Development of neovascular age-related macular degeneration in fellow eyes of patients undergoing intravitreal anti-VEGF therapy at a large tertiary ophthalmic hospital

Abstract

Purpose : Age-related macular degeneration (AMD) is usually a bilateral condition but may not progress at the same pace in both eyes. In this retrospective study, we describe the number of patients undergoing anti-VEGF treatment for neovascular AMD within a tertiary ophthalmic hospital encompassing multiple sites across London, and how many of these patients went on to receive treatment for the same condition in their fellow eye.

Methods : The Moorfields Eye Hospital Electronic Medical Records system was queried between 2007 and 2017 for patients undergoing intravitreal anti-VEGF treatment in one eye, and for those who went on to receive anti-VEGF treatment in their fellow eye. Baseline visual acuity was recorded at the start of treatment for the first and second eye in ETDRS format. Statistical analysis was carried out using SPSS version 23.

Results : Out of 5614 patients, 4372 were receiving anti-VEGF treatment in one eye only during the observation period, and 1242 (22%) patients had received anti-VEGF treatment to both eyes at some stage. Two-hundred and eighty (22.5%) patients presented with bilateral neovascular AMD (interval between injections for the first and second eye <28 days). Involvement of the second eye occurred after a median of 282 days. The mean (SD) difference in ETDRS letters at first injection was +6 (±18) between the eyes, with the first eye having a visual acuity of 55 ETDRS letters and the second eye having a visual acuity of 61 ETDRS letters.

Conclusions : Nearly a quarter of patients had received treatment for bilateral disease, indicating a high risk of developing the disease in fellow eyes. Patients are likely to present with a better baseline visual acuity when their fellow eye is affected. This may be due to closer monitoring and more frequent OCT imaging, and therefore earlier diagnosis, but patients may also be more vigilant of sudden changes in their vision.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.