Current management of choroidal neovascularization.

Age-related macular degeneration is the leading cause of blindness in Americans over age 65. In 1982, the Macular Photocoagulation Study (MPS) established that argon laser photocoagulation reduces the risk of severe visual loss in eyes with extrafoveal choroidal neovascularization (CNV) associated with macular degeneration. Subsequently, similar results were found for histoplasmic and idiopathic choroidal neovascularization. There are also encouraging data on photocoagulation of CNV in other diseases and with different wavelengths. The MPS Group has found the krypton laser to be effective for juxtafoveal CNV secondary to histoplasmosis and is evaluating argon green and krypton red lasers for subfoveal CNV. Other investigators are evaluating laser treatment of CNV associated with myopic degeneration, pigment epithelial detachment, and angioid streaks. The new tunable dye laser may further expand our ability to treat this disorder. Until CNV can be prevented, laser photocoagulation remains the treatment of choice, and clinical trials should identify appropriate cases.