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

Abstract

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 MEASURESThe 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. RESULTSWe 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 RELEVANCEThe presence of nonexudative neovascularization may predispose to the development of exudative changes.

Moorfields AMD database report 2: fellow eye involvement with neovascular age-related macular degeneration

“…[12,13,28] Specifically analysis of imaging biomarkers, possibly aided by artificial intelligence, might prove to be key in risk stratification of fellow eye involvement. [26,29,30] Our study demonstrates that non-sequentially treated fellow eyes do not share the typical fellow eye characteristics. They start treatment with a relatively low baseline VA and their gain in VA is higher, very similar to first eyes of sequentially treated patients.…”

“…This rate falls within the range reported in the Comparison of AMD Treatments Trials (20.6% at two years) and other studies. [12,13,[25][26][27] With demographic ageing, sight loss and blindness is predicted to increase by 2. In sequential treatment, fellow eyes have a higher baseline VA and maintain good vision over two years of treatment despite the absence of an initial gain in VA comparable to first eyes.…”

The Moorfields AMD Database Report 2 - Fellow Eye Involvement with Neovascular Age-related Macular Degeneration

“…[12,13,26] Specifically analysis of imaging biomarkers, possibly aided by artificial intelligence, might prove to be key in risk stratification of fellow eye involvement. [24,27,28] Our study demonstrates that non-sequentially treated fellow eyes do not share the typical fellow eye characteristics. They start treatment with a relatively low baseline VA and their gain in VA is higher, very similar to first eyes of sequentially treated patients.…”

“…This rate falls within the range reported in the Comparison of AMD Treatments Trials (20.6% at two years) and other studies. [12,13,[23][24][25] With demographic ageing, sight loss and blindness is predicted to increase by 2.4% from 2013 until 2050, reaching approximately 4 million people in the UK and the share of AMD is estimated to rise from 23% to 30%, representing 1.23 million people. [8] AMD is thus a major and growing contributor to healthcare burden.…”

Pachychoroid: current concepts on clinical features and pathogenesis

“…For example, in PCV, several morphological characteristics may influence the prognosis. Choroidal morphology, including characteristic features of pachychoroid and high vascularity, can serve as predictive factors for outcomes after combination PDT [40] or aflibercept [61][62][63]. Following IAI, greater improvements in VA at 12 months were significantly associated with greater baseline luminal area and smaller baseline stromal area in PCV [61].…”