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    Multimodal imaging as predictor

    The best predictor of response was multimodal imaging, said Dr. Dugel, noting that patients were analyzed based on optical coherence tomography (OCT), fluorescein angiography, and optical coherence angiography. The patients that fared best tended to be dry by conventional OCT and had no leakage by fluorescein angiography, but they did show flow by optical coherence angiography.

    “There appears to be an OCT and vision disconnect,” Dr. Dugel said.

    Normalized vessels may be necessary for this wound-healing response after the pruning of immature vessels, and there may be a “Goldilocks” principle of flow—where neither too little nor too much is ideal.

    “We do have a large structure and function disconnect,” Dr. Dugel said, “but we’re in the precipice of an imaging revolution that will bridge the disconnect and force us to reconsider our goals in patients with macular degeneration.”

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