Treatment Paradigms in AMD Management: Assessing Consistent Long-Term Dosing - Part 2

Dr. Clark: We use fluorescein angiography (FA) to identify CNV membranes, but can it be used to predict outcomes or how patients will respond to treatment?

Dr. Eichenbaum: I use liquid angiography less than I used to. I do get a traditional FA on all new wet AMD patients. I think that the angiographic findings have some predictive value for injection burden, anatomic response, and visual response. I do not talk to individual patients about my predictions for their lesions based on the angiographic findings because they are variable; each patient responds differently. A true type-2, well-defined classic lesion that is clear on angiography, however, is likely to respond faster and require less overall burden of care than a large, poorly defined, predominantly occult lesion. Obviously there is no hard-and-fast rule, and I do not think we can depend on the pr-treatment angiogram to give us a sensitive and specific predictor of response. But, it can inform our own “internal monologue” in each case.

Dr. Clark: How are you using OCT angiography for diagnosis and for any predictors of a treatment response?

Dr. Kaiser: We have not learned enough from OCT angiography to determine the imaging biomarkers that would allow us to make outcome predictions. It is too new. Similar to Dr. Eichenbaum, I still get an FA at baseline. I think it is an important tool in predicting how often a patient will need treatment, and there is some predictive value in knowing if it is a type 1, 2, or 3 lesion. As OCT angiography improves, however, we will use fluorescein angiography less and less in the future.

Dr. Clark: Would anyone repeat the angiogram after baseline?

Dr. Kaiser: It is rare for me to repeat the angiogram after baseline. I may consider repeating it in a nonresponder or a patient who isn’t responding like I expected. Usually at that point, however, an ICG angiogram would give me more information than a fluorescein angiogram.