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PubMed This is a summary of 9 peer-reviewed journal articles Updated
Ophthalmology

Protecting Your Long-Term Vision: CNV and Atrophy

At a Glance

To protect long-term vision with multifocal choroiditis, you must prevent abnormal blood vessel growth (secondary CNV) and expanding retinal scars (atrophy). Maintaining tight control of eye inflammation through continuous medication is the best defense against permanent sight loss.

While the initial flare of Multifocal Choroiditis (MFC) can be frightening, the long-term management focuses on preventing two major complications that can threaten your sight over time.

1. Secondary Choroidal Neovascularization (CNV)

The most urgent threat to your central vision is Secondary CNV. This occurs when the eye grows new, abnormal blood vessels under the retina [1].

  • The Threat: These fragile vessels often leak fluid or blood, causing sudden vision distortion (metamorphopsia) or a rapid loss of central vision.
  • The Good News: Modern medicine has highly effective treatments. The numbed eye injections (anti-VEGF) mentioned on the previous page can “dry up” these vessels and often restore lost vision [2][3].

2. Progressive Chorioretinal Atrophy

The second threat is the slow expansion of chorioretinal atrophy (permanent tissue loss or “scars”) [4].

  • Smoldering Inflammation: Even when your eyes feel fine, low-level or “smoldering” inflammation can persist at the borders of your existing scars [5].
  • The Threat: Over time, these scars can slowly enlarge, causing your blind spots (scotomas) to grow. Research shows that every time the disease flares up, the growth rate of these scars increases [6].

The Impact of High Myopia

If you are highly nearsighted (myopic), your eyes face additional challenges. High myopia causes the eye to be physically longer and the retina to be thinner [7]. Patients with high myopia often experience more frequent inflammatory relapses and a faster rate of scar expansion [7]. Myopia is also an independent risk factor for CNV [7].

Why “Tight Control” is Your Best Defense

Because every flare-up contributes to permanent tissue loss, the standard of care is tight control [1]. Using medications to keep the immune system quiet slows down the growth of atrophic scars [8]. Regular monitoring catches smoldering activity before it impacts your daily life [9].

Common questions in this guide

What is secondary CNV in multifocal choroiditis?
Secondary choroidal neovascularization (CNV) occurs when fragile, abnormal blood vessels grow underneath the retina. These vessels can leak fluid or blood, which often leads to sudden vision distortion or a rapid loss of central vision.
Why are my blind spots getting larger over time?
Even when your vision feels stable, low-level or 'smoldering' inflammation can persist at the borders of your existing eye scars. Over time, this chronic inflammation causes the scars to slowly expand, which makes your blind spots larger and causes permanent tissue loss.
How does being highly nearsighted affect my condition?
Severe nearsightedness, or high myopia, stretches the eye and makes the retina thinner. Patients with high myopia typically experience more frequent inflammatory flare-ups, faster scar expansion, and a higher risk of developing secondary CNV.
What does 'tight control' mean for treating multifocal choroiditis?
Tight control means using medications consistently to keep your immune system completely quiet, rather than only treating flares as they happen. This proactive approach slows down the growth of permanent atrophic scars and protects your long-term vision.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my imaging, do I have signs of 'smoldering' inflammation at the edges of my existing scars?
  2. 2.Does my degree of myopia (nearsightedness) put me at a higher risk for future CNV or atrophy expansion?
  3. 3.How does my history of inflammatory flares correlate with the growth of my 'blind spots' or atrophic areas?
  4. 4.If we achieve 'tight control' with my medications, can we slow down the expansion of these scars?
  5. 5.Should we be using FAF (Fundus Autofluorescence) more frequently to monitor the borders of my lesions?

Questions For You

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References

References (9)
  1. 1

    Immunomodulatory Treatment Versus Systemic Steroids in Inflammatory Choroidal Neovascularization Secondary to Idiopathic Multifocal Choroiditis.

    Airaldi M, Monteduro D, Tondini G, et al.

    American journal of ophthalmology 2024; (262()):62-72 doi:10.1016/j.ajo.2024.01.006.

    PMID: 38224927
  2. 2

    LATE RECURRENCE OF CHOROIDAL NEOVASCULARIZATION IN PATIENTS WITH MULTIFOCAL CHOROIDITIS: CLINICAL SURVEILLANCE IN PERPETUITY.

    Orellana-Rios J, Leong BCS, Fernández-Avellaneda P, et al.

    Retinal cases & brief reports 2022; (16(2)):233-241 doi:10.1097/ICB.0000000000000936.

    PMID: 31725597
  3. 3

    Long-Term Outcome of Punctate Inner Choroidopathy or Multifocal Choroiditis with Active Choroidal Neovascularization Managed with Intravitreal Bevacizumab.

    Chen SN, Chen YL, Yang BC

    Ocular immunology and inflammation 2020; (28(1)):33-38 doi:10.1080/09273948.2019.1588335.

    PMID: 30994378
  4. 4

    Distribution and Progression of Inflammatory Chorioretinal Lesions Related to Multifocal Choroiditis and Their Correlations with Clinical Outcomes at 24 Months.

    Erba S, Cozzi M, Xhepa A, et al.

    Ocular immunology and inflammation 2022; (30(2)):409-416 doi:10.1080/09273948.2020.1800048.

    PMID: 32946308
  5. 5

    PROGRESSION OF PERIPAPILLARY AND MACULAR CHORIORETINAL ATROPHY IN MULTIFOCAL CHOROIDITIS IS ASSOCIATED WITH PERIATROPHIC INFLAMMATORY PLUMES.

    Ossewaarde-van Norel J, Spaide RF

    Retina (Philadelphia, Pa.) 2024; (44(11)):1860-1868 doi:10.1097/IAE.0000000000004227.

    PMID: 39089007
  6. 6

    CORRELATION BETWEEN INFLAMMATORY FOCI REACTIVATION AND ATROPHY GROWTH IN EYES WITH IDIOPATHIC MULTIFOCAL CHOROIDITIS.

    Airaldi M, Zicarelli F, Forlani V, et al.

    Retina (Philadelphia, Pa.) 2023; (43(3)):472-480 doi:10.1097/IAE.0000000000003682.

    PMID: 36730577
  7. 7

    Idiopathic Multifocal Choroiditis and Punctate Inner Choroidopathy - Evaluation of Risk Factors for Increased Relapse Rate: A 2-Year Prospective Observational Cohort Study.

    de Groot EL, de Boer JH, Ossewaarde-van Norel J

    Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde 2022; (245(5)):476-486 doi:10.1159/000526663.

    PMID: 35995032
  8. 8

    The efficacy of corticosteroid-sparing immunomodulatory therapy in treating patients with central multifocal choroiditis.

    de Groot EL, Ten Dam-van Loon NH, de Boer JH, Ossewaarde-van Norel J

    Acta ophthalmologica 2020; (98(8)):816-821 doi:10.1111/aos.14473.

    PMID: 32410393
  9. 9

    DISAPPEARING CHOROIDAL SPOTS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY PRECEDING RECURRENCE OF MULTIFOCAL CHOROIDITIS WITH CHORIORETINAL ATROPHY.

    Marchese A, Bar-Meir A, Jampol LM, Mirza RG

    Retinal cases & brief reports 2025; (19(1)):14-18 doi:10.1097/ICB.0000000000001501.

    PMID: 37769259

This page provides educational information on long-term vision protection for multifocal choroiditis. Always consult your ophthalmologist or retina specialist regarding your specific symptoms, imaging results, and treatment plan.

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