OCTA and Exudative ARMD

72 year old white female with history of 12 PDT prior to 62 intravitreal injections right eye now followed by me with OCTA-Directed PDT Triple Therapy since 2015. She has had three treatments lasting an average of 8 months with maintenance of 20/80 vision.

She now has mild recurrent exudation and IVFA/ICG/OCT/OCTA was repeated.

As we know, IVFA offers little information in patients with Type 1 Occult CNV. The late ICG shows the presence of CNV. I have lectured extensively on how ICG shows the arteriolarized backbone of the CNV and how I used this information to target these vessels with PDT.

OCTA now shows these vessels more clearly. However, the size of the CNV is not clearly captured on the top image.

With a wider field image below, the size and extent of the CNV can now be appreciated.

Two questions:

1.      Do we really believe that anti-VEGF injections are “good enough” to treat this massive CNV with probable arteriolarized changes?

2.      Why are we using 21th century drugs with 20th century imaging?