Five-year follow-up of fellow eyes with ocular histoplasmosis and unilateral extrafoveal or juxtafoveal choroidal neovascularization (CNV)

Purpose: In fellow eyes of individuals with extra- or juxtafoveal CNV in one eye, to document the incidence of CNV; to determine whether the type and location of histo spots in the macula predict the site of future CNV; to describe changes over time in neovascular lesions present at baseline; and to describe changes in visual acuity (VA) of eyes with and without CNV at baseline. Methods: Fellow eyes of 516 patients enrolled in clinical trials of laser treatment of CNV were followed for 5 years. VA was measured and macular photographs were taken at 6-month intervals. Results: Photographically documented CNV developed in 9% of 394 eyes free of neovascular maculopathy initially; nevertheless, most newly affected eyes retained good VA. Macular histo spots of any type tripled the risk of later development of CNV in comparison to eyes free of them (p = 0.002). After 5 years, 8% of patients with bilateral involvement initially were legally blind compared to 1% of patients with unilateral involvement; 81% of all patients had VA ≥ 20/20 in at least one eye, including 55% of patients who had bilateral involvement at baseline. Conclusions: The incidence of CNV in second eyes at risk remained nearly constant at about 2% per year; thus, patients with unilateral CNV may be at lifelong risk of second eye involvement and, hence, visual impairment or blindness. Monitoring of second eyes at risk by patient and ophthalmologist are necessary to identify extra- or juxtafoveal CNV when it develops so that laser treatment is timely.