascularization. Am J Ophthalmol. Jun 15 1993;115(6):786-91. [Medline].

  46. Moisseiev J, Alhalel A, Masuri R, Treister G. The impact of the macular photocoagulation study results on the treatment of exudative age-related macular degeneration. Arch Ophthalmol. Feb 1995;113(2):185-9. [Medline].

  47. Nishijima K, Takahashi M, Akita J, Katsuta H, Tanemura M, Aikawa H, et al. Laser photocoagulation of indocyanine green angiographically identified feeder vessels to idiopathic polypoidal choroidal vasculopathy. Am J Ophthalmol. Apr 2004;137(4):770-3. [Medline].

  48. Shiraga F, Ojima Y, Matsuo T, Takasu I, Matsuo N. Feeder vessel photocoagulation of subfoveal choroidal neovascularization secondary to age-related macular degeneration. Ophthalmology. Apr 1998;105(4):662-9. [Medline].

  49. Reichel E, Musch DC, Blodi BA. Results from the TTT4CNV clinical trial. Invest Ophthalmol Vis Sci. 2005;46:E-abstract 2311.

  50. Aveline B, Hasan T, Redmond RW. Photophysical and photosensitizing properties of benzoporphyrin derivative monoacid ring A (BPD-MA). Photochem Photobiol. Mar 1994;59(3):328-35. [Medline].

  51. Allison BA, Waterfield E, Richter AM, Levy JG. The effects of plasma lipoproteins on in vitro tumor cell killing and in vivo tumor photosensitization with benzoporphyrin derivative. Photochem Photobiol. Nov 1991;54(5):709-15. [Medline].

  52. Hunt DW, Jiang H, Granville DJ, Chan AH, Leong S, Levy JG. Consequences of the photodynamic treatment of resting and activated peripheral T lymphocytes. Immunopharmacology. Jan 1999;41(1):31-44. [Medline].

  53. Novartis Ophthalmics. Visudyne launched in Japan for treatment of age-related macular degeneration [Novartis Web site]. May 10, 2004. Available at: http://www.us.novartisophthalmics.com/hcp/press-release/Visodyne_E_10.05.pdf. Accessed October 15, 2004.:[Full Text].

  54. Blumenkranz MS, Bressler NM, Bressler SB, Donati G, Fish GE, Haynes LA, et al. Verteporfin therapy for subfoveal choroidal neovascularization in age-related macular degeneration: three-year results of an open-label extension of 2 randomized clinical trials--TAP Report no. 5. Arch Ophthalmol. Oct 2002;120(10):1307-14. [Medline].

  55. Tolentino MJ, Brucker AJ, Fosnot J, Ying GS, Wu IH, Malik G, et al. Intravitreal injection of vascular endothelial growth factor small interfering RNA inhibits growth and leakage in a nonhuman primate, laser-induced model of choroidal neovascularization. Retina. Feb 2004;24(1):132-8. [Medline].

  56. Tolentino MJ, Husain D, Theodosiadis P, Gragoudas ES, Connolly E, Kahn J, et al. Angiography of fluoresceinated anti-vascular endothelial growth factor antibody and dextrans in experimental choroidal neovascularization. Arch Ophthalmol. Jan 2000;118(1):78-84. [Medline].

  57. Gragoudas ES, Adamis AP, Cunningham ET Jr, Feinsod M, Guyer DR. Pegaptanib for neovascular age-related macular degeneration. N Engl J Med. Dec 30 2004;351(27):2805-16. [Medline].

  58. Eyetech Pharmaceuticals. Eyetech announces launch date for Macugen (pegaptanib sodium injection) [Eyetech Web site]. January 20, 2005. Available at: http://media.corporate-ir.net/media_files/irol/13/134799/newspdfs/1-20-05.pdf. Accessed June 27, 2005. [Full Text].

  59. Eyetech Pharmaceuticals. Pfizer and Eyetech provide regulatory update on Macugen (pegaptanib sodium injection) [Eyetech Web site]. September 20, 2004. Available at: http://media.corporate-ir.net/media_files/irol/13/134799/newspdfs/9-20-04-Update.pdf. Accessed October 12, 2004. [Full Text].

  60. Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. Oct 5 2006;355(14):1432-44. [Medline].

  61. Genetech Press Release. Preliminary Results from a Phase IIIb Study Showed Patients with Wet AMD Treated with Lucentis Quarterly Experienced a 16-Letter Benefit over the Control Group at One Year. Available at http://www.gene.com/gene/news/press-releases/display.do?method=detail&id=9747. Accessed 2/21/2008.

  62. Fung AE, Lalwani GA, Rosenfeld PJ, Dubovy SR, Michels S, Feuer WJ. An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol. Apr 2007;143(4):566-83. [Medline].

  63. Genentech. Avastin [Genentech Web site]. Available at: http://www.gene.com/gene/products/information/oncology/avastin/index.jsp. Accessed June 28, 2005. [Full Text].

  64. Michels S, Rosenfeld PJ, Puliafito CA, et al. Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration twelve-week results of an uncontrolled open-label clinical study. Ophthalmology. Jun 2005;112(6):1035-47. [Medline].

  65. Rosenfeld PJ, Moshfeghi AA, Puliafito CA. Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging. Jul-Aug 2005;36(4):331-5. [Medline].

  66. Yoganathan P, Deramo VA, Lai JC, Tibrewala RK, Fastenberg DM. Visual improvement following intravitreal bevacizumab (Avastin) in exudative age-related macular degeneration. Retina. Nov-Dec 2006;26(9):994-8. [Medline].

  67. Emerson MV, Lauer AK, Flaxel CJ, Wilson DJ, Francis PJ, Stout JT. Intravitreal bevacizumab (Avastin) treatment of neovascular age-related macular degeneration. Retina. Apr-May 2007;27(4):439-44. [Medline].

  68. Abraham-Marin ML, Cortes-Luna CF, Alvarez-Rivera G, Hernandez-Rojas M, Quiroz-Mercado H, Morales-Canton V. Intravitreal bevacizumab therapy for neovascular age-related macular degeneration: a pilot study. Graefes Arch Clin Exp Ophthalmol. May 2007;245(5):651-5. [Medline].

  69. Bashshur ZF, Schakal A, Hamam RN, El Haibi CP, Jaafar RF, Noureddin BN. Intravitreal bevacizumab vs verteporfin photodynamic therapy for neovascular age-related macular degeneration. Arch Ophthalmol. Oct 2007;125(10):1357-61. [Medline].

  70. Lazic R, Gabric N. Verteporfin therapy and intravitreal bevacizumab combined and alone in choroidal neovascularization due to age-related macular degeneration. Ophthalmology. Jun 2007;114(6):1179-85. [Medline].

  71. Dhalla MS, Shah GK, Blinder KJ, Ryan EH Jr, Mittra RA, Tewari A. Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration. Retina. Nov-Dec 2006;26(9):988-93. [Medline].

  72. Augustin AJ, Puls S, Offermann I. Triple therapy for choroidal neovascularization due to age-related macular degeneration: verteporfin PDT, bevacizumab, and dexamethasone. Retina. Feb 2007;27(2):133-40. [Medline].

  73. Bressler NM, Bressler SB, Childs AL, Haller JA, Hawkins BS, Lewis H, et al. Surgery for hemorrhagic choroidal neovascular lesions of age-related macular degeneration: ophthalmic findings: SST report no. 13. Ophthalmology. Nov 2004;111(11):1993-2006. [Medline].

  74. Hawkins BS, Bressler NM, Miskala PH, Bressler SB, Holekamp NM, Marsh MJ, et al. Surgery for subfoveal choroidal neovascularization in age-related macular degeneration: ophthalmic findings: SST report no. 11. Ophthalmology. Nov 2004;111(11):1967-80. [Medline].

  75. Bressler NM. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: two-year results of 2 randomized clinical trials-tap report 2. Arch Ophthalmol. Feb 2001;119(2):198-207. [Medline].

  76. Drexler W, Sattmann H, Hermann B, Ko TH, Stur M, Unterhuber A, et al. Enhanced visualization of macular pathology with the use of ultrahigh-resolution optical coherence tomography. Arch Ophthalmol. May 2003;121(5):695-706. [Medline].

  77. Hageman GS, Luthert PJ, Victor Chong NH, Johnson LV, Anderson DH, et al. An integrated hypothesis that considers drusen as biomarkers of immune-mediated processes at the RPE-Bruch's membrane interface in aging and age-related macular degeneration. Progress in Retinal and Eye Research. November 2001;20:705-32.

  78. Johnson TM, Glaser BM. Focal laser ablation of retinal angiomatous proliferation. Retina. Sep 2006;26(7):765-72. [Medline].

  79. Klein RJ, Zeiss C, Chew EY, Tsai JY, Sackler RS, Haynes C, et al. Complement factor H polymorphism in age-related macular degeneration. Science. Apr 15 2005;308(5720):385-9. [Medline].

  80. MPS Group. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions of age-related macular degeneration. Updated findings from two clinical trials. Arch Ophthalmol. Sep 1993;111(9):1200-9. [Medline].

  81. MPS Group. Macular Photocoagulation Study Group. Recurrent choroidal neovascularization after argon laser photocoagulation for neovascular maculopathy. Arch Ophthalmol. Apr 1986;104(4):503-12. [Medline].

  82. MPS Group. Macular Photocoagulation Study Group. Subfoveal neovascular lesions in age-related macular degeneration. Guidelines for evaluation and treatment in the macular photocoagulation study. Arch Ophthalmol. Sep 1991;109(9):1242-57. [Medline].

  83. National Eye Institute. Comparison of Age-Related Macular Degeneration Treatment Trial (CATT). ClinicalTrials.gov. Available at http://clinicaltrials.gov/ct2/show/NCT00593450?term=ranibizumab+and+bevacizumab&rank=3. Accessed 2/21/2008.

  84. [Best Evidence] Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. Oct 5 2006;355(14):1419-31. [Medline].

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Further Reading

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Keywords

exudative ARMD, age-related macular degeneration, AMD, age-related maculopathy, ARM, macular degeneration, choroidal neovascularization, choroidal neovascular membrane, CNVM, CNV, vision loss

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Contributor Information and Disclosures

Author

Grant M Comer, MD, Vitreoretinal Service, Clinical Ophthalmologist, Kellogg Eye Center, University of Michigan
Grant M Comer, MD is a member of the following medical societies: American Academy of Ophthalmology, Michigan Society of Eye Physicians & Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas Ciulla, MD, Associate Professor, Department of Ophthalmology, Indiana University School of Medicine
Thomas Ciulla, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Mark H Criswell, PhD, Director of Retina Service Research Laboratories, Assistant Research Professor, Department of Ophthalmology, Indiana University School of Medicine
Mark H Criswell, PhD is a member of the following medical societies: Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Alon Harris, PhD, Lois Letzter Professor, Director of Glaucoma Research and Diagnostic Center, Department of Ophthalmology, Indiana University School of Medicine
Alon Harris, PhD is a member of the following medical societies: American College of Sports Medicine, American Physiological Society, American Society for Laser Medicine and Surgery, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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