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ASSESSING THE ACCURACY OF A LARGE OBSERVATIONAL REGISTRY OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2020; 40:866-872. [DOI: 10.1097/iae.0000000000002485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wintergerst MWM, Bouws J, Loss J, Heimes B, Pauleikhoff D, Holz FG, Finger RP. [Reasons for delayed and discontinued therapy in age-related macular degeneration]. Ophthalmologe 2019; 115:1035-1041. [PMID: 29138977 DOI: 10.1007/s00347-017-0610-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Critical prerequisites for successful therapy of neovascular age-related macular degeneration (nvAMD) are an early initiation and continuous monitoring; however, delays in starting therapy and non-medically indicated discontinuation of therapy are frequent, which limits therapy efficacy and, thus, visual outcomes. OBJECTIVE To identify the reasons for delay in therapy and non-medically indicated termination of therapy. MATERIAL AND METHODS Patients who had started a new therapy (starters) and those who independently terminated therapy (dropouts) were interviewed by telephone with a specific, standardized questionnaire. Results were summarized descriptively. RESULTS A total of 100 starters and 55 dropouts were interviewed. The mean therapy delay was 22 (±28 SD) days. This was mainly due to the time until the decision to see an ophthalmologist was made. Main reasons for dropping out were: transportation issues (27%), poor general health (25%) and the assumption that there is no benefit from therapy (11%). Of the patients who dropped out 63% would have liked to continue therapy. CONCLUSION There is potential for improvement in nvAMD management regarding therapy start as well as therapy maintenance. Sensitizing for initial nvAMD symptoms is important as is reduction of barriers to therapy maintenance, since most therapy dropouts would like to continue the therapy.
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Affiliation(s)
| | - J Bouws
- AMD-Netz, Münster, Deutschland
| | - J Loss
- Medizinische Soziologie, Institut für Epidemiologie und präventive Medizin, Universität Regensburg, Regensburg, Deutschland
| | - B Heimes
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - D Pauleikhoff
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - F G Holz
- Universitäts-Augenklinik Bonn, Bonn, Deutschland
| | - R P Finger
- Universitäts-Augenklinik Bonn, Bonn, Deutschland.
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Küçük B, Kadayıfçılar S, Eldem B. Assessment of the long-term visual and anatomical outcomes of ranibizumab to treat neovascular age-related macular degeneration. Int J Ophthalmol 2018; 11:645-649. [PMID: 29675385 PMCID: PMC5902371 DOI: 10.18240/ijo.2018.04.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/12/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the long-term visual and anatomical outcomes of patients who underwent intravitreal ranibizumab monotherapy to treat neovascular age-related macular degeneration (AMD) and followed-up for at least 2y. METHODS A total of 74 eyes of 74 patients who underwent ranibizumab monotherapy for neovascular AMD were included in this retrospective study. RESULTS The average patient age was 72.1±6.5 (range, 57-85)y, the average follow-up time 46.2±13.1 (range, 24-75)mo, and the average number of visits 24.1±9.5 (range, 8-48). The mean number of injections in year 1 was 4.5, 1.6 in year 2, 0.9 in year 3, 0.4 on year 4, and 0.1 in the following years. Within the entire follow-up period, the mean number of injections was 7.6±4.4 (range, 2-21). The mean visual acuity was 48.1±15 (range, 15-76) letters at baseline and 45.7±19 (range, 7-75) at year 5. The mean central macular thickness was 303±78 (range, 178-552) µm at baseline and 251±51 (range, 138-359) µm at year 5. Scars developed in 47 (63.5%) eyes at the end of the follow-up period, and atrophy was evident in 6 (8.1%) eyes. CONCLUSION Ranibizumab monotherapy can stabilize visual acuity for a mean period of 4y in patients with neovascular AMD.
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Affiliation(s)
- Bekir Küçük
- Department of Ophthalmology, Hacettepe University, Ankara 06100, Turkey
| | | | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, Ankara 06100, Turkey
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Parodi MB, Donati S, Semeraro F, Danzi P, Introini U, Viola F, Bottoni F, Pucci V, Musig A, Pece A, Azzolini C. Intravitreal Anti-Vascular Endothelial Growth Factor Drugs for Retinal Angiomatous Proliferation in Real-Life Practice. J Ocul Pharmacol Ther 2017; 33:123-127. [PMID: 28048946 DOI: 10.1089/jop.2016.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To describe the outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) in the treatment of retinal angiomatous proliferation (RAP) in real-life practice in 7 Italian centers under the Progetto Luce initiative. METHODS Clinical data of 95 eyes of 95 patients affected by RAP, regularly followed up and treated with either intravitreal ranibizumab or bevacizumab over 12 months, were examined. After a loading phase of 3 consecutive injections, retreatments were administered following a pro-re-nata regimen on the basis of the persistence or the recurrence of subretinal/intraretinal fluid on optical coherence tomography, or leakage on fluorescein angiography. RESULTS Overall, the mean best corrected visual acuity changed from 0.66 to 0.53 LogMAR (P: 0.0003); 36.8% of eyes gained at least 3 ETDRS lines, whereas 13.7% lost >3 lines at the end of the follow-up. Mean central retinal thickness improved from 384 μm at baseline to 262 μm at the 12-month examination (P < 0.001). A serous pigment epithelium detachment (PED) was identified in 68.4% of eyes at baseline, and it was still detectable in 30.5% at the end of follow-up. The mean number of injections was 4.4 over the follow-up. A significantly greater proportion of eyes showed PED resolution in the subgroup treated with ranibizumab (P < 0.001). CONCLUSIONS Intravitreal anti-VEGF treatment in routine clinical practice allows a significant improvement in visual function in patients affected by RAP. A limited number of anti-VEGF injections are generally required in most cases.
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Affiliation(s)
| | - Simone Donati
- 2 Section of Ophthalmology, Department of Surgical and Morphological Sciences, University of Insubria , Varese-Como, Italy
| | - Francesco Semeraro
- 3 Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia , Brescia, Italy
| | - Paola Danzi
- 3 Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia , Brescia, Italy
| | - Ugo Introini
- 1 Department of Ophthalmology, San Raffaele Hospital, Università Vita e Salute , Milano, Italy
| | - Francesco Viola
- 4 Ophthalmology Clinic, Clinical and Community Sciences, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan , Milan, Italy
| | - Ferdinando Bottoni
- 5 Eye Clinic, Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan , Milan, Italy
| | - Vincenzo Pucci
- 6 Department of Ophthalmology, Desenzano del Garda Hospital , Desenzano del Garda, Italy
| | - Andrea Musig
- 6 Department of Ophthalmology, Desenzano del Garda Hospital , Desenzano del Garda, Italy
| | - Alfredo Pece
- 7 Department of Ophthalmology, Melegnano Hospital , Milano, Italy
| | - Claudio Azzolini
- 2 Section of Ophthalmology, Department of Surgical and Morphological Sciences, University of Insubria , Varese-Como, Italy
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Kornhauser T, Barak A. Responding to a rebuttal letter concerning the BERVOLT study. Graefes Arch Clin Exp Ophthalmol 2016; 254:1025-6. [DOI: 10.1007/s00417-015-3217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 11/29/2022] Open
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Holz FG, Tadayoni R, Beatty S, Berger A, Cereda MG, Cortez R, Hoyng CB, Hykin P, Staurenghi G, Heldner S, Bogumil T, Heah T, Sivaprasad S. Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration. Br J Ophthalmol 2014; 99:220-6. [PMID: 25193672 PMCID: PMC4316940 DOI: 10.1136/bjophthalmol-2014-305327] [Citation(s) in RCA: 428] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background/aims Real-life anti-vascular endothelial growth factor (VEGF) therapy use in patients with wet age-related macular degeneration (wAMD) was assessed in a retrospective, observational study in Canada, France, Germany, Ireland, Italy, the Netherlands, UK and Venezuela. Methods Medical records of patients with wAMD, who started ranibizumab treatment between 1 January 2009 and 31 August 2009, were evaluated. Data were collected until the end of treatment and/or monitoring or until 31 August 2011. Results 2227 patients who received ≥1 anti-VEGF injection with a baseline visual acuity assessment and ≥1 postbaseline visual acuity assessment for the treated eye were evaluated. Visual acuity improved until about day 120; thereafter, visual acuity gains were not maintained. Mean change in visual acuity score from baseline to years 1 and 2 was +2.4 and +0.6 letters, respectively. Patients received a mean of 5.0 and 2.2 injections in the first and second year, respectively. There were substantial differences in visual outcomes and injection frequency between countries. More frequent visits and injections were associated with greater improvements in visual acuity. Conclusions In clinical practice, fewer injections are administered than in clinical trials. Anti-VEGF treatment resulted in an initial improvement in visual acuity; however, this was not maintained over time. Trial registration number NCT01447043.
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Affiliation(s)
- Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Ramin Tadayoni
- Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris 7-Sorbonne Paris Cité, France
| | - Stephen Beatty
- Department of Ophthalmology, Institute of Eye Surgery, Waterford, Ireland
| | - Alan Berger
- Department of Ophthalmology and Vision Sciences, University of Toronto, and St Michael's Hospital, Toronto, Canada
| | - Matteo G Cereda
- Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Philip Hykin
- NIHR Biomedical Centre for Research in Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Timon Bogumil
- Bayer HealthCare Pharmaceuticals, Montville, New Jersey, USA
| | - Theresa Heah
- Bayer HealthCare Pharmaceuticals, Montville, New Jersey, USA
| | - Sobha Sivaprasad
- NIHR Biomedical Centre for Research in Ophthalmology, Moorfields Eye Hospital, London, UK King's College Hospital, London, UK
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Reznicek L, Muhr J, Ulbig M, Kampik A, Mayer WJ, Haritoglou C, Neubauer A, Wolf A. Visual acuity and central retinal thickness: fulfilment of retreatment criteria for recurrent neovascular AMD in routine clinical care. Br J Ophthalmol 2014; 98:1333-7. [PMID: 24903670 DOI: 10.1136/bjophthalmol-2013-304399] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND To evaluate the fulfillment of retreatment criteria in recurrent neovascular age-related macular degeneration (nAMD) for a pro-re-nata treatment regime with ranibizumab in routine clinical care. METHODS Data from patients with treatment-naive nAMD were analysed retrospectively. As an 'upload', all patients had received three-monthly intravitreal ranibizumab injections in a university eye hospital and were then seen by ophthalmologists in private practice who referred them back in case of recurrence. Recurrence was defined as a decrease of visual acuity (VA) of one line or more (functional retreatment criteria), a central retinal thickness (CRT) increase of at least 100 µm upon Optical Coherence Tomography (OCT) examination (morphological retreatment criteria) or a new macular haemorrhage (clinical retreatment criteria). RESULTS We included 92 patients (36 men and 56 women). The mean VA before retreatment of a recurrence was -0.63 ± 0.33 logMAR and improved significantly (p<0.001) by 0.10 ± 0.16 logMAR to -0.53 ± 0.28 logMAR thereafter. Mean CRT before retreatment was 278.07 ± 87.56 µm and decreased significantly (p<0.001) by 71.22 ± 106.93 to 206.85 ± 60.30 µm. Evaluation of the fulfillment of retreatment criteria revealed functional retreatment criteria in 82.6% of patients. However, upon re-evaluation of VA using Early Treatment Diabetic Retinopathy Study (ETDRS) charts in the treatment centre, mean decrease of VA was 10 letters as compared with the end of upload therapy. All patients presented an increased CRT when treated for recurrence of nAMD (mean increase 69.47 µm), but the morphological retreatment criteria (CRT increase of 100 µm or more) were fulfilled in only 44.4% of patients upon Spectral Domain OCT (SD-OCT) evaluation in the treatment centre. CONCLUSIONS In a routine clinical care, evaluation of VA using ETDRS charts seems to be more sensitive than Snellen VA testing. Quantitative OCT-based retreatment criteria (eg, increase of CRT of 100 µm or more) appear to be not sensitive enough in a clinical setting with referring ophthalmologists.
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Affiliation(s)
- Lukas Reznicek
- Department of Ophthalmology, Ludwig-Maximilians-University Muenchen, Germany
| | - Johanna Muhr
- Department of Ophthalmology, Ludwig-Maximilians-University Muenchen, Germany
| | - Michael Ulbig
- Department of Ophthalmology, Ludwig-Maximilians-University Muenchen, Germany
| | - Anselm Kampik
- Department of Ophthalmology, Ludwig-Maximilians-University Muenchen, Germany
| | - Wolfgang J Mayer
- Department of Ophthalmology, Ludwig-Maximilians-University Muenchen, Germany
| | - Christos Haritoglou
- Department of Ophthalmology, Ludwig-Maximilians-University Muenchen, Germany
| | - Aljoscha Neubauer
- Department of Ophthalmology, Ludwig-Maximilians-University Muenchen, Germany
| | - Armin Wolf
- Department of Ophthalmology, Ludwig-Maximilians-University Muenchen, Germany
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Finger RP, Holz FG. [Health services for patients with neovascular age-related macular degeneration in Germany]. Ophthalmologe 2014; 111:438-42. [PMID: 24838864 DOI: 10.1007/s00347-013-2922-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In neovascular age-related macular degeneration (NVAMD) successful treatment outcome depends on regular intravitreal injections of vascular endothelial growth factor inhibitors (anti-VEGF). Several observational trials on the use of ranibizumab in the clinical routine demonstrated a low injection frequency, a low number of ophthalmic reviews which included optical coherence tomography, and suboptimal treatment outcomes in Germany. To date it remains unclear whether the use of ranibizumab reflects the use of all anti-VEGF agents including aflibercept and bevacizumab in the clinical routine in Germany. However, based on available data, treatment provision and outcomes seem to be suboptimal, in particular for elderly patients with NVAMD. As poorly treated NVAMD carries a high risk of loss of vision and ultimately blindness, service provision and treatment outcomes need to be improved.
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Affiliation(s)
- R P Finger
- Universitäts-Augenklinik Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Deutschland,
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Mirshahi A, Ponto KA, Höhn R, Wild PS, Pfeiffer N. [Ophthalmological aspects of the Gutenberg Health Study (GHS): an interdisciplinary prospective population-based cohort study]. Ophthalmologe 2013; 110:210-7. [PMID: 23504093 DOI: 10.1007/s00347-012-2666-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The Gutenberg Health Study (GHS) is a prospective, single center, population-based cohort study. It is an interdisciplinary project for investigation of ocular, cardiovascular, psychosomatic and immune diseases in the population of the City of Mainz and the district of Mainz-Bingen in central Germany. The main goals of the ophthalmological branch of GHS are determination of the prevalence and incidence of major ocular risk factors and diseases, exploring the genetic determinants and assessing complex interdisciplinary associations. The study cohort includes 15,010 participants aged between 35 and 74 years at the time of inclusion. After completing the baseline investigations the 5-year follow-up of the whole study cohort started in April 2012. The GHS is the most extensive data set of major ophthalmological conditions and risk factors in Germany and will help researchers in understanding complex medical associations.
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Affiliation(s)
- A Mirshahi
- Augenklinik, Universitätsmedizin der J. Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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Holz FG, Bandello F, Gillies M, Mitchell P, Osborne A, Sheidow T, Souied E, Figueroa MS. Safety of ranibizumab in routine clinical practice: 1-year retrospective pooled analysis of four European neovascular AMD registries within the LUMINOUS programme. Br J Ophthalmol 2013; 97:1161-7. [PMID: 23850682 PMCID: PMC3756427 DOI: 10.1136/bjophthalmol-2013-303232] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Purpose Evaluation of 1-year safety profile of intravitreal ranibizumab 0.5 mg in neovascular age-related macular degeneration (NV-AMD) within routine clinical practice. Methods The LUMINOUS programme comprises a prospective observational study assessing ranibizumab ‘real-world’ safety and clinical effectiveness across licensed indications worldwide and an annual retrospective pooled safety analysis from completed NV-AMD ranibizumab registries. 1-year data from four European registries are available. This retrospective pooled safety analysis assessed 1-year incidence rates for safety events of particular interest (key ocular or systemic events possibly related to the injection procedure or vascular endothelial growth factor inhibition) together with treatment exposure. Patients were treated according to local protocols within the ranibizumab licence. Results Data of 4444 patients from registries in Germany (n=3470), the Netherlands (n=243), Belgium (n=260) and Sweden (n=471) were retrospectively pooled. Between 70.4% and 84.4% of enrolled patients completed 1 year of follow-up. Most frequent overall ocular events of particular interest were retinal pigment epithelial tears (27 patients; <1%) and intraocular pressure-related events (12 patients; <0.3%). Most frequent non-ocular event of particular interest was stroke (19 patients; 0.4%); annual incidence of stroke was low across all registries (0.0–0.5%). Conclusions Ranibizumab demonstrated favourable 1-year safety profile for NV-AMD in this routine clinical practice sample, consistent with previous reported trial data. Additional data from a larger patient population are needed to better describe the long-term safety profile of ranibizumab in routine clinical practice and further evaluate risk for infrequent but serious events in ‘real-life’ settings. The 5-year LUMINOUS prospective observational study will address this need.
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Affiliation(s)
- Frank G Holz
- Department of Ophthalmology, University of Bonn, Germany.
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