This secondary analysis of data from two clinical trials explores whether the type of anti-VEGF agent and baseline characteristics influence fellow eye conversion to neovascular AMD.

Study design

The authors conducted a post hoc analysis of the VIEW 1 and VIEW 2 clinical trials, which were randomized, double-masked, active-controlled, multicenter, 96-week, phase 3 trials comparing the efficacy and safety of intravitreal aflibercept and ranibizumab for treatment-naive eyes with wet AMD. They analyzed a subgroup of participants with no fellow eye involvement at baseline. The primary outcome measure was the incidence of conversion to wet AMD in patients with untreated fellow eyes that had no signs of neovascularization at baseline.

Outcomes

Of the 1,561 participants included in the analysis, 375 patients experienced conversion to wet AMD in the fellow eye (24.0%) over the 96-week study period. Increased age and female sex were associated with a higher risk for fellow eye conversion. Treatment drug (ranibizumab or aflibercept) or regimen did not affect fellow eye conversion rates.

Limitations

The study is limited by its design as a post-hoc analysis of existing data. There were no OCT data available for fellow eyes. The choroidal neovascularization determination in fellow eyes came from fluorescein angiography data and investigator documentation in case report forms.

Clinical significance

This study provides key evidence that patients with active neovascular AMD in 1 eye are at a much higher risk for fellow eye conversion than previously thought based on prior cohort studies. These patients should be monitored closely in the fellow eye for the onset of neovascular disease.