Fellow-Eye Conversion and Treatment in Exudative Age-Related Macular Degeneration

Abstract

Purpose: This article assesses anatomical and visual outcomes after intravitreal antivascular endothelial growth factor (anti-VEGF) treatment in fellow eyes with wet age-related macular degeneration (AMD). Methods: A retrospective chart review was conducted of 349 patients diagnosed with wet AMD between 2005 and 2017 at a single academic institution. Initial diagnosis of unilateral wet AMD and a minimum follow-up time of 1 year after diagnosis were required for inclusion. Individuals were excluded if the initial diagnosis of wet AMD was made at an outside institution, if they had received prior treatment at another institution, or if they had bilateral wet AMD at the time of inclusion. Best-corrected visual acuity, optical coherence tomography (OCT) parameters, and frequency and type of intravitreal anti-VEGF injections were recorded. MedCalc Statistical Software version 17.6 (MedCalc Software) and GraphPad Software (GraphPad Software, Inc) were used for statistical analysis. Results: Of the 349 patients with wet AMD, 192 were included in the study (55%). Of these, 47 (24.5%) developed wet AMD in the fellow eye. The average time to second-eye conversion was 2.6 years, with fellow-eye conversion more likely to occur after 2 years of unilateral disease. On average, patients received 2.16 fewer injections per year in the fellow eye compared with the initially diagnosed eye ( P = .03), and fellow eyes tended to have better OCT results after 12 months of treatment. In addition, compared with ranibizumab and bevacizumab, aflibercept injections appeared to improve visual acuity both in initially diagnosed and fellow eyes. Conclusions: Exudative AMD in the fellow eye has a decreased treatment burden and better visual outcomes compared with the initial eye, which may be attributed to more frequent surveillance and early diagnosis.

American Society of Retina Specialists Clinical Practice Guidelines on Multimodal Imaging for Retinal Disease

“…For example, retrospective studies of patients monitored by OCT found that one half of patients with unilateral diabetic macular edema (DME) and 20% to 30% of patients with unilateral exudative AMD develop fellow-eye involvement over 2 years. [4][5][6][7] The fellow eye often has a decreased treatment burden and better visual outcomes than the initial eye, which may be attributed to more frequent surveillance and early diagnosis and treatment. 7 Following are some practical guidelines to consider toward making the most of the more commonly available multimodal imaging in the approach to diagnosing and treating medical and surgical retinal diseases.…”

“…[4][5][6][7] The fellow eye often has a decreased treatment burden and better visual outcomes than the initial eye, which may be attributed to more frequent surveillance and early diagnosis and treatment. 7 Following are some practical guidelines to consider toward making the most of the more commonly available multimodal imaging in the approach to diagnosing and treating medical and surgical retinal diseases. This review is not exhaustive but rather is designed to provide practical guidance to the practicing clinician.…”

“…For example, retrospective studies of patients monitored by OCT found that one half of patients with unilateral diabetic macular edema (DME) and 20% to 30% of patients with unilateral exudative AMD develop fellow-eye involvement over 2 years. 4 –7 The fellow eye often has a decreased treatment burden and better visual outcomes than the initial eye, which may be attributed to more frequent surveillance and early diagnosis and treatment. 7…”

“…4 –7 The fellow eye often has a decreased treatment burden and better visual outcomes than the initial eye, which may be attributed to more frequent surveillance and early diagnosis and treatment. 7…”