Choroidal Neovascularization in Symptomatic and Asymptomatic Patients Secondary to Age-Related Macular Degeneration

Abstract

Purpose: : To compare the incidence and outcomes of symptomatic and asymptomatic patients with newly diagnosed choroidal neovascularization (CNV) and a fellow eye affected with exudative age-related macular degeneration (AMD).

Methods: : A retrospective chart review of approximately 500 consecutive patients (1000 eyes) with neovascular AMD was performed. For the purpose of this research, the onset of neovascular AMD in the first eye will be referred to as the ‘primary eye’ and the onset of neovascular AMD in the second eye will be referred to as the ‘fellow eye.’ Visual acuity, macular pathology, symptoms, Ocular Coherence Tomography (OCT) central retinal thickness, treatment history, and follow up period of both eyes were recorded. These data points were analyzed in order to determine what percentage of patients who have wet AMD were symptomatic at the onset of the CNV.

Results: : 480/500 (96%) of patients were symptomatic in their primary eyes and 461/500 (92%) of patients were symptomatic in their fellow eyes.The visual acuity in the primary eyes of symptomatic and asymptomatic patients was examined. Primary eyes of symptomatic patients had an average vision of 0.86 logMAR (20/143 Snellen) at the onset of diagnosis of wet AMD. Asymptomatic patients had an average vision of 0.72 logMAR (20/104 Snellen) at the onset of diagnosis of wet AMD. At the end of the treatment and follow up periods, it was found that the average visual acuity in the primary eyes of symptomatic patients decreased to 1.11 logMAR (20/258 Snellen), while the average vision in the primary eyes of asymptomatic patients decreased to 0.80 logMAR (20/127 Snellen).The visual acuity in the fellow eyes of symptomatic and asymptomatic patients was examined. Fellow eyes symptomatic patients had an average vision of 0.72 logMAR (20/105 Snellen) at the onset of diagnosis of wet AMD. Asymptomatic patients had an average vision of 0.48 logMAR (20/60 Snellen) at the onset of diagnosis of wet AMD. At the end of the treatment and follow up periods, it was found that the average visual acuity in the fellow eyes of symptomatic patients increased to 0.48 logMAR (20/60 Snellen), while the average vision in the fellow eyes of asymptomatic patients decreased to 0.83 logMAR (20/135 Snellen).

Conclusions: : Approximately 59/1000 (6%) of eyes with new onset of wet AMD are asymptomatic. Screening both eyes of patients who have unilateral wet AMD may be invaluable in preventing visual loss in the fellow eyes of these patients.

Keywords: age-related macular degeneration • choroid: neovascularization • visual acuity