Visual acuity outcomes after anti-vascular endothelial growth factor (anti-VEGF) treatment for choroidal neovascularization (CNV) are better in fellow eyes of previously treated patients with neovascular age-related macular degeneration (nvAMD), according to a retrospective study


Anti-VEGF treatment is effective for nvAMD, but not for nonneovascular AMD, so patients with nvAMD in one eye and nonneovascular AMD in the fellow eye must wait until signs of nvAMD emerge in the fellow eye before definitive treatment can be started.

Dr. Tarek S. Hassan from William Beaumont Hospital, in Royal Oak, Michigan, and colleagues examined the medical records of 264 patients to determine if fellow eyes fared better regarding posttreatment visual acuity (VA) after conversion to nvAMD than had the index eyes.

The team routinely examines and obtains optical coherence tomography (OCT) imaging of fellow eyes with neovascular AMD in patients who are being actively treated for nvAMD in the other (index) eye.

Compared with the index eyes, the fellow eyes presented with better VA (mean VA, 20/50 versus 20/90 for index eyes) at the time of conversion to nvAMD, the researchers report in JAMA Ophthalmology, online May 10.

After an equivalent follow-up of approximately 20 months, the level of VA achieved was significantly better in the fellow eyes (mean, 20/50) than in the index eyes (mean, 20/70), a difference of eight letters.

There was no difference in the mean number of anti-VEGF injections received by index and fellow eyes during equal periods of follow-up.

"We conclude that routine screening for new CNV in fellow eyes with nonneovascular AMD of patients currently being treated for nvAMD at each office visit may be worthwhile because it could lead to the early detection and treatment of CNV when VA is still good, thus preserving VA among fellow eyes," the researchers conclude.

"Future studies may aim to determine whether the frequent office visits, VA measurements, or OCT testing might be responsible for the detection of new CNV at a better level of VA."

nvAMD in one eye

Dr. Sean D. Adrean told that "I completely agree with the authors, that at each visit that the patient makes for treatment for nvAMD in the treated eye, the fellow eye should at the very least have SD-OCT performed and fundoscopic exam if the patient allows dilation at that visit. It is our protocol to dilate both eyes and examine both eyes at each visit when patients are being treated for nvAMD in one eye."

He added, "Patients should also be encouraged to be vigilant in monitoring their fellow eye since the incidence of conversion to nvAMD is so high and be instructed to return to the clinic earlier if they notice new or increasing metamorphopsia and blurred vision."

Dr. Karsten Kortuem from Ludwig-Maximilians-University Munich, in Germany, and Moorfields Eye Hospital, in London, U.K., who recently evaluated the use of machine learning to predict VA in patients treated for nvAMD, told Reuters Health by email, "It’s good to see the hypothesis of improved VA in second eye patients confirmed by retrospective analysis."

"If patients have neovascular AMD in one eye treated with anti-VEGF injections, it is advisable to check always the fellow eye," he said. "Also, treatment thresholds like in the UK should be lowered for second eye involvement."