Significant Risk for Neovascular Disease in Fellow Eye in Patients with AMD

Patients with unilateral wet age-related macular degeneration (AMD) have a significant risk for progression to neovascular disease in the fellow eye, according to a recent real-world study. The results of the study were published as part of the American Society of Retina Specialists 2020 Virtual Annual Meeting.

Researchers retrospectively analyzed longitudinal, aggregated electronic health records from multiple U.S. retinal centers that comprised more than 3.4 million eyes. Patients with unilateral wet AMD who were treated with anti-vascular endothelial growth factor (VEGF) therapy between January 1, 2013, and August 31, 2019, were included. A total of 24,078 patients had at least three years of follow-up after initiating treatment in the first eye. Researchers calculated the frequency of fellow eye conversion within a three-year window after onset of wet AMD in the first eye. Visual acuity (VA) and central retinal thickness at time of development of wet AMD were recorded for both eyes, when possible.

During the study, fellow eyes of 8,522 patients (38%) converted to wet AMD. The conversion rate was highest in the first year and declined over time: The rate of conversion was 11.7% in the first year and fell to 5.5% by year four. Patients had a nearly 33% chance that the fellow eye would convert in the first four years of therapy. Median time to conversion in the second eye was 672 days.

When comparing VA between the first and fellow eyes, the fellow eye had significantly better VA at the time of conversion from dry to wet AMD, as well as one year after conversion. Fellow eyes also had significantly thinner retinas at both the conversion from dry to wet AMD, as well as one year later. “Fellow eyes had significantly better vision at diagnosis and maintained better VA at 12 months, with less office visits and less number of anti-VEGF injections,” the authors noted.

“The fellow eye should be monitored at regular intervals to detect signs of neovascularization. Fellow eyes presented with significantly better vision at diagnosis than the initial eye and maintained better VA at 12 months,” the researchers concluded.

Starr M, Xu D, Patel LG, et al. Characteristics of Fellow Eye Conversion to Neovascular Age-Related Macular Degeneration in Patients with Unilateral Neovascular Disease. Presented during the ASRS 2020 Virtual Annual Meeting, July 24-26, 2020.