Abstract
Purpose :
To investigate genetic and non-genetic risk factors for fellow eye progression in patients with unilateral exudative age-related macular degeneration (AMD).
Methods :
This retrospective analysis included 127 patients from European genetic database (EUGENDA) with unilateral exudative AMD in one eye and non-exudative AMD without central geographic atrophy (GA) in the fellow eye, who have been regularly treated in the Department of Ophthalmology, University Hospital of Cologne. All patients had minimum of 2 years follow-up with fundus photographs, fluorescein angiography and spectral-domain optical coherence tomography at baseline. Grading was performed for AMD, for presence of hyperreflective foci (HF) (<10 or ≥10 lesions with reflectivity equal/higher than the retinal pigment epithelium), for reticular drusen (RD), drusenoid pigment epithel detachment (dPED) (≥360µm) and paracentral atrophy (≥175µm). Cox regression analysis for progression to late AMD (central GA or exudative AMD) included age, gender, RD, dPED, HF, paracentral atrophy, environmental factors (artery hypertension, diabetes, cardiovascular risk factors, body mass index, smoking) and genetic factors (ARMS2 rs10490924, CFH rs1061170).
Results :
During a mean follow-up time of 5.26±2.46 years, 69 of 127 patients (54.33%) developed late AMD in the fellow eye (exudative AMD n=49, central GA n=20). In Cox-Regression analysis patients with either intermediate AMD and paracentral atrophy (Hazard ratio (HR)=3.04, 95%Confidence interval (CI): 1.01-9.10, p=0.047), RD (HR=1.70, 95%CI: 1.05-2.76, p=0.032) or the presence of HF (<10HF: HR=2.58, 95%CI: 1.47-4.53, p=0.001; HF≥10 HR=3.16, 95%CI: 1.76-5.68, p=0.0001) showed a significantly increased likelihood of developing late AMD in the fellow eye. After adjusting for age and gender, HF still showed a significant influence on progression in the fellow eye (HF<10 HR=2.44, 95%CI: 1.27-4.66, p=0.007; HF≥10 HR=3.12, 95%CI: 1.57-6.19, p=0.001), whereas RD and intermediate AMD plus paracentral atrophy in the fellow eye were not significantly correlated.
Conclusions :
The role of HF as a biomarker for progression in the fellow eye of patients with unilateral exudative AMD was confirmed in this study. In those cases intensified monitoring potentially with new high resolution imaging modalities for early detection of progression seems advisable to prevent vision loss.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.