THE NATURAL-HISTORY OF IDIOPATHIC SUBFOVEAL CHOROIDAL NEOVASCULARIZATION

Purpose: To study the long-term natural history of idiopathic subfovea l choroidal neovascularization (CNV) in young patients. Methods: A ret rospective survey of 19 consecutive patients with idiopathic subfoveal CNV diagnosed in an urban eye hospital and a single practice. Results : Twenty-three (26%) of 87 consecutive patients with idiopathic CNV de monstrated subfoveal CNV. Nineteen patients with subfoveal involvement were followed for a median of 87 months (range, 5-230 months). On ini tial examination, the median best-corrected Snellen visual acuity was 20/100 (range, 20/40-counting fingers); at final examination, the medi an visual acuity was 20/70 (range, 20/20-counting fingers). A total of 95% of patients had stable or significantly improved visual acuity, w hereas only 5% had significant visual loss. Size of the CNV was the on ly variable associated with long-term final visual acuity. Lesions 1 d isc area or smaller at the time of initial fluorescein angiography wer e more likely to be associated with a final visual acuity of 20/60 or better and less likely to be associated with a final visual acuity of 20/200 or worse (P = 0.038) as compared with larger lesions. These res ults were confirmed with multiple logistic regression analysis (P = 0. 027). Fellow eyes remained unaffected during the follow-up period. Con clusions: The natural history of idiopathic subfoveal CNV is not neces sarily associated with a profound loss of vision. Therapies for this t ype of subfoveal lesion must take into consideration the possibility o f a favorable natural course.