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Subretinal hemorrhage size determines treatment options

Healio Optometry15h ago1 min read

FORT LAUDERDALE, Fla. — The choice between surgical and nonsurgical management of subretinal hemorrhage in age-related macular degeneration depends on the size of the hemorrhage, according to a speaker.In his presentation at Retina World Congress, J. Fernando Arevalo, MD, PhD, said about 12% of patients with neovascular AMD end up developing subretinal hemorrhage (SRH).“I believe classifying these hemorrhages is important to make the diagnosis and, especially, management,” he said.Arevalo described three classifications of SRH based on size: small (1 to

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AI Summary

Quick Take

At the Retina World Congress, Dr. J. Fernando Arevalo highlighted that approximately 12% of patients with neovascular age-related macular degeneration (nAMD) will develop subretinal hemorrhage (SRH). He argued that the size of the hemorrhage is the most critical factor in determining whether a patient requires surgical intervention or can be managed through nonsurgical means.

Why It Matters

Subretinal hemorrhage represents a significant clinical hurdle in nAMD management, as the presence of blood can cause rapid, irreversible damage to photoreceptors through iron toxicity and physical displacement. While anti-VEGF injections treat the underlying choroidal neovascularization, they may not be sufficient for large hemorrhages that require mechanical displacement. Standardizing management based on a size-based classification system allows for more predictable outcomes and helps clinicians decide when to escalate from medical to surgical care.

Key Findings

Approximately 12% of patients with neovascular age-related macular degeneration develop subretinal hemorrhage during the course of their disease.
Management strategies for subretinal hemorrhage are categorized into surgical and nonsurgical options based primarily on the size of the bleed.
A formal classification system for subretinal hemorrhage is necessary to standardize diagnosis and optimize treatment selection.
Dr. Arevalo proposed three distinct classifications of subretinal hemorrhage based on size to guide clinical decision-making.

Practice Implications

Clinicians should carefully measure and classify the extent of subretinal blood in nAMD patients, as this size-based assessment dictates the necessity of surgical referral. Given that over 10% of nAMD patients are at risk, prompt identification of SRH size is essential to prevent permanent macular damage and to select the appropriate intervention level.

Who's Affected

Retina SpecialistsOphthalmologistsOptometrists

Evidence StrengthModerate

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