5-YEAR FOLLOW-UP OF FELLOW EYES OF INDIVIDUALS WITH OCULAR HISTOPLASMOSIS AND UNILATERAL EXTRAFOVEAL OR JUXTAFOVEAL CHOROIDAL NEOVASCULARIZATION

Objectives: To document the incidence of choroidal neovascularization (CNV) in unaffected fellow eyes among individuals with ocular histopla smosis and extrafoveal or juxtafoveal CNV in 1 eye; to determine wheth er the location and type of ''histo spots'' in the macula predict the site of future CNV development in second eyes; to describe changes ove r time in neovascular lesions present in fellow eyes at baseline; and to describe changes in visual acuity of fellow eyes with and without C NV at baseline. Design, Patients, and Setting: Five-year prospective f ollow-up study of fellow eyes of 516 patients enrolled in 2 randomized clinical trials of laser photocoagulation of extrafoveal and juxtafov eal CNV. Best-corrected visual acuity and reading vision were measured , and both maculas were photographed at baseline and at 6-month interv als. Main Outcome Measures: Cumulative incidence of CNV in fellow eyes free of neovascular maculopathy at the time of study enrollment, 5-ye ar change in visual acuity of fellow eyes from baseline, and incidence of legal blindness (visual acuity less than or equal to 20/200 in the better eye). Results: Photographically documented CNV developed in 35 (9%) of 394 eyes initially free of neovascular maculopathy; neverthel ess, good visual acuity was maintained in most newly affected eyes unt il the end of the 5-year follow-up period. Histo spots of any type in the macula at baseline tripled the risk for later development of CNV i n comparison to eyes without histo spots in the macula. Although the t ype of histo spots present in the central macula at baseline did not p redict future CNV development, in 32 of 35 second eyes in which CNV de veloped and in 7 of 9 fellow eyes in which a second area of CNV develo ped during follow-up, CNV was preceded by an ''atypical'' histo spot i n the same location. Among 122 patients who had bilateral neovascular maculopathy initially, 100 were examined 5 years later; 8 (8%) were le gally blind, compared with 3 (1%) of 339 patients examined who had uni lateral CNV initially. At the 5-year examination, 355 (81%) of 439 pat ients examined had a visual acuity of 20/20 or better in at least 1 ey e, including 74 (55%) of 134 patients who had bilateral neovascular ma culopathy. Conclusions: Although the incidence of CNV in fellow eyes t hat initially were unaffected remained low throughout 5 years of follo w-up, it persisted at a nearly constant rate. The risk of legal blindn ess was low, even for patients who had bilateral involvement. Perhaps most important, 81% of all patients followed up for 5 years retained a visual acuity of 20/20 in at least 1 eye, and 20% retained this visua l acuity in both eyes. Retrospective review of photographs suggests th at the ophthalmologist should pay special attention to areas of the ce ntral macula in which new ''atypical'' histo spots are observed, with the goal of treating CNV that may develop in the same area at a time w hen the benefits of laser treatment may be greatest.