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Ben John Lloyd Burton, Tom H Webber, Adnan Tufail, Aaron Y Lee; Treat-and-extend follow-up regimens for neovascular age-related macular degeneration adversely affect visual acuity in the second eye which is usually the better seeing eye.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2335.
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© ARVO (1962-2015); The Authors (2016-present)
To study the effect of extended follow-up intervals for unilateral neovascular age-related macular degeneration (nAMD) on the visual acuity (VA) of the second initially unaffected eyes at the time of diagnosis of nAMD in the second eye.
2133 patients with sequential nAMD (first then second eye nAMD development) undergoing review and anti-vascular endothelial growth factor (VEGF) treatment with optical coherence tomography (OCT) monitoring prior to second eye diagnosis. Up to 5 years of routinely-collected, anonymised data was collected using the Medisoft electronic medical record (EMR) systeem. Patients were categorized into groups according to the interval between OCT monitoring visits prior to second eye treatment starting. These groups were less than or equal to 4weeks, 4-8, 8-12, and >12 weeks intervals. Some patients were seen earlier than their anticipated follow up interval when the second eye was diagnosed and this group was classified as “sudden” since they were presumed to have presented earlier due to worsening visual symptoms in their second eye.
Second treated eyes were the better-seeing eye for 74.5% of patients prior to diagnosis and treatment start. Mean VA in the second treated eye was 52.5 letters (standard deviation, 20.7) for patients who presented suddenly, and 54.5 (20.4). 51.1 (23.1), 47.4 (25.9)), and 44.8 (28.1) letters for patients being reviewed at <4, 4-8, 8-12, and >12 week intervals at the time of second eye diagnosis, respectively (p values <0.05 for comparing differences between <4, 4-8, 8-12, and >12 week review and sudden groups). 11.7% of patients in the sudden group lost more than 3 lines of vision between pre-diagnosis and diagnosis, compared to 14.4%, 17.7%, 23.6%, and 31.5% of patients reviewed at <4, 4-8, 8-12, and >12 week intervals (p<0.001). The odds ratio defining risk of losing 3 or more lines of vision at second eye diagnosis were 1.61, 2.25, 3.47 for patients reviewed in <4, 4-8, 8-12, and >12 week review groups compared to sudden group (p<0.001).
: This real-world clinical data demonstrates that extended follow-up intervals for unilateral nAMD patients adversely affects VA at presentation in the second eye. This is of importance because the second eye of such patients is usually the better-seeing eye in terms of visual function.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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