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Original Investigation
August 2018

Incidence of Fellow Eye Involvement in Patients With Unilateral Exudative Age-Related Macular Degeneration

Author Affiliations
  • 1Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  • 2Ophthalmology and Visual Sciences Program, Duke-NUS Medical School, National University of Singapore, Singapore
JAMA Ophthalmol. 2018;136(8):905-911. doi:10.1001/jamaophthalmol.2018.2154
Key Points

Question  What is the incidence of fellow eye involvement in patients with unilateral exudative age-related macular degeneration with and without nonexudative neovascularization as detected by optical coherence tomography angiography and/or indocyanine green angiography?

Findings  In this prospective observational study of 95 patients with unilateral age-related macular degeneration, the estimated annual incidence of fellow eye involvement was 18.1% and 2.0% in those with and without nonexudative neovascularization, respectively, with a statistically significant difference.

Meaning  The presence of nonexudative neovascularization predisposes to the development of exudative changes; however, treatment should only commence when exudation develops.


Importance  Since the advent of optical coherence tomography angiography (OCT-A), nonexudative neovascularization has been described in the fellow eyes of unilateral exudative age-related macular degeneration (AMD). However, there is limited literature describing the natural course and optimal management of these lesions.

Objective  To determine the incidence of fellow eye involvement in patients presenting with unilateral typical AMD or polypoidal choroidal vasculopathy and to evaluate the patterns of OCT-A changes within 6 months before the onset of exudative changes, especially focusing on nonexudative neovascularization.

Design, Setting, and Participants  Data for this study were taken from a prospective, observational cohort study involving Asian patients with exudative AMD in the Asian AMD Phenotyping Study between October 2015 and March 2016. Analyses began in June 2017. Only patients who had gradable OCT-A and indocyanine green angiography (ICGA) scans of the fellow eye at baseline and follow-up at least 6 months apart were included for the analysis. The contralateral eye was evaluated for presence of nonexudative neovascularization based on multimodal imaging, which included ICGA, spectral domain optical coherence tomography, and OCT-A.

Main Outcomes and Measures  The difference between the incidence of those with nonexudative choroidal neovascularization and those without as analyzed using log-rank test and qualitative analysis of OCT-A images.

Results  We included 95 fellow eyes of 95 patients who presented with unilateral exudative AMD with a mean (SD) age of 68.6 (8.6) years. Nonexudative neovascularization was present in 18 eyes (19%) (8 [22.9%] and 10 [19.0%] fellow eyes with typical AMD and polypoidal choroidal vasculopathy, respectively; 8 [44.4%] on OCT-A; 5 [27.8%] on ICGA; and 5 [27.8%] on both OCT-A and ICGA). Development of exudative changes was noted in 6 fellow eyes (6.3%). Four eyes developed exudation from previously noted nonexudative neovascularization, and 2 eyes arose exudative changes from de novo. The probability of developing exudation within 6 months was significantly higher in eyes with baseline nonexudative neovascularization (0.087; 95% CI, 0.0033-0.210) compared with eyes without (0.010; 95% CI, 0.0026-0.041) (P = .008). In all eyes whose OCT-A images were available immediately before the onset of exudative changes, there was an increase in the size of network vessels compared with baseline.

Conclusions and Relevance  The presence of nonexudative neovascularization may predispose to the development of exudative changes.