Improved structure and function in early detected second eye neovascular age-related macular degeneration; FASBAT/EDNA report 1

Abstract

Abstract Purpose Visual Acuity (VA) and structural biomarker assessment before and at 24-months after early detection and routine treatment of second eye involvement with neovascular age-related macular degeneration (nAMD) and additional comparison with the first eye affected.

Design Prospective, 22-centre observational study of participants with unilateral nAMD in the Early Detection of Neovascular AMD (EDNA) study, co-enrolled into the Observing fibrosis, macular atrophy and subretinal highly reflective material, before and after intervention with anti-VEGF treatment (FASBAT) study for an additional 2-year follow-up.

Participants Older adults (>50 years) with new onset nAMD in the first eye.

Methods Assessment of both eyes with optical coherence tomography (OCT), colour fundus photography (CFP), clinic-measured visual acuity (VA) and quality-of-life (QoL).

Main Outcome Measures Prevalence of Atrophy, Subretinal Hyperreflective Material (SHRM), Intraretinal fluid (IRF), Subretinal fluid (SRF) and changes in VA over the study duration in both the first and second eyes affected with nAMD. Composite QoL scores over time.

Results Of 431 participants recruited to the FASBAT study, the second eye converted to nAMD in 100 participants at a mean of 18.9 months. VA was 18 letters better at the time of early diagnosis in the second eye compared with conventional diagnosis in the first eye (72.9 vs 55.6 letters). 24.9-months post-conversion in the second eye, VA was 69.5 letters compared with at a similar matched time point in the first eye (59.7 letters; 18.9 months). A greater proportion of participants had vision >70 letters in the second eye versus the first eye, 24.9-months post-conversion (61 vs 38). Prevalence of SHRM and IRF was lower in the second eye compared with the first eye at 24.9-months post-conversion to nAMD. However, SRF prevalence was greater in the second eye at 24.9-months post-conversion. The development and progression of total area of atrophy appears similar in both eyes. Mean composite QoL scores increased over time, with a significant correlation between VA for the second eye only 24.9 months post-conversion.

Conclusion This study has shown that early detection of exudative AMD in the second eye is associated with reduced prevalence of SHRM and IRF and greater visual acuity which is significantly correlated with maintained quality-of-life.