Implication of Recurrent or Retained Fluid on Optical Coherence Tomography for Visual Acuity During Active Treatment of Neovascular Age-Related Macular Degeneration With a Treat and Extend Protocol

Abstract

During ranibizumab treatment, vision can decrease without signs of fluid. When fluid is present, IRF is associated with poorer vision. New occurrence of any fluid on optical coherence tomography is likely to lead to vision loss, but small amounts of persistent fluid can be tolerated without compromising vision.

Dietary zinc intake is associated with macular fluid in neovascular age‐related macular degeneration

“…Our study found that decreased dietary zinc intakes were associated with a greater likelihood of the presence of SRF in nAMD patients. New‐onset IRF or SRF correlates with loss of vision but a small amount of persistent fluid can be tolerated, particularly SRF, without deteriorating visual outcomes . While SRF indicates a positive prognosis in comparison to IRF and the 24‐month results from the FLUID study similarly showed that some amount of SRF can be tolerated with regard to VA, SRF activity is still widely used as criteria for re‐treatment .…”

To dry or not too dry: should we be more tolerant of stable subretinal fluid in patients receiving anti‐vascular endothelial growth factor treatment for neovascular age‐related macular degeneration?

“…Rather, they may represent chronic, degenerative changes or potential anatomical spaces . The latest evidence indicates that small volumes of stable sub‐retinal fluid (SRF) may be tolerable and even protective in nAMD . This suggests a paradigm shift whereby, in simple terms, ‘not all retinal fluid is bad, nor needs to be got rid of’.…”

“…Because VEGF is important in the normal function of the retina, choriocapillaris and RPE, excessive blocking of VEGF could affect the onset and growth of GA. The presence of SRF between the retina and choriocapillaris may possibly protect against the development of GA as well . The imperative is therefore to develop an evidence‐based protocol to test this hypothesis.…”

“…10 The latest evidence indicates that small volumes of stable sub-retinal fluid (SRF) may be tolerable and even protective in nAMD. 11 This suggests a paradigm shift whereby, in simple terms, 'not all retinal fluid is bad, nor needs to be got rid of'. The implication is that fewer anti-VEGF treatments may be needed for selected patients with nAMD, which could substantially reduce the treatment burden at the population level.…”

“…The presence of SRF between the retina and choriocapillaris may possibly protect against the development of GA as well. 11,16 The imperative is therefore to develop an evidencebased protocol to test this hypothesis.…”