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AE Elsner, AJ Morandi, JP Walker, GL Wing, PA Raskauskas, AT Ghuman, C Kiesel, DC Fletcher; Fellow Eye status in the Longitudinal SW Florida Age-related Macular Degeneration Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1214.
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Purpose: To understand the factors leading to vision loss in a 5 yr study of early age-related macular degeneration (AMD). To assess potential risk factors that predict visual outcome, combining advanced imaging techniques with clinical and systemic variables. Methods: The 100 patients, 61 females and 39 males, initially recruited in 1994-1995 were recruited for retest in 1999-2001, and clinical data were recorded. The entry criteria were no significant atrophy or exudation in the central macula, best visual acuity at least 20/60, no eye disease other than AMD for the test eye, plus no diabetes. Imaging performed at study entry was with a scanning laser ophthalmoscope (SLO). We previously reported focal hyperpigmentation on entry, scored in 1998 for the central 3000 microns surrounding fixation, and that this factor alone was related to eventual loss of visual acuity (Elsner, 1999,2000,2001). The first outcome measure is whether a patient had at least a doubling of minimum angle of resolution associated with exudation, permanently or for ≷ 2 yr. Patients were excluded from analysis who did not meet the length criteria or lost vision concomitant with other factors, epiretinal membrane being the most common. To examine the effect of the outcome of the fellow eye, we removed patients with unrelated causes of poor vision, e.g. amblyopia. Several models with potential risk factors were evaluated using logistic regression for statistical significance, and for the numbers of cases correctly classified. Results: Patients who developed exudation and permanent vision loss had worse focal hyperpigmentation than those who did not. While focal hyperpigmentation is partially correlated with visual acuity in the fellow eye, the unweighted combination of both focal hyperpigmentation in the test eye and visual acuity in the fellow eye is more significant than either alone (p = .0011, .0279, .0144, respectively). Neither age nor self-report of heart disease significantly improved the model. Self-report of heart disease, which we initially reported was related to the extent of drusen, reclassified some of the patients, but not always correctly. Conclusion: Patients with history of vision loss in the fellow eye or clumped macular hyperpigmentation may be at greater risk of permanent vision loss, particularly if they develop exudation in the test eye.
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