Do OCTA morphological patterns in neovascular AMD actually matter? A scoping review of clinical utility and terminological overlap
Year: 2026
Type: article
Study design: Systematic Review
Abstract: PURPOSE: Optical coherence tomography angiography (OCTA) has enabled detailed in vivo imaging of macular neovascularization (MNV) in neovascular age-related macular degeneration (nAMD), leading to a proliferation of morphological descriptive terms. This scoping review aimed to systematically map the existing literature on OCTA-based MNV morphology and evaluate its correlation with disease activity. METHODS: A systematic literature search covering publications through 2025 was performed. After screening 2,445 titles and obtaining 60 full texts, 43 studies were included. Data on morphological terminology, study design, and correlation with disease activity were extracted and synthesized. RESULTS: The included studies, encompassing a total of 2,712 eyes, identified a vast and heterogeneous lexicon of qualitative descriptors, including terms such as "medusa," "sea-fan," and "glomerulus", characterized by significant terminological overlap and inconsistent definitions across studies. Inconsistent, low-certainty associations between specific OCTA morphologies and MNV activity were identified across studies, with findings limited by significant methodological heterogeneity. The evidence for these patterns as reliable biomarkers of disease activity is weak and often contradictory, and several studies were found to use OCTA features to define activity, creating circular arguments that undermine their conclusions. CONCLUSION: The current terminology for OCTA morphology in nAMD is fragmented and inconsistently applied. The link between these patterns and disease activity is poorly established, severely limiting their clinical utility. These findings highlight a need for a standardized, consensus-based framework for describing and interpreting OCTA findings in nAMD.
Source: Retina
Institutions: University of Florence, Moorfields Eye Hospital NHS Foundation Trust, Queen's University Belfast, Royal Victoria Hospital, University of Alabama at Birmingham, University of Zurich, NIHR Moorfields Biomedical Research Centre, Kantonsspital Winterthur, University College London, Vitreous Retina Macula Consultants of New York, New York University, Oregon Health & Science University, Northwestern University, University Hospital of Bern, Medical University of Vienna, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Hôpital Intercommunal de Créteil, Tufts University
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7171383128
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