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Clinical science
Moorfields AMD database report 2: fellow eye involvement with neovascular age-related macular degeneration
  1. Katrin Fasler1,2,
  2. Dun Jack Fu1,
  3. Gabriella Moraes1,
  4. Siegfried Wagner1,
  5. Eesha Gokhale1,
  6. Karsten Kortuem1,3,
  7. Reena Chopra1,
  8. Livia Faes1,4,
  9. Gabriella Preston1,
  10. Nikolas Pontikos1,
  11. Praveen J Patel1,
  12. Adnan Tufail1,
  13. Aaron Y Lee5,
  14. Konstantinos Balaskas1,
  15. Pearse A Keane1
  1. 1 NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2 Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
  3. 3 University Eye Hospital, Ludwig Maximilians University, Munich, Germany
  4. 4 Department of Ophthalmology, Luzerner Kantonsspital, Luzern, Switzerland
  5. 5 Department of Ophthalmology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Pearse A Keane, Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK; pearse.keane1{at}nhs.net

Abstract

Background/Aims Neovascular age-related macular degeneration (nAMD) is frequently bilateral, and previous reports on ‘fellow eyes’ have assumed sequential treatment after a period of treatment of the first eye only. The aim of our study was to analyse baseline characteristics and visual acuity (VA) outcomes of fellow eye involvement with nAMD, specifically differentiating between sequential and non-sequential (due to macular scarring in the first eye) antivascular endothelial growth factor treatment and timelines for fellow eye involvement.

Methods Retrospective, electronic medical record database study of the Moorfields AMD database of 6265 patients/120 286 single entries with data extracted between 21 October 2008 and 9 August 2018. The data set for analysis consisted of 1180 sequential, 807 non-sequential and 3410 unilateral eyes.

Results Mean VA (ETDRS letters±SD) of sequentially treated fellow eyes at baseline was significantly higher (63±13), VA gain over 2 years lower (0.37±14) and proportion of eyes with good VA (≥70 letters) higher (46%) than the respective first eyes (baseline VA 54±16, VA gain at 2 years 5.6±15, percentage of eyes with good VA 39%). Non-sequential fellow eyes showed baseline characteristics and VA outcomes similar to first eyes. Fellow eye involvement rate was 32% at 2 years, and median time interval to fellow eye involvement was 71 (IQR: 27–147) weeks.

Conclusion This report shows that sequentially treated nAMD fellow eyes have better baseline and final VA than non-sequentially treated eyes after 2 years of treatment. Sequentially treated eyes also had a greater proportion with good VA after 2 years.

  • age-related macular degeneration
  • choroidal neovascularization
  • ranibizumab
  • aflibercept
  • anti-vascular endothelial growth factor
  • fellow eye
  • electronic medical record
  • visual acuity

http://dx.doi.org/10.1136/bjophthalmol-2019-314446

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    Footnotes

    • Twitter @dunjackfu

    • Contributors KF has drafted the manuscript and contributed to data acquisition, analysis and interpretation of data. She is accountable for all aspects of the work and has approved the final version to be published. SW and KK have contributed to design of the study, interpretation of data as well as critical revision of the manuscript. They share accountability for all aspects of the work and have approved for the final version to be published. LF, DJF and AYL have contributed to analysis and interpretation of the data and critical revision of the manuscript. They share accountability for all aspects of the work and have approved for the final version to be published. GM, GP, RC, EG and NP have contributed to acquisition of data and critical revision of the manuscript. They share accountability for all aspects of the work and have approved for the final version to be published. KB, PJP, AT and PAK have contributed to conception of the work, interpretation of data and critical revision of the manuscript. They share accountability for all aspects of the work and have approved for the final version to be published.

    • Funding The research is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology.

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests KF has received fellowship support from Alfred Vogt Stipendium and Schweizerischer Fonds zur Verhütung und Bekämpfung der Blindheit. She has been an external consultant for DeepMind. SW is an academic clinical fellow funded by the National Institute of Health Research (NIHR). PAK has received speaker fees from Heidelberg Engineering, Topcon, Carl Zeiss Meditec, Haag-Streit, Allergan, Novartis and Bayer. He has served on advisory boards for Novartis and Bayer and has been an external consultant for DeepMind and Optos. PAK is supported by a UK NIHR Clinician Scientist Award (NIHR-CS-2014-12-023). RC received studentship support from the College of Optometrists and is a paid intern at DeepMind. PJP has received speaker fees from Novartis UK, Bayer UK and Roche UK and has received an advisory board honorarium from Novartis UK and Bayer UK. AYL has received research funding from Novartis, NVIDIA and Microsoft Corporation. He is supported by the National Institutes of Health (K23EY029246) and Research to Prevent Blindness.

    • Patient consent for publication Not required.

    • Ethics approval Approval for data collection and analysis from Moorfields (ROAD17/031).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository.