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Optometric Management

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Advanced AMD Monitoring Using OCT-A

OCT-A enables precise, long-term monitoring of non-exudative macular neovascularization in AMD.

By: Damon Dierker, OD, FAAO
Optometric Management November 6, 2025

Clinical Scorecard: Advanced AMD Monitoring Using OCT-A

At a Glance

CategoryDetail
ConditionNon-exudative macular neovascularization (NE-MNV) in age-related macular degeneration (AMD)
Key MechanismsDetection and monitoring of non-exudative type 1 neovascularization using OCT-A; risk of progression to exudation
Target PopulationPatients with intermediate AMD and diagnosed NE-MNV, typically older adults
Care SettingOphthalmology/optometry clinics with access to OCT and OCT-A imaging; supplemented by home monitoring

Key Highlights

  • OCT-A enables precise, long-term monitoring of NE-MNV in AMD patients.
  • Presence of NE-MNV increases 2-year risk of exudation by 13.6 times compared to eyes without lesions.
  • Observation is recommended; anti-VEGF therapy reserved for cases with exudation evidence.

Guideline-Based Recommendations

Diagnosis

  • Use OCT and OCT-A imaging to detect and monitor NE-MNV and assess for exudation.
  • Evaluate visual acuity and perform comprehensive ocular examination including intraocular pressure measurement.

Management

  • Recommend observation and regular monitoring for NE-MNV without exudation.
  • Continue nutritional supplementation with AREDS 2.
  • Initiate anti-VEGF therapy only if intraretinal or subretinal fluid indicating exudation is present.

Monitoring & Follow-up

  • Schedule follow-up every 4 to 6 months for chronic NE-MNV lesions.
  • Increase frequency of examinations and imaging if a new non-exudative lesion is detected.
  • Encourage compliance with home monitoring technologies such as ForeseeHome.

Risks

  • NE-MNV is a strong risk factor for future exudation and vision loss.
  • Conversion mechanisms from non-exudative to exudative MNV remain incompletely understood.

Patient & Prescribing Data

Older adults with intermediate AMD and diagnosed NE-MNV, including those with comorbidities like diabetes without retinopathy.

Stable NE-MNV may persist for years without exudation; home monitoring and AREDS 2 supplements support management; anti-VEGF reserved for exudative conversion.

Clinical Best Practices

  • Utilize OCT-A imaging for detailed assessment of NE-MNV size and stability.
  • Maintain patient compliance with home vision monitoring devices to detect early changes.
  • Adjust follow-up intervals based on lesion status: more frequent for new lesions, standard 4-6 months for chronic stable lesions.
  • Avoid premature anti-VEGF treatment in absence of exudation to potentially reduce risk of geographic atrophy.

References