**5. Subclinical Neovascular membranes**

Subclinical neovascular membranes are membranes that are not exuding. Therefore, this is an important biomarker either for an exudative form or for the atrophic form of the disease.

Analyzing the NIR, B Scans and OCT-A, a neovascular complex can be observed without exudation and it is providing an elevated but shallow contour of the pigmented epithelium (**Figure 4**). The initial nomenclature of this type of membrane was quiescent neovascular membrane but more recently terminology for this finding is Shallow Irregular RPE Elevation (SIRE) [25, 26].

#### **Figure 3.**

*Calcified small drusen (white arrowheads). In this OCT-B scan, it is possible to identify a hyperreflective sheath with a hyporreflective content. There may be hyperreflective dots inside the lesions.*

#### **Figure 4.**

*SIRE. Superiorly,* en face *OCT-A slabs show subretinal neovascular complexes. Inferiorly, the OCT-B scan demonstrates a SIRE with the presence of heterogeneous material beneath the RPE. Additionally, it is possible to note the absence of intraretinal or subretinal fluid.*

The baseline prevalence of this type of neovascularization in patients with AMD was around 13 to 14%. Exudative shift at 12 months had a prevalence of 6.8% among patients without Non-Exudative Macular Neovascularization (NE-MNV) and of 21.1% among patients with NE-MNV. Exudative shift at 24 months had a prevalence of 6.3% among patients without NE-MNV and of 34.5% among patients with NE-MNV. Therefore, it is recommendable a very close follow-up of the patients identified with SIRE [25, 26]*.*
