Neovascular age-related macular degeneration without drusen in the fellow eye: clinical spectrum and therapeutic outcome

Abstract

Purpose

To investigate the clinical characteristics and therapeutic outcome of patients with neovascular age-related macular degeneration (nAMD) in 1 eye, without drusen in the fellow eye.

Patients and methods

Medical records of 381 patients were analyzed to identify the cases. The main outcomes included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) and change in central retinal thickness (CRT). These parameters were reviewed at baseline, first follow-up visit, and after 6, 12, and 24 months.

Results

Out of 381 patients, 29 cases (8%) were included (of whom 3 had polypoidal choroidal vasculopathy [PCV]) who were treated with anti-vascular endothelial growth factor (anti-VEGF) therapy which was supplemented by photodynamic therapy (PDT) in the PCV patients. Overall, no statistically significant change in mean BCVA was observed during follow-up. BCVA improved or remained stable (defined as a gain in BCVA, a stable BCVA, or a loss of <5 ETDRS letters) in 22 patients (76%), and 7 patients (23%) had lost ≥5 ETDRS letters at final follow-up. A gain of ≥15 ETDRS letters at final follow-up was seen in 5 patients (17%). Mean CRT had decreased significantly with 99 µm (P<0.001) at 24 months after the initial visit.

Conclusion

There is a clinical spectrum of nAMD that is not associated with drusen in the fellow eye. Patients with nAMD without drusen in the fellow eye respond to anti-VEGF treatment and, in cases of PCV, to supplemental PDT. The pathophysiology of this spectrum of nAMD may be different from drusen-associated age-related macular degeneration.

Keywords:

• anti-vascular endothelial growth factor
• unilateral age-related macular degeneration
• non-neovascular age-related macular degeneration
• polypoidal choroidal vasculopathy
• precursor lesion
• best-corrected visual acuity

Acknowledgments

The authors thank MSc Ron Wolterbeek from the Department of Medical Statistics and Bioinformatics of the Leiden University Medical Center, for his statistical support. This research was supported by the Mathilde Grant, Stichting Leids Oogheelkundig Ondersteuningsfonds, Rotterdamse Stichting Blindenbelangen, and the Netherlands Organisation for Scientific Research (NWO). The funding organizations MD Fonds, Landelijke Stichting voor Blinden en Slechtzienden, Retina Netherlands, and BlindenPenning contributed through UitZicht. The aforementioned funding sources provided unrestricted grants and had no role in the design or conduct of this research.

Disclosure

The authors report no conflicts of interest in this work.