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Brief Report
July 2018

Outcomes of Anti–Vascular Endothelial Growth Factor Treatment for Choroidal Neovascularization in Fellow Eyes of Previously Treated Patients With Neovascular Age-Related Macular Degeneration

Author Affiliations
  • 1Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
  • 2Oakland University William Beaumont School of Medicine, Rochester, Michigan
  • 3Devers Eye Institute, Legacy Health, Portland, Oregon
JAMA Ophthalmol. 2018;136(7):820-823. doi:10.1001/jamaophthalmol.2018.1534
Key Points

Question  Is there a difference in visual outcomes between eyes with established neovascular age-related macular degeneration (index eyes) and fellow eyes that more recently developed choroidal neovascularization?

Findings  In this single-center case series of 264 patients, fellow eyes presented with better visual acuity (VA; mean VA, 20/50) than index eyes (mean VA, 20/90) at the time of conversion to neovascular age-related macular degeneration. Fellow eyes maintained better VA than index eyes after equivalent follow-up (20/50 vs 20/70).

Meaning  Fellow eyes of patients with established neovascular age-related macular degeneration achieved better VA than index eyes after an equivalent follow-up period, which may be attributed to earlier diagnosis and treatment of choroidal neovascularization in fellow eyes compared with index eyes.

Abstract

Importance  Neovascular age-related macular degeneration (nvAMD) is a leading cause of vision loss. The optimal screening protocol to detect choroidal neovascularization (CNV) in fellow eyes of patients undergoing treatment for unilateral CNV has not been determined.

Objective  To compare the visual outcomes of eyes with established, active nvAMD in index eyes with outcomes of fellow eyes that subsequently developed CNV during the management protocol.

Design, Setting, and Participants  In this retrospective single-center case series conducted at a private vitreoretinal practice, data were collected for all patients treated for bilateral nvAMD between October 1, 2015, and October 1, 2016, for whom we could determine the date of index eye and fellow eye conversion to nvAMD (n = 1600). Per institutional protocol, patients were screened for new CNV in the fellow eye at every office visit. Patients were excluded if they had a condition that could result in marked asymmetric vision loss.

Exposures  Development of nvAMD.

Main Outcomes and Measures  Visual acuity (VA) at the time of diagnosis of nvAMD and at equivalent time points following conversion to nvAMD for both index eyes and fellow eyes.

Results  A total of 264 patients met the inclusion criteria; 197 (74.6%) were women and 253 (95.8%) were white, and the mean (SD) age was 79.1 (8.2) years at time of index eye conversion to nvAMD and 80.6 (8.2) years at time of fellow eye conversion to nvAMD. Fellow eyes presented with better VA (mean VA, 20/50 [0.40 logMAR]) compared with index eyes (mean VA, 20/90 [0.67 logMAR]) at the time of conversion (difference, 14 letters [0.27 logMAR]; 95% CI, 10-17 [0.20-0.34]; P < .001). Index eyes did not achieve the same level of VA as fellow eyes after an equivalent postconversion follow-up of approximately 20 months (mean VA: index eye; 20/70 [0.56 logMAR]; fellow eye, 20/50 [0.40 logMAR]; difference, 8 letters [0.15 logMAR]; 95% CI, 4-11 [0.08-0.22]; P < .001). No difference was detected between the mean number of anti–vascular endothelial growth factor injections received by fellow eyes and index eyes (9.7 vs 10.0 injections, respectively).

Conclusions and Relevance  This retrospective study suggests that fellow eyes of previously treated patients with nvAMD may achieve better VA than their index eye counterparts after an equivalent amount of follow-up. This may be because the CNV was detected and treated earlier and at a better level of VA, although it is unknown whether the frequent office visits, VA measurements, or optical coherence tomography testing was responsible for the detection at a better level of VA.

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