One important disease easily visualized with ICG angiography is a variant of CNV known as polypoidal choroidal vasculopathy [30]. This particular form of neovascularization is highly prevalent in Asia.

7.4.3Autofluorescent Imaging

›Testing modalities help confirm the presence of CNV; most patients will be correctly suspected of having CNV by their symptoms and ophthalmoscopic signs.

Natural fluorophores occur in the retina, and these accumulate within the RPE over time. The fluorophores are related to retinoid metabolism. They can be made to fluoresce and the resultant fluorescence can be recorded with either a fundus camera or a scanning laser ophthalmoscope. Autofluorescence imaging is very helpful in estimating the health of the RPE.

7.4.4Optical Coherence Tomography

OCT uses short coherence length light in a modified Michelson interferometry arrangement to obtain highresolution cross-sectional images of the fundus. Commercially available devices have a theoretical resolution of 5–7 mm, although the real-life resolution does not approach the theoretical resolution. OCT is a noninvasive imaging modality that provides architectural information concerning the retina, subretinal space, and retinal pigment epithelium. Recent developments such as swept source OCT using 1 mm light sources and EDI-OCT have provided improved imaging of the choroid.

Summary for the Clinician

›Decreased visual acuity is the most common presenting symptom, but the patient will often not specifically mention acuity, but rather tasks that are now difficult.

›Distortion is very difficult to measure. Common testing can help establish if distortion is present or not.

›Amsler grid testing has poor sensitivity and specificity.

›Newer methods such as preferential hyperacuity perimetry do not appear to have a high enough sensitivity or specificity to merit widespread adoption.

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