Preliminary Observations of Bilateral Neovascular Age-Related Macular Degeneration Progression: A Real-World Retrospective Case Series

Background: This study investigated the clinical timeline, patient monitoring behaviors, and cumulative bilateral treatment burden in patients with bilateral neovascular age-related macular degeneration. Methods: We retrospectively analyzed follow-up patterns and treatment intensity from first-eye (FE) diagnosis to second-eye (SE) conversion. Results: SE conversion occurred within a mean of 2.0 years in the FE-active group (62.5%) while the FE remained exudative, contrasting with 6.2 years in the FE-inactive group (37.5%). Upon SE conversion, the total annual intravitreal injection burden escalated 3.4-fold (p = 0.002). Notably, the FE-inactive group exhibited numerically lower annual outpatient visit counts (4.40 ± 2.71 vs. 10.29 ± 5.02; p = 0.116), which potentially widened the monitoring window. Additionally, baseline SE retinal pigment epithelium (RPE) abnormalities independently predicted progression (aOR: 19.04; p = 0.032). Conclusions: While previous literature focuses on individual eyes, our findings highlight a vigilance gap in SE detection based on FE status. Clinicians must maintain proactive surveillance for patients with baseline SE RPE abnormalities, particularly when FE stability or next-generation long-acting therapies extend clinic intervals. Due to the limited sample size, these preliminary findings warrant validation in larger prospective cohorts.