gms | German Medical Science

Background: Approximately 28.9% of age-related macular degeneration (AMD) patients will experience visual impairment. Neovascular AMD (nAMD) remains a major threat to functional vision. Currently, little is known regarding long-term progression to nAMD nor vision prognoses of fellow-eyes that have not progressed to nAMD.

Method: Unilateral nAMD patients were referred to our tertiary outpatient clinic by collaborating retinal specialists. Patients were then imaged biannually using i.a. SD-OCT, OCT-angiography for at least 1 year. Presenting visual acuity was measured (ETDRS-chart). Ophthalmic history was assessed via questionnaires. Outcomes include the progression rate to nAMD in the fellow eye per 100-person years (PR) and functional vision (best-seeing eye >.5 (decimal)). Progression during follow-up was evaluated using fluorescein angiography. Patients lost to follow-up were contacted by telephone. Patients were allotted in groups at the study baseline according to time since nAMD diagnosis ranging from <2 years (group 1), 2 to 5 years (group 2) and 5+ years (group 3). Functional vision and PR group differences were compared via chi-squared tests.

Results: We included n = 133 patients from Jan 2018 to Nov 2022, aged 77 (9) years, (female 87/133). Median (IQR) time since diagnosis was 3 (5) years. PR was 10 per 100 person-years for the total cohort. The PR for groups 1–3 did not differ (14, 10, 10 per 100 person-years resp.) (P >.05). The median (IQR) time since diagnosis in group 3 was 9 (4) years. Only group 3 featured patients without functional vision (87%) whilst group 1 (100%) and 2 (100%) did not (P <.05).

Conclusion: Unilateral nAMD patients remain at a high risk of progression to bilateral nAMD even after a decade. For patients whose fellow-eye does not progress, functional vision is preserved for the majority of patients regardless of time since diagnosis.