title: The neovascular age-related macular degeneration database: report 2: incidence, management, and visual outcomes of second treated eyes.
abstract: OBJECTIVE
  To study the characteristics of second treated eyes in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab in the United Kingdom National Health Service.
  
  
  METHODS
  Multicenter national nAMD database study.
  
  
  METHODS
  Twelve thousand nine hundred fifty-one treatment-naïve eyes of 11,135 patients receiving 92,976 ranibizumab injections.
  
  
  METHODS
  Up to 5 years of routinely collected, anonymized data within electronic medical record systems were extracted remotely from 14 centers. Participating centers exclusively used ranibizumab to treat nAMD (loading phase of 3 monthly injections followed by monthly visits and pro re nata re-treatment). The minimum data set included: age, logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) at baseline and at all subsequent visits, and injection episodes.
  
  
  METHODS
  Baseline, change and actual VA over 3 years, and number of treatments and clinic visits.
  
  
  RESULTS
  During the study, 1816 (16.3%) of the 11 135 patients received treatment to the fellow eye. Mean baseline and final VA were 0.66 (standard deviation, 0.32) and 0.65 (0.40) for first treated eyes and 0.41 (0.34) and 0.56 (0.40) for second treated eyes. The rate of VA loss after the loading phase was similar in first and second treated eyes (0.03 and 0.05 logMAR units/year). When fellow eyes with baseline VA worse than 20/200 were excluded to restrict analyses to eyes at risk of nAMD, the rate of second-eye involvement was 14.0% per year (42%/3 years). Mean number of injections/visits in years 1, 2, and 3 were similar for first and second treated eyes (5.6/8.2, 3.9/8.0, 3.8/8.2 and 5.5/8.7, 3.6/9.4, and 3.8/9.1, respectively).
  
  
  CONCLUSIONS
  Second treated eyes with nAMD commence treatment with better baseline VA, do not show significant vision gain but maintain better VA than first treated eyes at all time points for at least 3 years, making them the more important eye functionally. These data highlight the high burden of second eye involvement, with almost half of all eyes at risk requiring bilateral treatment by 3 years, and the need for regular monitoring of fellow eyes for best visual outcomes which theoretically may reduce the benefits of extended monitoring regimens.
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Javier
authors: J
authors: Zarranz-Ventura
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Gerald
authors: G
authors: Liew
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Robert L
authors: RL
authors: Johnston
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Wen
authors: W
authors: Xing
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Toks
authors: T
authors: Akerele
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Martin
authors: M
authors: McKibbin
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Louise
authors: L
authors: Downey
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Salim
authors: S
authors: Natha
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Usha
authors: U
authors: Chakravarthy
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Clare
authors: C
authors: Bailey
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Rehna
authors: R
authors: Khan
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Richard
authors: R
authors: Antcliff
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Stewart
authors: S
authors: Armstrong
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Atul
authors: A
authors: Varma
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Vineeth
authors: V
authors: Kumar
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Marie
authors: M
authors: Tsaloumas
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Kaveri
authors: K
authors: Mandal
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom.
authors: Catey
authors: C
authors: Bunce
authors: Moorfields Eye Hospital NHS Trust, London, United Kingdom. Electronic address: Adnan.Tufail@moorfields.nhs.uk.
authors: Adnan
authors: A
authors: Tufail
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008268:Macular Degeneration / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D006113:United Kingdom / Q000453:epidemiology; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab