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Identifying early symptoms of choroidal neovascularisation in second eyes of patients with unilateral wet age related macular degeneration using a telephone evaluation method

Abstract

Background/Objectives

Patients undergoing intravitreal injections for nAMD are often anxious about early detection of nAMD in their fellow eyes. The purpose of this study was to evaluate a home-based telephone method for helping patients to monitor for symptoms of second eye involvement.

Subjects/Methods

Using a five-staged evaluation tool, telephone-assisted evaluations were repeatedly performed on the patients’ fellow eyes every 4 weeks for 1 year. A decision on presence or absence of nAMD was made after each telephone evaluation. Slitlamp examination and OCT scan were performed at 3, 6, 9 and 12 months or whenever nAMD was suspected from the telephone evaluation. The sensitivity and specificity values were calculated from the true and false positive and negative rates of each of the five composite stages.

Results

In total, 514 telephone episodes comprising 2570 evaluations were conducted on fellow eyes of 50 patients over one year. Three patients (6%) developed nAMD in fellow eyes. The sensitivity of all of the stages was low (33.3%). The specificity of the five stages ranged from 91.3% to 98.6%. The highest specificity was achieved by the near acuity component of the tool.

Conclusions

We were unable to demonstrate a high sensitivity for the five-staged tool but the near acuity component of this tool had a very high specificity. This could have potential for “ruling out” nAMD and reducing the burden of false positive episodes for a large group of patients who are at risk of developing nAMD in their second eyes.

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Fig. 1: Example of modified A4 Bailey-Lovie Chart.
Fig. 2: OCT showing development of CNV.

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Funding

Funding

Funded in part by the Tripartite grant from three charitable bodies South Staffordshire Medical FoundationReg. Charity No: 1075209 Rotha Abraham Bequest Reg. Charity No: 509234 The Royal Wolverhampton Hospitals NHS Trust Charity Reg. Charity No: 1059467.

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Correspondence to William Fusi-Rubiano.

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Fusi-Rubiano, W., Webb, R., Narendran, N. et al. Identifying early symptoms of choroidal neovascularisation in second eyes of patients with unilateral wet age related macular degeneration using a telephone evaluation method. Eye 35, 3028–3034 (2021). https://doi.org/10.1038/s41433-020-01364-2

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