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Shokufeh Tavassoli, Miranda Buckle, Ahmed A I Sallam, Robert Johnston; First signs of neovascular age-related macular degeneration requiring anti-VEGF treatment in second eyes under monthly surveillance after treatment in the first eye.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3407.
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To identify the first signs of neovascular age related macular degeneration (nAMD) in the second eye of patients on treatment with anti-VEGF intravitreal injections for their first eye.
All nAMD patients have monthly review with OCT and fundal examination. At each review a standardised dataset was prospectively recorded within an electronic medical record including: subjective change in vision, ETDRS letter score, central 1mm retinal thickness and the presence or absence of: subretinal fluid (SRF), intraretinal cysts, intraretinal fluid (IRF), new macular haemorrhage, pigment epithelial detachment.
101 patients developed nAMD in their ‘second’ eye between 2009 and 2012. The first indicator of disease was: a loss of greater than 5 letters since the last visit alone in 27%, the presence of subretinal fluid alone in 8%, the presence of intraretinal fluid or cysts alone in 7%, a 20% increase in retinal thickness since the previous visit alone in 7%, the presence of pigment epithelial detachment alone in 2%, the presence of new macular haemorrhage alone in 1%, and other combinations in 48%. A loss of greater than 5 letters since the last visit with or without other signs was present in 51% and signs of fluid (subretinal fluid, intraretinal fluid or cysts) alone or in combination with each other or other signs in 55%. The mean time from first detection of a new abnormality to first injection was 255 days. The mean visual acuity at detection was LogMAR 0.35. The mean 1mm central macular thickness at first detection of an abnormality was 281mm.
This study shows that the earliest signs of nAMD in second eyes are most frequently drops in visual acuity, subretinal fluid and intraretinal cysts or fluid with or without the other signs, although these initial signs are often asymptomatic. There is often a prolonged interval between first detection of second eye disease and initiating treatment, partly due to funding restrictions in the UK for eyes with visual acuity better than logMAR 0.3.
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