Vascular endothelial growth factor inhibitor use and treatment approach for choroidal neovascularization secondary to pathologic myopia

ABSTRACT

Introduction: Myopic choroidal neovascularization (CNV) is the most common cause of CNV in those under 50 years of age. It is a significant cause of visual loss in those with pathologic myopia. The current standard of care involves therapy with intravitreal inhibitors of vascular endothelial growth factor (VEGF).

Areas Covered: The epidemiology of myopia, high myopia, pathologic myopia, and myopic CNV is reviewed, along with a brief discussion of historical treatments. The pharmacology of the three most commonly used anti-VEGF agents is discussed, with an emphasis on the licensed drugs, ranibizumab and aflibercept. A comprehensive clinical approach to diagnosis and treatment of myopic CNV is presented.

Expert Opinion: The current standard of care for myopic CNV is intravitreal inhibition of VEGF, with ranibizumab and aflibercept licensed for intraocular use. The diagnosis, OCT features of disease activity and retreatment algorithm for myopic CNV is different from wet age-related macular degeneration. In the long-term, myopic CNV may be associated with gradual, irreversible visual loss due to progressive chorioretinal atrophy, for which there is currently no treatment.

KEYWORDS:

• Aflibercept
• anti-VEGF
• chorioretinal atrophy
• choroidal neovascularization
• myopia
• pathologic myopia
• ranibizumab

Article highlights

• mCNV causes significant visual morbidity in an increasing group of the population with pathologic myopia.

• Anti-VEGF therapy is the current gold standard for the treatment of mCNV; previous treatments are no longer recommended.

• A diagnostic algorithm is presented, with emphasis on differentiating mCNV mimics.

• A 1 + PRN approach is recommended in most cases, with OCT-guided indicators of disease activity that are often subtle.

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Declaration of interest

A Tufail has participated on advisory boards for Novartis, Bayer, Allergan, Roche and Heidelberg Engineering. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.