might be biased towards smaller scars in the study eyes. However, there is evidence that SFCNV is usually larger than non-SFCNV. Bressler and colleagues (1993) found that 66% of CNV involving the subfoveal region were bigger than 1500 μm as opposed to 12% of CNV that did not. In addition, to our knowledge there is no evidence that the rate of CNV progression differs according to the location of the CNV. Therefore the subsequent scar is expected to be larger for SFCNV which is the location of CNV that all our study eyes had at presentation. Our results suggest that PDT may alter this expectation with a beneﬁcial effect on the evolution of the DS secondary to SFCNV. This appears to be related to the effect of PDT on the activity of the CNV as discussed above. Another drawback is that the DS that was already present in the fellow eye of these 14 patients at the time of initial examination might have developed over years. Thus, comparison with actual and potential disciform scars that developed or could have developed over the ﬁnite follow-up period of this study might be also biased. The best way to address this factor is by prospectively following a study group and a control group for a long period of time. However, the availability of treatment options such as PDT for SFCNV nowadays makes studies with a control group unfeasible. In addition, to our knowledge, these comparisons have not been performed in such prospective trials to date (TAP 1999; VIP 2001a, 2001b; Bressler 2001, 2002). A third drawback is that no measures of the central visual function other than visual acuity were performed on our patients. As has been demonstrated, central visual ﬁeld function and scotoma characteristics as demonstrated by microperimetry may yield valuable information regarding ﬁnal visual function and visual rehabilitation (Schmidt-Erfurth 2004). This study shows evidence that the DS and potentially the subsequent central scotoma that might develop following PDT is expected to be smaller than that which develops naturally secondary to predominantly classic SFCNV. In microperimetric analysis studies of the central scotoma, PDT was associated with an improvement in the central visual ﬁeld and reduction in scotoma size and intensity (Schmidt-Erfurth 1999, 2004). This might prove to be a very signiﬁcant effect of PDT in neovascular maculopathy particularly in patients who fail the beneﬁt of PDT in preventing visual loss. The literature has accumulating evidence that visual rehabilitation of patients with a smaller DS and central scotoma might be easier and more rewarding (Timberlake et al 1986, 1987; Whittaker et al 1988; Fletcher and Schuchard 1997; Schuchard and Fletcher 2000). This is because the size of the central scotoma is thought to be Clinical Ophthalmology 2008:2(4) PDT-lesion size-disciform scar the most important factor in determining both the functional characteristics of the preferred retinal locus/loci (PRL(s)) that these patients develop for ﬁxation, and the anatomic proximity of that locus/loci to the fovea (von Noorden and Mackensen 1962; Sunness et al 1996). Both factors may be signiﬁcantly important in rehabilitating patients who lost central vision (von Noorden and Mackensen 1962; Fletcher and Schuchard 1997; Schuchard and Fletcher 2000). In recent studies, reading speed, macular sensitivity, macular electrophysiology, and ﬁxation patterns correlated with the extent of macular impairment in choroidal neovascularization and appeared to improve following PDT (Ergun et al 2003; Midena et al 2004; Varano et al 2005; Yodoi et al 2007). Ophthalmologists and researchers should not overlook the beneﬁt of PDT emphasized in this paper. This important beneﬁt has been probably underestimated and overshadowed because of the emphasis that ophthalmologists invest in the direction of ﬁnal visual acuity outcome following treatment. Long-follow-up, controlled prospective studies with emphasis on the size of the DS and central scotoma, with utilization of microperimetry with scanning laser ophthalmoscopy could demonstrate the value of PDT in limiting the size of the eventual DS and central scotoma in patients with predominantly classic SFCNV. Also they could possibly determine any beneﬁcial effect of PDT in the rehabilitation process of treated patients. However, prospectively following a control group with SFCNV might not be feasible nowadays due to the availability of treatment options such as PDT. Re-evaluating patients enrolled in previous clinical trials (TAP 1999; VIP 2001a, 2001b; Bressler 2001, 2002) is one potential way for testing our hypothesis. Disclosure None of the authors have any proprietary or conﬂict of interest related to the manuscript. References Bressler NM, Bressler SB. 2000. Photodynamic therapy with verteporﬁn (Visudyne): impact on ophthalmology and visual sciences. Invest Ophthalmol Vis Sci, 41:624–8. Bressler NM. 2001. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with vertepor- ﬁn: two-year results of 2 randomized clinical trials – TAP Report 2. Arch Ophthalmol, 119:198–207. Bressler NM. 2002. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization – verteporﬁn in photodynamic therapy report 2. Am J Ophthalmol, 133:168–9. 779