LAUSR

Supplemental Digital Content is Available in the Text. The 5-year cumulative incidence of fellow eye involvement in Asian neovascular age-related macular degeneration is lower than that among Caucasians because of a higher prevalence of polypoidal choroidal vasculopathy. Drusens, shallow irregular retinal pigment epithelium elevation, and pigment epithelial detachment are risk factors for progression to exudation in fellow eyes. Purpose: To assess 5-year cumulative incidence and risk factors of fellow eye involvement in Asian neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy. Methods: In a prospective cohort study of Asian nAMD and polypoidal choroidal vasculopathy, the fellow eyes were evaluated for exudation. The 5-year incidence of exudation was compared between nAMD and polypoidal choroidal vasculopathy. Results: A total of 488 patients were studied. The 5-year incidence of exudation in fellow eyes was 16.2% (95% confidence interval: 12.0–20.2). Polypoidal choroidal vasculopathy compared with nAMD in the first eye was associated with lower fellow eye progression (9.8% [95% confidence interval: 5.1–14.3]) vs. 22.9% [95% confidence interval: 15.8–29.3], P < 0.01). Drusen (hazards ratio 2.11 [95% confidence interval: 1.10–4.06]), shallow irregular retinal pigment epithelium elevation (2.86 [1.58–5.18]), and pigment epithelial detachment (3.01 [1.27–7.17]) were associated with greater progression. A combination of soft drusens and subretinal drusenoid deposits, and specific pigment epithelial detachment subtypes (multilobular, and sharp peaked) were associated with progression. Pigment epithelial detachment, shallow irregular retinal pigment epithelium elevation, and new subretinal hyperreflective material occurred at 10.4 ± 4.2 months, 11.1 ± 6.0 months, and 6.9 ± 4.3 months, respectively, before exudation. Conclusion: The 5-year incidence of fellow eye involvement in Asian nAMD is lower than among Caucasians because of a higher polypoidal choroidal vasculopathy prevalence. Drusens, shallow irregular retinal pigment epithelium elevation, and pigment epithelial detachment are risk factors for fellow eye progression.