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Monitoring both eyes of patients with unilateral age-related macular degeneration (AMD) led to early diagnosis of AMD in the second eye and better vision outcomes, a multicenter prospective study showed.

At conversion of the second eye, visual acuity (VA) was substantially better compared with diagnosis of the first eye and remained better at all time points during 2 years of follow-up after conversion. More patients retained vision >70 letters in the second eye, and prevalence of subretinal hyperreflective material (SHRM) and intraretinal fluid (IRF) was lower in the second eye. Subretinal fluid (SRF) occurred more commonly in the second eye.

Quality-of-life (QoL) scores improved over time and had a significant correlation with visual acuity (VA) in the second eye but not the first, reported Richard Gale, MBChB, PhD, of the University of York in England, and co-authors in .

"Our study results substantiate the need for regular monitoring of fellow eyes of unilateral nAMD [neovascular AMD] to prevent significant changes to retinal structure and function," they concluded.

Consistent with , the study showed that about a fourth of patients with unilateral AMD subsequently develop the condition in the second eye, said Ninel Gregori, MD, of the University of Miami and spokesperson for the American Academy of Ophthalmology.

"This study underlines the importance of early diagnosis, particularly in the second eye, to maintain QoL and prevent significant visual loss for patients with nAMD in the long-term," Gregori told MedPage Today via email. "Economic modeling has also identified that earlier diagnosis of the second eye in nAMD with OCT [optical coherence tomography] is indeed cost effective for patients with nAMD in the first eye.

"Thus, routine monitoring of the second eye is important during treatment of the first eye to result in better visual outcome in the second eye and to miss conversion of the second eye. OCT has been shown to be a better modality for monitoring than self-reported visual decline, Amsler grid, or fundus examination."

When a fellow eye converts to AMD, prompt treatment generally results in better visual function at diagnosis and over time, as compared with the first eye, Gale and colleagues noted in their introduction. Morphologic studies have identified several associated with nAMD, particularly foveal atrophy and fibrosis.

A recent identified five key biomarkers identified by OCT as being related to progression of nAMD: SHRM, drusen, IRF, outer retinal tubulations, and hyperreflective foci. Of those, IRF has the greatest impact on visual outcomes. Continuing that line of research, Gale and colleagues compared VA outcomes and prevalence of 12 retinal biomarkers in the first and second eye of patients with AMD.

The investigation comprised two separate but parallel studies conducted from 2015 to 2017 at 22 centers in the National Health Service. The previously reported included 562 patients with unilateral nAMD evaluated OCT, self-monitoring with an Amsler grid, self-reported visual function, slit lamp evaluation, and dye-based angiography for early detection of nAMD in the second dye. The EDNA study population included 431 patients co-enrolled in the , conducted during 2018-2022, evaluating biomarkers associated with nAMD and included an additional 2 years of follow-up.

The FASBAT population included patients >50 with new-onset nAMD in the first eye. Investigators examined both eyes by means of OCT, color fundus photography, clinic-measured VA, and QoL. The primary outcomes were prevalence of atrophy, SHRM, IRF, and SRF.

Subsequently, 100 of the 431 (23%) converted to nAMD in the second eye. Mean time to conversion was 18.9 months. Mean time to nAMD diagnosis was 18.9 months for the first eye and 24.9 months for the second eye.

VA was 18 letters better in the second eye at diagnosis of nAMD (72.9) as compared with the first eye (55.6). At follow-up, VA had improved in the first eye to 59.7 letters as compared with a loss in the second eye (69.5).

Prevalence of OCT-detected atrophy at diagnosis was 31.3% in the first eye and 23.4% in the second eye. At follow-up, prevalence was 55.3% versus 53.5%. Prevalence by color fundus photography was substantially lower: 15.9% vs 17.3% at diagnosis and 42.9% versus 43.9% at follow-up.

Other findings by OCT at diagnosis and follow-up were (first versus second eye):

• SHRM: 93% vs 77.2%, 92.4% vs 80.5%
• SRF: Mean maximal height: 59.8% vs 35.6%, 25.4% vs 28%
• SRF: Mean foveal maximal height: 20.6% vs 13.7%, 4.2% vs 8.5%
• IRF: 57.7% vs 32.9%, 46.5% vs 34.1%

Despite the numeric decrease in VA at follow-up in the second eye, visual performance was consistently better in the second eye throughout the post-diagnosis follow-up, supporting previous research, the authors noted. The proportion of second eyes with good vision (>70 letters) at 24 months was almost double that of the first eye (65.6% vs 36.5%).

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