5-YEAR FOLLOW-UP OF FELLOW EYES OF PATIENTS WITH AGE-RELATED MACULAR DEGENERATION AND UNILATERAL EXTRAFOVEAL CHOROIDAL NEOVASCULARIZATION

Objectives: To assess the visual prognosis of patients with age-relate d macular degeneration and unilateral extrafoveal choroidal neovascula rization (CNV), and to determine the risk of CNV developing in fellow eyes that were initially unaffected. Design, Patients, and Setting: Fi ve-year prospective follow-up study of fellow eyes of 228 patients enr olled in a randomized clinical trial of laser photocoagulation of extr afoveal CNV. Visual acuity was measured and macular photographs were t aken at 6-month intervals. Main Outcome Measures: Five-year change in visual acuity of fellow eyes from baseline, incidence of legal blindne ss (visual acuity of less-than-or-equal-to 20/200 in the better eye), and cumulative incidence of CNV in fellow eyes free of neovascular mac ulopathy at the time of study enrollment. Results: Photographically do cumented CNV developed in 33 (26%) of 128 fellow eyes that were initia lly free of neovascular maculopathy, and was associated with poor visu al acuity at the end of the 5-year follow-up period. Among 67 patients who had bilateral neovascular maculopathy initially and were examined 5 years later, 33 (49%) were legally blind compared with 13 (12%) of 106 patients who had unilateral neovascular maculopathy initially. In all 13 of the latter group, CNV had developed in the fellow eye. Concl usions: Patients with age-related macular degeneration and CNV in one eye are at high risk of legal blindness within 5 years, and, thus, sho uld be followed up carefully to ensure that laser treatment can be app lied to CNV in either eye whenever it is likely to improve the visual prognosis.