Texas Retina’s Dr. Ashkan Abbey recently discussed neovascular (wet) age-related macular degeneration (AMD) management on Vumedi, a video education and peer-to-peer learning platform for doctors and medical professionals.
Dr. Abbey’s video presentation focuses on using optical coherence tomography (OCT) to guide treatment strategies and how he thinks about anti-VEGF durability in everyday retina practice.
What is AMD?
AMD is one of the most common causes of vision loss in older adults. It affects the macula, the part of the retina responsible for sharp central vision used for reading and driving.
Wet AMD occurs when abnormal blood vessels develop beneath or within the retina. These vessels grow into areas where they do not belong, a process called neovascularization.
Once these abnormal vessels form, a signaling protein called vascular endothelial growth factor (VEGF) becomes a major driver of disease activity. VEGF promotes growth of the abnormal blood vessels, leading to fluid leakage or bleeding.
If left untreated, wet AMD can cause rapid vision loss.
How is AMD Treated?
Most patients with AMD receive anti-VEGF injections to suppress the abnormal blood vessel growth and leakage, and newer medications have made longer treatment intervals possible for many patients.
“Twelve-week intervals have become increasingly common, and some patients can successfully reach 16-week intervals,” says Dr. Abbey.
Today, many retina specialists favor a treat-and-extend approach for AMD. With this strategy:
- The disease is first brought under control.
- Treatment continues proactively.
- Injection intervals are gradually extended if the retina remains stable.
The goal is to maintain disease suppression while reducing unnecessary visits and injections. Rather than following a one-size-fits-all schedule, treatment is tailored to each patient’s individual disease behavior.
“Stable retinal anatomy can lead to extension of treatment intervals,” shares Dr. Abbey. “However, even patients who have successfully extended treatment may need more frequent visits if signs of activity return. OCT is central to our treat-and-extend approach, helping us individualize treatment intervals, detect subtle disease activity, and make more informed decisions for each patient.”
The Role of OCT in Managing Wet AMD
An OCT scan provides a detailed cross-sectional image of the retina and allows detection of disease activity long before vision noticeably changes. Because of this, it has become the primary tool used to determine whether treatment intervals should stay the same, be extended or be shortened.
Among the various OCT findings, intraretinal fluid, which is fluid trapped within the layers of the retina, is often considered the most concerning.
“Intraretinal fluid is a sign that the disease is not fully controlled,” explains Dr. Abbey. “If it is persistent or recurrent, this may prompt more frequent injections, shorter treatment intervals and consideration of switching to a different anti-VEGF medication.”
In contrast to intraretinal fluid, subretinal fluid is located beneath the retina rather than within it.
“Interestingly, a small amount of stable subretinal fluid may not be as harmful as intraretinal fluid,” comments Dr. Abbey. “In some patients with good vision and stable OCT findings, we may tolerate a small, unchanged amount of subretinal fluid while continuing to extend treatment intervals. However, the key word is stable. New or worsening subretinal fluid can indicate disease progression and the need for a more aggressive treatment schedule.”
Additional Imaging Tests Used to Monitor AMD
Although OCT is the primary tool used to monitor AMD, additional imaging tests, including fluorescein angiography (FA) and OCT angiography (OCTA), are sometimes used to provide additional information.
FA involves injecting a dye into the bloodstream and taking photographs as it travels through retinal blood vessels. It may be used when the diagnosis is uncertain, leakage needs confirmation, the type of lesion will affect treatment decisions, or there is suspicion that other conditions may be mimicking wet AMD.
OCTA is a newer, noninvasive imaging technique that can visualize abnormal blood vessel networks without using dye. It can be useful when disease activity is unclear; fluid is absent, but suspicion remains; or large pigment epithelial detachments are present.
“In some cases, OCTA can reveal a hidden or silent neovascular network before leakage develops,” says Dr. Abbey. “Finding such a network may lead us to monitor the eye more closely.”
The Need for Regular Monitoring
Because vision can remain stable even when AMD is becoming more active, regular monitoring is critical. By the time vision worsens, some damage may already be permanent. Regular OCT imaging helps detect subtle changes early, allowing treatment adjustments before significant vision loss occurs.
“Today’s anti-VEGF treatments have dramatically improved outcomes for patients with wet AMD, especially when therapy is guided by OCT imaging and individualized using a treat-and-extend approach,” shares Dr. Abbey. “As treatment options continue to evolve, durability becomes an increasingly important part of the conversation. For me, the goal remains the same: maintaining excellent disease control while thoughtfully reducing treatment burden whenever possible.”
Click HERE to access Dr. Abbey’s full video with a Vumedi account.