Sir,

We thank Diago1 for the interest shown in our recent article. We reported for the first time the use of intravitreal aflibercept as primary treatment for choroidal neovascularisation (CNV) in angioid streaks (AS) using a pro re nata regimen.2 This approach, in which treatment is withheld unless there is CNV activity, has been the most widely adopted in this setting.3, 4

Treat and extend (T&E) is a treatment modality that aims to treat the CNV proactively, in order to find an optimal treatment interval, and has been more commonly used in the context of neovascular age-related macular degeneration (nAMD). While we find the T&E modality to be an interesting approach for AS-associated CNV, we agree with previous reports that the CNV in this context is closer to myopia-related CNV than nAMD-related CNV, and therefore may require fewer injections.4 Additionally, patients can be activity-free for several years, or develop new CNV lesions in a different location altogether, making it difficult to identify a specific pattern of recurrence.4 This could lead to overtreatment with subsequent increase of associated risks such as chorioretinal atrophy.5

Even though larger prospective trials are needed to elucidate on the best treatment protocol, they are difficult to arrange due to the rarity of the condition.