Final visual acuity is better in the second eye than in the initial eye in patients with bilateral wet age-related macular degeneration treated with intra-vitreal injection of anti-vascular endothelial growth factor antibodies.

Abstract

Purpose: To compare the visual acuity of the initial eye with that of the second eye in patients with bilateral wet AMD being treated with intra-vitreal vascular endothelial growth factor antibodies.

Methods: This is a retrospective interventional case series. Charts of patients undergoing treatment for wet AMD between January 1, 2010 and December 31, 2012 were reviewed to identify patients who developed wet AMD in the fellow eye requiring treatment. Patients who were being examined less frequently then every 3 months and who had less than 6 months of follow-up from initiation of therapy in the second eye were excluded. The measured Snellen visual acuity in both the first and the fellow eye were noted at the following office visits: i. Prior to development of wet AMD in the second eye. ii. At presentation with wet AMD in the second eye. and iii. At the most recent office visit.

Results: Twenty-five patients developed incident wet AMD in the fellow eye while undergoing treatment for the first eye. At the time of the development of AMD in the fellow eye, the first eye was being treated, on average, every 8 weeks. Nine patients were being treated with bevacizumab (Avastin) and 16 with ranabizumab (Lucentis). At last evaluation, the initial eye had received 26 injections and the second eye had received 18 injections. Prior to the development of wet AMD, the second eye had the better visual acuity in 14 (56%) patients, and had symptoms of vision change in 19 (76%) of patients. Average follow-up from the onset of treatment in the second eye was 25 months. At the most recent follow-up, the average visual acuity (logMar) in the second eye was 20/40 and in the first eye was 20/50. (p=0.10)

Conclusions: The results show that with treatment, there is a trend toward better final visual acuity in the second wet AMD eye compared to the first. Development of wet AMD in the second eye can be devastating to patients who are already in treatment for wet AMD. These preliminary findings should however help reassure patients that if the second eye does become afflicted, that with treatment the second eye tends to have better final visual acuity. A larger sample will need to be studied to see if the trend can be duplicated and shown to be significant.

Keywords: 412 age-related macular degeneration • 754 visual acuity