Bilateral Neovascular Age-Related Macular Degeneration: Comparisons between First and Second Eyes

PURPOSE: To compare 12-month outcomes and clinical presentations between first and second eyes of patients who developed neovascular age-related macular degeneration (nAMD) in both eyes and received ranibizumab intravitreal therapy (IVT). METHODS: This is a retrospective case series of 45 patients undergoing IVT for unilateral nAMD who subsequently developed second-eye nAMD. At each visit, both eyes underwent visual acuity (VA) measurement and optical coherence tomography (OCT). RESULTS: In second eyes, 53% were asymptomatic at baseline, with OCT retinal fluid as the only sign of nAMD among 33% of patients. In eyes with baseline VA >6/9, 82% of second treated eyes maintained this vision versus 12% of first eyes (p = 0.05). At 12 months, 70% of second eyes were fluid free versus 41% of first eyes (p = 0.02). CONCLUSIONS: A large proportion of patients are asymptomatic at diagnosis of second-eye nAMD. Early intervention following earlier detection of nAMD in the second eye may lead to improved clinical outcomes.