Choroidal neovascularization (CNVM) associated with age-related macular degeneration (AMD) is the most common cause of legal blindness in patients over the age of 60. The neovascular lesions are usually composed of well-formed neovascularization and occult (less well-formed) neovascularization. While clinical trials have shown that some patients, mostly those with well-formed CNVM, may benefit from laser photocoagulation or photodynamic therapy, at present there is no treatment for patients who have combined CNVM lesions (both well-formed and occult) whose area of occult neovascularization is greater than 50% or who have other presentation of CNVM such as pigment-epithelial detachment or neovascular fibrosis. Retinal histopathology of patients with choroidal neovascularization has revealed that areas of CNVM are usually fed by a few smaller choroidal feeder vessels originating from the choroid or choriocapillaris. Therefore, it has been hypothesized that closure of these feeder vessels would infarct the large CNVM complex. Until recently, identification of these feeder vessels has been difficult but new high speed indocyanine imaging of the choroid (Phi-motion) indocyanine green angiography (ICG) has allowed for more precise detection of these vessels. This hypothesis is being tested in a clinical trial, ?Feasibility Study of the Identification and Treatment of Feeder-Vessels of Choroidal Neovascularization in Age-related Macular Degeneration, by utilizing Phi-motion ICG to identify choroidal feeder vessels in patients with CNVM not amenable to approved treatments. To date, approximately 15 patients with various forms of vascular AMD have been selected and in all patients feeder vessels were identified. Using the Iridex milli-pulse-diode laser, photocoagulation is being used to attempt closure of these vessels. This study is designed to provide information on the feasibility of standardizing this procedure and estimating its potential efficacy. Plans are underway to examine ways to increase the imaging, quantification and treatment of these feeder vessels. A collaboration has been established with CIT and an image analysis software program is being established for image capture enhancement, analysis and quantification.
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