Ma. Sandberg et al., HIGH-RISK CHARACTERISTICS OF FELLOW EYES OF PATIENTS WITH UNILATERAL NEOVASCULAR AGE-RELATED MACULAR DEGENERATION, Ophthalmology, 105(3), 1998, pp. 441-447
Objective: This study aimed to determine whether clinical tests of ocu
lar function and macular appearance independently can help to predict
which patients with unilateral neovascular age-related macular degener
ation (AMD) will have a choroidal neovascular membrane (CNVM) develop
in their fellow eye. Design: The study design was a prospective cohort
study. Participants: One hundred twenty-seven patients with unilatera
l neovascular AMD observed for up to 4.5 years participated. Intervent
ion: Functional measurements included visual acuity, macular visual fi
eld, glare recovery time, and foveal electroretinogram amplitude and i
mplicit time. Main Outcome Measure: The age-adjusted proportion of pat
ients having a CNVM develop over follow-up assessed by the Cox proport
ional hazards model with stepwise selection was measured, Results: On
average, 8.8% of patients had a CNVM develop each year. Independent ri
sk factors for the fellow eye were its glare recovery time in minutes
(relative risk = 1.30, confidence interval = 1.10-1.54, P = 0.003) and
its extent of visible macular abnormalities on a four-point scale (re
lative risk = 1.62, confidence interval = 1.06-2.59, P = 0.03). Of the
fellow eyes that converted, the interval to have a CNVM develop was i
nversely related to the foveal electroretinogram implicit time. Conclu
sions: A slower recovery from glare and more extensive funduscopic cha
nges appear to be independent risk factors for the development of a CN
VM in the fellow eyes of patients with unilateral neovascular AMD. A s
lower foveal electroretinogram implicit time may be a sign of early st
age CNVM development, perhaps because of outer retinal ischemia. These
results have clinical management implications, particularly for those
patients at high risk of having a potentially treatable form of AMD d
evelop.