The old schoolyard adage is true, “first is the worst, second is the best.” At least, that’s the case for patients dealing with neovascular or ‘wet’ age-related macular degeneration (AMD). It remains standard protocol in any eye care office to screen the fellow eye for wet AMD once the first—or “index”—eye has been diagnosed. In a JAMA Ophthalmology review of 264 patients, fellow eyes of patients with established wet AMD presented with a mean visual acuity (VA) of 20/50. That’s significantly better than the mean VA of the index eyes in the study, 20/90.

The research used baseline VA and at equivalent points throughout progression as a metric. It also notes that no difference was detected between the mean number of antivascular endothelial growth factor injections received by fellow eyes and index eyes.

The retrospective study attributes the superior outcomes of the second eyes to patients’ increased follow-up after diagnosis in the index eye, giving physicians the chance to detected and treat choroidal neovascularization in the fellow eye earlier, and when it is at a better level of VA; however, the study makes clear that that is simply speculation and the authors admit that “it is unknown whether the frequent office visits, VA measurements, or optical coherence tomography testing was responsible for the detection at a better level of VA.”

Stem M, Moinuddin O, Kline N, et al. Outcomes of anti–vascular endothelial growth factor treatment for choroidal neovascularization in fellow eyes of previously treated patients with neovascular age-related macular degeneration. JAMA Ophthalmol. May 10, 2018. [Epub ahead of print].