Incidence and Risk Factors of Visual Impairment in Patients with Angioid Streaks and Macular Neovascularization

Maria Vittoria Cicinelli*, Edoardo Torrioli, Lamberto La Franca, Hitesh Agrawal, Daniel Barthelmes, Jay Chhablani, Itay Chowers, Nastasia Foa, Michaella Goldstein, Ahmad Mansour, Raheeba Pakeer Muhammed, Sobha Sivaprasad, Manuel A.P. Vilela, Sandrine Zweifel, Francesco Bandello, Maurizio Battaglia Parodi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: To estimate the incidence and risk factors of visual impairment and complications in eyes with macular neovascularization (MNV) because of angioid streaks (ASs). Design: Longitudinal multicenter retrospective cohort study. Subjects: Patients with AS-associated MNV treated with anti-VEGF agents and a follow-up of > 3 months. Methods: Clinical and MNV characteristics were collected at baseline. Visual acuity (VA) values and the presence of atrophy or fibrosis were collected at each visit. Main Outcome Measures: Rate of VA change over time and associated factors; the incidence rate of moderate-to-severe visual impairment (MSVI) and blindness and hazard ratio (HR) of candidate risk factors for MSVI; the incidence rate of fibrosis and macular atrophy. Results: Overall, 84 eyes of 66 patients (39 men, 58%) with a mean (standard deviation) age of 55.7 (13.8) years were followed for a mean (standard deviation) of 67.7 (48.5) months. The median number of anti-VEGF doses per eye was 13. The average rate (95% confidence interval [CI]) of visual loss was +0.04 (0.02–0.06) logarithm of the minimum angle of resolution/year (P < 0.001); the visual loss was faster in nonnaive eyes (P = 0.007) and those with better baseline VA (P < 0.001); it was slower in eyes with pattern dystrophy–like features (P = 0.04). The incidence rates (95% CI) of MSVI and blindness were 10.4 (6.88–15)/100-eye-years and 2.33 (1.12–4.29)/100-eye-years. A higher number of injections (HR [95% CI] = 0.45 [0.19–0.94] for receiving ≥ 13 injections vs. < 13; P = 0.03) was protective against MSVI. The incidence rates (95% CI) of fibrosis and macular atrophy were 24.1 (17.5–32.3)/100-eye-years and 14.3 (10.1–19.6)/100-eye-years. Conclusions: Eyes with MNV-related AS had a high rate of visual impairment and propensity to macular fibrosis and atrophy. A higher number of injections yielded better chances of maintaining good VA, suggesting the need for intensive treatment. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Original languageEnglish
Pages (from-to)431-440
Number of pages10
JournalOphthalmology Retina
Issue number5
StatePublished - May 2023


  • Angioid streaks
  • Long-term follow-up
  • Macular atrophy
  • Macular fibrosis
  • Risk factors


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