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Reply to Letter to the Editor regarding “Ophthalmic artery angioplasty for age-related macular degeneration”

We are delighted that the authors of the letter see merit in what we have done, and the previous imaging studies in agerelated macular degeneration (AMD) that they cite served as inspiration for our intervention. We agree wholeheartedly with the need for better imaging, especially sweptsource optical coherence tomography (SSOCT) imaging of the choroid both before and after the ophthalmic artery (OA) intervention. Our report was intended as a proofofconcept demonstration of using offtheshelf tools to perform OA angioplasty; however, there is a great need to not only design better instrumentation for manipulating the OA, but also for demonstrating better blood flow in the OA after angioplasty. So much more needs to be done before OA angioplasty can be considered a routine intervention for the treatment of AMD, but we hope our report will serve as a gateway into a new era of AMD management. We were encouraged further by the recent Perspective by Rosenfeld et al in the American Journal of Ophthalmology in which they provided a convincing argument that choroidal hemodynamics plays an important role in the progression and severity of AMD. It is important to note that the primary endpoint for the first cases was to demonstrate the safety and technical feasibility of performing an angioplasty of the OA in patients with latestage AMD. Although not an endpoint, we were able to observe what appeared to be some improvement in vision. Future studies will certainly benefit from the use of new imaging technologies such as SSOCT, which will help us improve our imaging followup to better understand this disease.