The second eye of Japanese patients with unilateral exudative age related macular degeneration

Abstract

Aim-To clarify the incidence of choroidal neovascularisation (CNV) and predisposing findings for development of CNV in the second eye of Japanese patients with unilateral exudative age related macular degeneration (AMD). Methods-The second eyes of unilaterally aVected patients with exudative (neovascular) AMD treated in our clinic during the past 10 years (1988-97) were carefully followed up for more than a year. Evidence of CNV was confirmed by fluorescein and indocyanine green angiography. Macular lesions in patients, in whom CNV developed in the second eye, were retrospectively evaluated from patient records. Results-170 patients met the criteria. The average follow up period was 47 months (range 12-108 months). All patients were Japanese. CNV developed in the second eye in 12 (7%) of 170 patients, 30.3 months on average after the first examination. Cumulative incidence of developing CNV in the second eye using Kaplan-Meier life table analysis was: 0.6% by 1 year, 5.6% by 3 years, and 12.3% by 5 years, and was relatively low compared with that in white patients. CNV developed most frequently from serous pigment epithelial detachment (PED) in the macula (58%). Soft drusen were not prevalent and risk of developing CNV was not very high (18%). Conclusion-It was confirmed that there were some diVerences in the incidence and predisposing findings for CNV developing in AMD among Japanese and other Asian patients compared with those in white people. It is important to recognise these diVerences between the two populations to understand the pathogenesis and epidemiology of AMD. (Br J Ophthalmol 2000;84:1018-1023 Exudative (neovascular) age related macular degeneration (AMD) is a leading cause of blindness in elderly people in Western countries.1-4 Although, in Japanese as well as in other Asian people, the number of patients with exudative AMD is not as great as in Western people, the number of patients has been rapidly increasing recently and is now becoming one of the major causes of blindness in the elderly. Epidemiology and clinical features of exudative AMD have been well established in the United States and United Kingdom. In Japan, clinical manifestations of AMD have become clearer during the past 20 years.5 6 Following the increase in patients with AMD, we have recognised that Japanese patients show some diVerences from white patients with regard to epidemiological features and predisposing findings for the development of choroidal neovascularisation (CNV). In white people, soft drusen at the macula prevalent among elderly people, are commonly present in AMD, and these people show the highest risk for developing CNV. 1-4 7-17 In Japanese people, however, soft drusen are not as commonly seen among elderly people, or among patients with AMD but, rather, serous retinal pigment epithelial detachments (PED) are the most frequent predisposing lesions for developing CNV.5 18 These findings were also similar to those in other Asian patients. 19Many papers have reported a very high annual incidence of CNV in ...

Ethnic variation in AMD-associated complement factor H polymorphism p.Tyr402His

“…It has long been known that the prevalence of AMD varies widely among different ethnicities [Gregor and Joffe, 1978;Munoz et al, 2000;Oshima et al, 2001;Sommer et al, 1991;Eye Diseases Prevalence Research Group, 2004;Varma et al, 2004;Yuzawa et al, 1997]. Moreover, the phenotypic spectrum of AMD among these groups is quite heterogeneous [Andersen, 2004;Lim et al, 1998;Schachat et al, 1995;Sho et al, 2003;Uyama et al, 1992Uyama et al, , 2000Yuzawa et al, 1991].…”

Second eye of patients with unilateral neovascular age-related macular degeneration: Caucasians vs Chinese

“…Data from the Asian population suggest a lower incidence of CNV in the second eye. 6,8,22 The MPS study has shown that characteristics of drusen and retinal pigmentary abnormalities are independent prognostic indicators for development of CNV. 15,16 These findings have been quantified in large population-based studies 1-3 and they provide a strong rationale for using these features to design a universally accepted grading system for stratifying ARM.…”

“…[25][26][27] However, soft drusen are not as prevalent in the Orientals. 22,24,28 In addition, the prevalence of retinal pigmentary changes is lower in the Orientals. 22 These findings contribute to the fact that the Chinese cohort has less ARM severity compared to Caucasians.…”

“…This is further substantiated by the fact that serous pigment epithelial detachments (PED) were found to be a higher risk factor for development of CNV in the Chinese and Japanese compared to soft drusen. 22,24,28 Serous PEDs are not included in the Rotterdam grading. It may be that if ARM severity is analysed by including all morphological abnormalities in the retina, there may not be significant differences in ARM severity between races.…”

Development of Age-Related Macular Degeneration (AMD) in the Fellow Eye of Patients with AMD Treated by Treat-and-Extend Intravitreal Therapy with Aflibercept

“…In Japanese patients, Uyama et al [12] reported an incidence in the fellow eye of 12.3% over 5 years; Yuzawa et al [13] estimated incidences of 8% for 3 years, 12% for 5 years, and 20% for 10 years. These studies were conducted without the use of any anti-VEGF agents for the treatment of AMD.…”