Second eyes to develop neovascular age-related macular degeneration have fewer symptoms and better one-year visual outcomes

BackgroundThis study compares the visual and anatomical outcomes for the eyes of patients who developed sequential neovascular age-related macular degeneration (nAMD), both at the time of diagnosis and at one year after treatment.MethodsThe study comprised a retrospective case series of 52 patients whose eyes were diagnosed sequentially with nAMD. All eyes were treated with three monthly loading doses of anti-vascular endothelial growth factor agents, followed by further intravitreal injections, as required. Baseline characteristics and outcomes at one year after diagnosis and initial treatment were compared between first and second eyes and included visual acuity (VA), central macular thickness (CMT), and pigment epithelial detachment (PED) height on optical coherence tomography (OCT) imaging.ResultsVA at diagnosis was better for second eyes compared with first eyes to develop nAMD (logMAR 0.68 & PLUSMN; 0.51 versus logMAR 0.41 & PLUSMN; 0.34, P = 0.002) and remained so at one year (logMAR 0.61 & PLUSMN; 0.60 versus logMAR 0.42 & PLUSMN; 0.37, P = 0.041). Similarly, PED height at diagnosis was higher in first eyes (225 & PLUSMN; 176 & mu;m versus 155 & PLUSMN; 144 & mu;m, P = 0.003) and also at one year (188 & PLUSMN; 137 & mu;m versus 140 & PLUSMN; 112 & mu;m, P = 0.019). Whereas most patients reported symptoms at first eye diagnosis (71.2%), half as many second eyes were symptomatic (28.8%, P < 0.001). Significantly more symptomatic first eyes experienced visual distortions (32.4% versus 13.3%) or scotomas (29.4% versus 6.7%), compared with a less specific visual complaint of blurry vision (38.2% versus 80.0%, P = 0.006).ConclusionsCompared with first eyes to develop nAMD, second eyes tended to have better vision, smaller PED heights, and fewer symptoms likely because monitoring permitted earlier diagnosis.