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. 2018 Aug 1;136(8):905-911.
doi: 10.1001/jamaophthalmol.2018.2154.

Incidence of Fellow Eye Involvement in Patients With Unilateral Exudative Age-Related Macular Degeneration

Yasuo Yanagi  1   2 , Aditi Mohla  1 , Shu Yen Lee  1   2 , Ranjana Mathur  1   2 , Choi Mun Chan  1   2 , Ian Yeo  1   2 , Tien Yin Wong  1   2 , Chui Ming Gemmy Cheung  1   2
Affiliations

Incidence of Fellow Eye Involvement in Patients With Unilateral Exudative Age-Related Macular Degeneration

Yasuo Yanagi et al. JAMA Ophthalmol. .

Abstract

Importance: Since the advent of optical coherence tomography angiography (OCT-A), nonexudative neovascularization has been described in the fellow eyes of unilateral exudative age-related macular degeneration (AMD). However, there is limited literature describing the natural course and optimal management of these lesions.

Objective: To determine the incidence of fellow eye involvement in patients presenting with unilateral typical AMD or polypoidal choroidal vasculopathy and to evaluate the patterns of OCT-A changes within 6 months before the onset of exudative changes, especially focusing on nonexudative neovascularization.

Design, setting, and participants: Data for this study were taken from a prospective, observational cohort study involving Asian patients with exudative AMD in the Asian AMD Phenotyping Study between October 2015 and March 2016. Analyses began in June 2017. Only patients who had gradable OCT-A and indocyanine green angiography (ICGA) scans of the fellow eye at baseline and follow-up at least 6 months apart were included for the analysis. The contralateral eye was evaluated for presence of nonexudative neovascularization based on multimodal imaging, which included ICGA, spectral domain optical coherence tomography, and OCT-A.

Main outcomes and measures: The difference between the incidence of those with nonexudative choroidal neovascularization and those without as analyzed using log-rank test and qualitative analysis of OCT-A images.

Results: We included 95 fellow eyes of 95 patients who presented with unilateral exudative AMD with a mean (SD) age of 68.6 (8.6) years. Nonexudative neovascularization was present in 18 eyes (19%) (8 [22.9%] and 10 [19.0%] fellow eyes with typical AMD and polypoidal choroidal vasculopathy, respectively; 8 [44.4%] on OCT-A; 5 [27.8%] on ICGA; and 5 [27.8%] on both OCT-A and ICGA). Development of exudative changes was noted in 6 fellow eyes (6.3%). Four eyes developed exudation from previously noted nonexudative neovascularization, and 2 eyes arose exudative changes from de novo. The probability of developing exudation within 6 months was significantly higher in eyes with baseline nonexudative neovascularization (0.087; 95% CI, 0.0033-0.210) compared with eyes without (0.010; 95% CI, 0.0026-0.041) (P = .008). In all eyes whose OCT-A images were available immediately before the onset of exudative changes, there was an increase in the size of network vessels compared with baseline.

Conclusions and relevance: The presence of nonexudative neovascularization may predispose to the development of exudative changes.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Cheung reports nonfinancial support from Topcon during the conduct of the study; grants, personal fees, and nonfinancial support from Bayer; grants, personal fees, and nonfinancial support from Novartis; personal fees and nonfinancial support from Roche; personal fees and nonfinancial support from Allergan; personal fees and nonfinancial support from Topcon; and personal fees from Samsung outside the submitted work. No other conflicts were disclosed.

Figures

Figure 1.
Figure 1.. Time to Developing Exudative Changes
Exudative change was used as an end point.
Figure 2.
Figure 2.. Left Eye of a Man With Nonexudative Neovascularization
A, Color fundus photograph. B, Indocyanine green angiography (ICGA) showing nonexudative neovascularization located at subfovea. C, Fluorescein angiography showing window defect. D, Cross-sectional optical coherence tomography showing undulation of retinal pigment epithelium line.
Figure 3.
Figure 3.. Left Eye of a Man With Nonexudative Neovascularization That Developed Exudative Changes
Follow-up examinations at 2 (A and B), 5 (C), and 9 (D) months. Optical coherence tomography angiography (OCT-A) scans through the fovea showing flow signal between retinal pigment epithelium and Bruch membrane (B) and vascular flow within the outer retina corresponding to the irregular retinal pigment epithelium elevation (A). Neovascularization increased in size on en face OCT-A from 1 087 000 μm2 to 1 212 527 μm2 (A vs C) before the onset of exudative changes (D). Double layer sign (white arrowheads) can be seen to increase from 2 months (B) to 9 months (D). Exudation developed at 9 months as evidenced by presence of subretinal fluid (yellow arrowhead).
Figure 4.
Figure 4.. Indolent Nonexudative Neovascularizations Detected by Indocyanine Green Angiography (ICGA) and Optical Coherence Tomography Angiography (OCT-A)
A and B, Right eye of a woman. Cross-sectional OCT-A scans through the fovea showing slightly undulated retinal pigment epithelium line (B, arrowheads) and clearly detects vascular flow within the outer retinal slab (A). The size of nonexudative neovascular membrane (A) was 679 834 μm2. There was no change in the size (670 869 μm2) and vascularity of the neovascularization at 9-month follow-up (C and D).
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