Choroidal neovascularization (CNV) 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. At present, approved therapies for CNV include photodynamic therapy and intravitreal injection of Macugen. However, both these therapies result only in a slowing of vision loss. Retinal histopathology of patients with choroidal neovascularization has revealed that areas of CNV 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 CNV 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 was 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 CNV not amenable to approved treatments. Recruitment of all 20 patients with various forms of vascular AMD and a 2 year follow-up period is now complete. In all enrolled patients, feeder vessels were identified. Using the Iridex milli-pulse-diode laser or a Coherent milli-pulsed yellow/green laser, photocoagulation was performed on all these patients in an attempt to close these vessels. To aid in this study, the Center for Information Technology at the NIH was recruited to develop image software which allowed for image enhancement for easier identification of the vessels and image registration to localized the precise site of treatment on a visible color fundus photograph. """"""""Image Analysis Software for Ophthalmology"""""""" has been further updated is now being routinely used in the study. Results of this study are now being analyzed.
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