Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment
in Western Countries. It is a well-established fact that vascular endothelial growth factor
(VEGF) plays a key part in the development of the neovascular (or exsudative) form of AMD.
Today, VEGF-inhibition by means of injection of anti-VEGF agents into the vitreous cavity
constitutes the gold standard of AMD therapy. In physiological conditions, VEGF acts as a
vasodilator by activating endothelial nitric oxide synthase. As a consequence, VEGF
inhibition should result in significant ocular vasoconstriction, which has in fact been
demonstrated for bevacizumab and ranibizumab, two of the three available VEGF-inhibitors. The
understanding and awareness of potentially harmful implications of the induced
vasoconstriction on retinal and/or optic nerve head structure and function is sparse. This is
especially delicate, as most patients with exsudative AMD require repeated injections on a
monthly basis for many years. Aflibercept, the latest anti-VEGF agent approved for
intravitreal use in 2011, offers a superior binding affinity for VEGF compared to the former
two drugs. However, as of today, its effect on ocular circulation is unclear. With Laser
Speckle Flowgraphy (LSFG), a commercially available, non-invasive and patient-friendly method
for the evaluation of blood flow at the optic nerve head, the choroid and retina has arisen
in recent years.
We aim to measure ocular perfusion with LSFG before and after 3 consecutive injections of
aflibercept in unilateral neovascular age-related maculopathy.