Name: 4D-150 in Neovascular age-related macular degeneration: Clinical presentation - signs and symptoms
Published: 2026-09-17T18:33:01-04:00

Visual symptoms: metamorphopsia, decreased vision, and scotoma

Symptom listed for initial history	Quoted text
Distortion	“Metamorphopsia”
Reduced acuity	“Decreased vision”
Central field loss	“Scotoma”
Light flashes	“Photopsia”
Low-luminance function	“Difficulties in dark adaptation”

“Ophthalmologists, optometrists, and ancillary clinical personnel should be aware that patients with the onset of new symptoms suggestive of AMD (e.g., new visual loss, metamorphopsia, or scotoma) should be examined promptly.” (opens the source at this quote in a new tab)

Clinical signs: hemorrhage, exudates, subretinal fluid, and fibrosis

“Binocular slit-lamp biomicroscopy of the ocular fundus is often necessary to detect subtle clinical signs of MNV. These include small areas of hemorrhage, hard exudates, subretinal fluid, macular edema, subretinal fibrosis, or pigment epithelial elevation.” (opens the source at this quote in a new tab)

Care-seeking after onset of visual symptoms

“Most (73%) patients visited a health care professional within 1 month of experiencing vision changes and 54% began treatment immediately.” (opens the source at this quote in a new tab)

Functional impairment: activities of daily living

“The prevalence of impaired basic, instrumental and total ADL was 37.76%, 67.82% and 39.59%, respectively. In multivariate-adjusted models, moderate visual impairment [OR 5.65, 95% CI (2.31-13.83) and blindness [OR 5.43, 95% CI (2.09-14.12)] were associated with greater odds of impaired total ADL.” (opens the source at this quote in a new tab)

Psychological effects: depressive and anxiety symptoms

“The prevalence of depressive symptoms was 42.04% and 31.78% as per the CES-D-10 and MHI scales, respectively.” (opens the source at this quote in a new tab)

“Qualitative data showed that 56% of patients (n = 132) reported anxiety related to anti-VEGF treatment. The main sources of anxiety were fear of going blind owing to intravitreal injections and concerns about treatment effectiveness, rather than around pain. From validated questionnaires, 17% of patients (n = 52) showed clinical levels of anxiety and 12% (n = 36) showed clinical levels of depression.” (opens the source at this quote in a new tab)

“The prevalence estimates, taken from nine cross-sectional and cohort studies, ranged from 15.7%-44% for depressive symptoms and 9.6%-30.1% for anxiety symptoms in people with AMD.” (opens the source at this quote in a new tab)

Perceptual symptoms: Charles Bonnet syndrome visual hallucinations

“We found an overall prevalence of CBS of 15.8% (95% confidence interval: 11.0%-21.2%). When looking at consecutively recruited patients with neovascular AMD from the clinic, prevalence of CBS was 7.2% (95% confidence interval: 4.3%-10.6%).” (opens the source at this quote in a new tab)

“Depression and visual hallucinations (Charles Bonnet syndrome) frequently accompany severe central vision loss. Patients who have Charles Bonnet syndrome and their family members should be informed that visual symptoms are not unusual and do not represent a sign of psychosis or mental deterioration.” (opens the source at this quote in a new tab)

“Twenty-five (8.3%) patients of 300 had hallucinations attributable to CBS.” (opens the source at this quote in a new tab)