Neovascular age-related macular degeneration presenting at extremities of age: a comparative study

Purpose: To compare the characteristics and response to treatment between patients with NVAMD presenting at the extremities of the AMD age spectrum. Methods: Fifty-four eyes of 47 patients were included in this retrospective study, divided by age at NVAMD presentation under 65 (n = 15) or over 85 (n = 39) years. All patients were initially treated with 3 monthly bevacizumab injections, followed by a PRN protocol. Clinical parameters and OCT characteristics were recorded and analyzed at presentation, after the initial 3 monthly injections and at 1 year. Results: At presentation, patients in the young group had significantly higher rates of subretinal fluid (p = 0.005), a polypoidal choroidal vasculopathy–like pattern (p < 0.01) and a history of smoking (p = 0.004). Submacular hemorrhage and pigment epithelial detachments were more common in young patients, and intraretinal fluid was more common in elderly patients (all with borderline statistical significance). VA improved significantly more in the younger patients at 3 months and 1 year (p = 0.001 and 0.002, respectively), despite similar treatment protocols and mean number of injections. Bilateral involvement at baseline was more common in elderly patients (p = 0.008). The differences in OCT characteristics between groups remained throughout the study period. Conclusion: There are considerable differences in the clinical manifestations and response to treatment between NVAMD patients at the extremities of the AMD age spectrum. Different pathophysiological, systemic, and genetic factors may play a role in such patients. [Figure not available: see fulltext.].