High-risk characteristics of fellow eyes of patients with unilateral neovascular age-related macular degeneration

Ophthalmology. 1998 Mar;105(3):441-7. doi: 10.1016/S0161-6420(98)93025-1.


Objective: This study aimed to determine whether clinical tests of ocular function and macular appearance independently can help to predict which patients with unilateral neovascular age-related macular degeneration (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 unilateral neovascular AMD observed for up to 4.5 years participated.

Intervention: Functional measurements included visual acuity, macular visual field, glare recovery time, and foveal electroretinogram amplitude and implicit time.

Main outcome measure: The age-adjusted proportion of patients having a CNVM develop over follow-up assessed by the Cox proportional hazards model with stepwise selection was measured.

Results: On average, 8.8% of patients had a CNVM develop each year. Independent risk 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 (relative 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 inversely related to the foveal electroretinogram implicit time.

Conclusions: A slower recovery from glare and more extensive funduscopic changes appear to be independent risk factors for the development of a CNVM in the fellow eyes of patients with unilateral neovascular AMD. A slower foveal electroretinogram implicit time may be a sign of early stage 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 develop.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Choroid / blood supply*
  • Cohort Studies
  • Electroretinography
  • Female
  • Follow-Up Studies
  • Fundus Oculi
  • Glare
  • Humans
  • Macular Degeneration / complications*
  • Macular Degeneration / diagnosis*
  • Macular Degeneration / physiopathology
  • Male
  • Middle Aged
  • Neovascularization, Pathologic / complications*
  • Neovascularization, Pathologic / diagnosis*
  • Neovascularization, Pathologic / physiopathology
  • Proportional Hazards Models
  • Prospective Studies
  • Retina / physiology
  • Risk Factors
  • Visual Acuity / physiology
  • Visual Fields / physiology