scholarly journals Use of Imaging Modalities in Real Life: Impact on Visual Acuity Outcomes of Ranibizumab Treatment for Neovascular Age-Related Macular Degeneration in Germany

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Joachim Wachtlin ◽  
Georg Spital ◽  
Steffen Schmitz-Valckenberg ◽  
Sandra Liakopoulos ◽  
Jessica Vögeler ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Functional Outcomes ◽  
Real Life ◽  
Treatment Decisions ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Oct Imaging ◽  
The Impact ◽  
Ranibizumab Treatment

Background. To date, there are limited prospective real-world data on the impact of optical coherence tomography (OCT) diagnostics on treatment outcomes in neovascular age-related macular degeneration (nAMD). Therefore, the prospective, noninterventional OCEAN study (NCT02194803) evaluated the use of OCT imaging and its impact on functional outcomes in Germany. Methods. The use of OCT imaging for treatment decisions was documented in nAMD patients receiving intravitreal ranibizumab injections at 347 study centres. Best-corrected visual acuity (BCVA) testing and treatment were performed according to routine clinical practice and documented over 24 months. Results. The majority of the 3,631 nAMD patients (59.6%) received a combination of OCT and fluorescein angiography imaging within the first 6 months. Over the remaining study course, this combination was used infrequently (range: 7.6% to 13.4%) and continually decreased over time; most patients received only OCT examinations (range: 48.9% to 52.5%; median: 3 within 12 months and 4 within 24 months). Subgroups according to the number of OCT examinations (≤4, rarely OCT examined; 5–8, moderately OCT examined; ≥8, well monitored) were associated with different treatment frequencies and outcomes: Rarely OCT-examined patients had received a median of 4 injections (range: 1–19) at 24 months; well-monitored patients had received a median of 8 injections (range: 1–21) at 24 months. Rarely OCT-examined patients had a mean change of BCVA of −0.3 letters (±26.1) at 24 months (n = 165); well-monitored patients showed a change of +2.0 letters (±20.8) at 24 months (n = 249). Time-to-response was greater for rarely examined than well-monitored patients, while duration-of-response was similar. Conclusion. Low number of visits as well as high number of treatment decisions without the use of OCT may contribute to undertreatment and poorer functional outcomes in patients undergoing ranibizumab treatment for nAMD in Germany. One potential reason for this could be that OCT was not covered by insurance for all patients during the study.

scholarly journals A Retrospective Analysis of the Real-Life Utilization of Ranibizumab in Patients with Wet Age-Related Macular Degeneration from Portugal

2017 ◽  
Vol 30 (6) ◽  
pp. 449 ◽  
Author(s):  
Rufino Silva ◽  
Carla Goncalves ◽  
Angela Meireles ◽  
Carla Teixeira ◽  
Paulo Rosa ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Macular Degeneration ◽  
Real Life ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Age Related ◽  
Real Life Setting ◽  
Actual Use ◽  
Acuity Score

Introduction: Anti-vascular endothelial growth factor therapy has revolutionized the treatment of wet age-related macular degeneration; however, it is important to monitor actual use of ranibizumab and related treatment outcomes in routine practice.Material and Methods: This was a retrospective, observational study to monitor the 2-year outcomes following ranibizumab treatment for wet age-related macular degeneration in Portugal. Patients treated between January 2009 and December 2009 were retrospectively evaluated. All decisions were made by the treating physician in accordance with their usual routine clinical practice. The primary assessment was mean change in visual acuity score using Early Treatment Diabetic Retinopathy Study or Snellen equivalent.Results: A total of 128 patients with wet age-related macular degeneration were analyzed (mean age 79.4 years; mean visual acuity score 54.2 letters). Mean change in visual acuity score from baseline was –1.6 letters (n = 82) at year one and –5.1 letters (n = 72) at year two. The mean number of ranibizumab injections was 3.8 (year one) and 1.6 (year two). On average, patients attended 8.6 and 5.0 visits and optical coherence tomography was used in 75.0% of patients in year one and in 56.3% of patients in year two, respectively.Discussion: Despite a relatively high number of visits, including monitoring visits and use of optical coherence tomography - guided therapy, few injections were administered and visual acuity was not improved.Conclusion: These findings indicate that as-needed treatment resulted in under-dosing in a real-life setting in Portugal. Such limitations may also be related to increasing numbers of patients, resulting in clinic saturation.

scholarly journals ORCA study: real-world versus reading centre assessment of disease activity of neovascular age-related macular degeneration (nAMD)

2020 ◽  
pp. bjophthalmol-2019-315717 ◽  
Author(s):  
Sandra Liakopoulos ◽  
Georg Spital ◽  
Christian K Brinkmann ◽  
Tina Schick ◽  
Focke Ziemssen ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Image Interpretation ◽  
Subretinal Fluid ◽  
Treatment Decisions ◽  
Age Related Macular Degeneration ◽  
Correct Identification ◽  
Age Related ◽  
Ocean Study ◽  
The Impact ◽  
Sd Oct

Background/aimsThe prospective, non-interventional ORCA module of the OCEAN study (Observation of Treatment Patterns with Lucentis in Approved Indications) evaluated the qualiy of spectral domain-optical coherence tomography (SD-OCT) image interpretation and treatment decisions by clinicians in Germany and the impact on visual outcomes over 24 months in patients with neovascular age-related macular degeneration (nAMD).Methods2286 SD-OCT scans of 205 eyes were independently evaluated by clinicians and reading centres (RCs) regarding signs of choroidal neovascularisation (CNV) activity, including presence of intraretinal fluid, subretinal fluid, and/or increase in pigment epithelial detachments. Agreement between clinicians and RCs was calculated. Treatment decisions by clinicians and the impact on treatment outcomes were evaluated.ResultsCNV activity was detected by RCs on 1578 scans (69.0%) and by clinicians on 1392 scans (60.9%), with agreement in 74.9% of cases. Of the 1578 scans with RC detected CNV activity, anti-vascular endothelial growth factor injections were performed by clinicians in only 35.5% (560/1578). In 19.7% of cases (311/1578), lack of treatment was justified by patients request, termination criteria or chronic cystoid spaces without other signs for CNV activity. In 44.8% of cases (707/1578) with RC detected CNV activity, clinicians claimed no treatment was necessary despite having correctly detected CNV activity in about 2/3 of these cases. In 34% of cases with presumed undertreatment, visual acuity declined in the following visit.ConclusionAlthough broad agreement on CNV activity parameters was observed between clinicians and RCs, correct identification of CNV activity did not always lead to the initiation of (re-)treatment. To preserve vision over time, correct interpretation of SD-OCT scans and careful retreatment decisions are required.Trial registration numberNCT02194803.

scholarly journals Myopia and age-related macular degeneration: structural and anatomical changes of the eye

2019 ◽  
Vol 12 (3) ◽  
pp. 5-12
Author(s):  
I. B. Alekseev ◽  
Ju. A. Nam
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Central Zone ◽  
Age Related Macular Degeneration ◽  
Visual Functions ◽  
Chorioretinal Atrophy ◽  
Age Related ◽  
High Degree ◽  
The Impact

The purpose of the study was to find out how age-related macular degeneration and medium-high degree myopia affect the structural and anatomical parameters of the eyeball, and to find whether a relationship exists between various types of myopic staphylomas and changes of visual functions.Material and methods. 120 patients (236 eyes), with medium and high degree myopia and age-related retinal changes, aged 44 to 81 years were tested for two groups of parameters: quantitative and qualitative. The former included the patients’ age, best corrected visual acuity (BCVA), computer perimetry data, the axial length, and the thickness of the retina in the central zone. The latter included retinal changes, in particular pigment epithelium (PE) defects, drusen, PE detachment, choroidal neovascular membrane (CNV), Fuchs spot and diffuse chorioretinal atrophy. The impact of various types of staphylomas on visual functions was evaluated. Results. Visual functions were found to directly depend on retinal PE integrity. If defects, detachment, or drusen are present, computer perimetry parameters and BVCA are reducing. Fuchs spot presence and diffuse chorioretinal atrophy reduces BCVA and causes an MD decrease. The lowest visual acuity and considerable light sensitivity loss was noted in patients with combined staphylomas. Conclusion. The obtained data confirm that retinal dystrophic processes directly affect visual functions: BCVA and retinal photosensitivity levels drop in all retinal changes studied. The presence of staphyloma, being a factor that aggravates myopia, undoubtedly worsens the most of the parameters studied. 

scholarly journals Percentage of Foveal versus Total Macular Geographic Atrophy as a Predictor of Visual Acuity in Age-related Macular Degeneration

2019 ◽  
Author(s):  
Saghar Bagheri ◽  
Ines Lains ◽  
Rebecca Silverman ◽  
Ivana Kim ◽  
Dean Eliott ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Fundus Autofluorescence ◽  
Cross Sectional Study ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Cross Sectional ◽  
Age Related ◽  
The Impact ◽  
Foveal Sparing

AbstractObjectivesTo investigate the relationship between visual acuity (VA), total area of geographic atrophy (GA) and percentage of foveal GA.MethodsMulticenter, retrospective cross-sectional study of patients with GA due to age-related macular degeneration. Demographics, VA, fundus autofluorescence (FAF) and optical coherence tomography (OCT) images were collected. Using FAF images aided by OCT, foveal sparing status, GA pattern, total GA size, and percentage of GA covering the foveal area - area within a 1.5 mm diameter circle centered on the fovea centralis - were assessed. Univariable and multiple linear regression analyses were performed.Results54 eyes (mean age 78.7 ±7.7 (SD), 60.0% female) were studied. Mean VA was 0.8 ± 0.6 logMAR, mean total GA 8.8 ± 6.7 mm2 and mean percentage of foveal GA was 71.5 ± 30.9%. Of all assessed eyes, 48.2% (n = 26) presented with multifocal GA, and 18.5% (n = 10) had foveal sparing. Multiple regression analysis revealed that, controlling for age and GA pattern, the percentage of foveal GA presented a statistically significant association with VA (ß = 0.41, P = 0.004). No significant associations were observed with mean total GA size, while controlling for the same variables (ß = 0.010, P = 0.440).ConclusionPercentage of foveal GA was significantly associated with VA impairment, while the same was not verified for total GA area. These findings suggest that percentage of foveal GA may represent a more useful tool for assessing the impact of GA on VA. Further validation is needed in larger cohorts.

scholarly journals Key drivers of visual acuity gains in neovascular age-related macular degeneration in real life: findings from the AURA study

2016 ◽  
Vol 100 (12) ◽  
pp. 1623-1628 ◽  
Author(s):  
Frank G Holz ◽  
Ramin Tadayoni ◽  
Stephen Beatty ◽  
Alan Berger ◽  
Matteo Giuseppe Cereda ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Real Life ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Key Drivers

Change in vision-related quality of life and influencing factors in Asians receiving treatment for neovascular age-related macular degeneration

2017 ◽  
Vol 102 (3) ◽  
pp. 377-382 ◽  
Author(s):  
Eva K Fenwick ◽  
Gemmy Chui Ming Cheung ◽  
Alfred TL Gan ◽  
Gavin Tan ◽  
Shu Yen Lee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Reading Scores ◽  
Related Factors ◽  
Age Related ◽  
Related Quality ◽  
The Impact

AimTo assess the change in vision-related quality of life (VRQoL) after treatment for neovascular age-related macular degeneration (nAMD) and factors influencing this change in an Asian population.MethodsIn this longitudinal study, 116 patients (mean age±SD=66.5±9.9 years; 59.5% male) who underwent treatment for nAMD were recruited from a tertiary eye centre in Singapore. Best-corrected visual acuity (BCVA) and the Impact of Vision Impairment (IVI) questionnaire were evaluated at baseline and month 12. We defined three categories of BCVA change in the treated eye: BCVA gain ≥2 lines; no change in BCVA; BCVA loss ≥2 lines. The main outcome measures were the Rasch-derived IVI Reading, Mobility, and Emotional Scores. Multivariable linear regression analyses assessed the influence of sociodemographic, clinical and treatment-related factors on change in VRQoL.ResultsFollowing treatment, mean treated-eye BCVA improved by almost 2 lines (−0.22±0.40 logMAR, p<0.001) and 43% (n=50) patients reported a gain in BCVA of ≥2 lines. Mean±SD scores for Reading, Mobility and Emotional demonstrated positive changes of 0.43±1.73, 0.45±1.54 and 0.66±1.6, respectively (p<0.001 for all). In multivariable models, a ≥2 line improvement in BCVA was independently associated with a 47% (β=0.20; CI 0.01 to 0.39) increase in Reading Scores, but was not independently associated with Mobility or Emotional Scores.ConclusionNearly half of patients undergoing treatment for nAMD reported a 2-line improvement in vision which was, in turn, associated with substantial positive increases in Reading Scores. Improvements in Mobility and Emotional Scores appear to be driven by factors other than visual acuity.

Quality of life: Investigating the impact of two major mental disorders, anxiety and depression, in patients with age-related macular degeneration

2020 ◽  
pp. 026461962097370
Author(s):  
Marios Papalamprou ◽  
Constantine D Georgakopoulos ◽  
Nikolaos Pharmakakis
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Mental Disorders ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Anxiety And Depression ◽  
Cart Analysis ◽  
Age Related ◽  
The Impact

Purpose: The purpose of this study was to investigate the impact on the quality of life of patients with age-related macular degeneration (AMD) in relation to common mental disorders, namely anxiety and depression, and determine specific factors (e.g., thoughts/feelings, sociodemographic characteristics) that may be used to refer such patients to psychiatrists. Materials–Methods: To classify the patients into different categories, regarding the development of the mental disorders under consideration, the “Hospital Anxiety and Depression Scale” (HADS) has been utilized. The main statistical methodologies applied are classification and regression trees (CART) techniques and logistic regression. For the purposes of the aforementioned statistical analysis, the R software package has been used. Results: Both depression and anxiety scores varied considerably across visual acuity (VA) severity. Patients with severe visual acuity problems tend to have also higher HADS scores. Women were more likely to be affected by depression; sociodemographic factors did not have any significant effect. According to the performed CART analysis, responses to two HADS items (namely, “I can enjoy a good book or radio or television program” and “I have lost interest in my appearance”) identified the vast majority of severely to moderately depressed patients. Furthermore, the level of VA severity was found as a main driver for diagnosing an AMD patient with depression. Conclusions: VA impairment (or decline) severity level was found to be the main factor associated with depression in patients with AMD. Moreover, specific thoughts/feelings present in patients with AMD have been found as significant regarding the level of their mental disorders under consideration and could be asked by the ophthalmologist to refer (or not) them to psychiatrists.

scholarly journals High frequency SD-OCT follow-up leading to up to biweekly intravitreal ranibizumab treatment in neovascular age-related macular degeneration

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cengiz Tuerksever ◽  
Christian Pruente ◽  
Katja Hatz
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
High Frequency ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Intravitreal Ranibizumab ◽  
Age Related ◽  
Ranibizumab Treatment ◽  
Sd Oct

AbstractA remarkable proportion of neovascular age-related macular degeneration (nAMD) patients respond rather poorly to ranibizumab treatment, in spite of the minimum 4-week follow-up and treatment interval. Usually, retreatments are based on nAMD activity as evaluated by Spectral-domain Optical coherence Tomography (SD-OCT), biomicroscopic fundus examination and visual acuity changes. In this prospective pilot study, we aimed to study SD-OCT changes in a high-frequent follow-up manner (weekly (month 0–6), biweekly (month 7–12)) throughout the first year, which consequently led to intravitreal ranibizumab being administered up to biweekly. Best corrected visual acuity (BCVA) was already significantly improved at week 2. Central retinal thickness (CRT), intraretinal and subretinal fluid (SRF) were significantly improved from week 1 onwards. Half of the patients showed nAMD activity at week 2 or 3 and received the first retreatment earlier than 4 weeks after baseline injection. In total, 46% of retreatments were already applied 2 or 3 weeks after the previous treatment. Greater range of CRT and SRF fluctuation during follow-up was associated with lower final BCVA. Lower baseline BCVA and better SRF improvement at week 2 was associated with greater BCVA improvement. In conclusion, high-frequency SD-OCT follow-up provided a good option for adapting treatment in nAMD individually.

Sign in / Sign up

Export Citation Format

Share Document