title: Neovascular age-related macular degeneration without drusen in the fellow eye: clinical spectrum and therapeutic outcome.
abstract: OBJECTIVE
  To investigate the clinical characteristics and therapeutic outcome of patients with neovascular age-related macular degeneration (nAMD) in 1 eye, without drusen in the fellow eye.
  
  
  METHODS
  Medical records of 381 patients were analyzed to identify the cases. The main outcomes included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) and change in central retinal thickness (CRT). These parameters were reviewed at baseline, first follow-up visit, and after 6, 12, and 24 months.
  
  
  RESULTS
  Out of 381 patients, 29 cases (8%) were included (of whom 3 had polypoidal choroidal vasculopathy [PCV]) who were treated with anti-vascular endothelial growth factor (anti-VEGF) therapy which was supplemented by photodynamic therapy (PDT) in the PCV patients. Overall, no statistically significant change in mean BCVA was observed during follow-up. BCVA improved or remained stable (defined as a gain in BCVA, a stable BCVA, or a loss of <5 ETDRS letters) in 22 patients (76%), and 7 patients (23%) had lost ≥5 ETDRS letters at final follow-up. A gain of ≥15 ETDRS letters at final follow-up was seen in 5 patients (17%). Mean CRT had decreased significantly with 99 µm (P<0.001) at 24 months after the initial visit.
  
  
  CONCLUSIONS
  There is a clinical spectrum of nAMD that is not associated with drusen in the fellow eye. Patients with nAMD without drusen in the fellow eye respond to anti-VEGF treatment and, in cases of PCV, to supplemental PDT. The pathophysiology of this spectrum of nAMD may be different from drusen-associated age-related macular degeneration.
authors.affiliation: Department of Ophthalmology, Leiden University Medical Center, Leiden.
authors.forename: Wing H
authors.initials: WH
authors.lastname: Chung
authors.affiliation: Department of Ophthalmology, Leiden University Medical Center, Leiden.
authors.forename: Elon H C
authors.initials: EH
authors.lastname: van Dijk
authors.affiliation: Department of Ophthalmology, Leiden University Medical Center, Leiden.
authors.forename: Danial
authors.initials: D
authors.lastname: Mohabati
authors.affiliation: Department of Ophthalmology, Leiden University Medical Center, Leiden.
authors.forename: Greet
authors.initials: G
authors.lastname: Dijkman
authors.affiliation: Rotterdam Eye Hospital, Rotterdam.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Yzer
authors.affiliation: Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Eiko K
authors.initials: EK
authors.lastname: de Jong
authors.affiliation: Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Fauser
authors.affiliation: Department of Ophthalmology; Ocular Angiogenesis Group, Departments of Ophthalmology and Cell Biology and Histology, Academic Medical Center; Netherlands Institute for Neuroscience, Amsterdam, the Netherlands.
authors.forename: Reinier O
authors.initials: RO
authors.lastname: Schlingemann
authors.affiliation: Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Carel B
authors.initials: CB
authors.lastname: Hoyng
authors.affiliation: Department of Ophthalmology, Leiden University Medical Center, Leiden; Department of Ophthalmology.
authors.forename: Camiel J F
authors.initials: CJ
authors.lastname: Boon
keywords: anti-vascular endothelial growth factor; best-corrected visual acuity; non-neovascular age-related macular degeneration; polypoidal choroidal vasculopathy; precursor lesion; unilateral age-related macular degeneration