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Ozawa Y, Yoshihara K, Mezghani M, Pierzchała P, Nikodem M, Barbier S, Nomoto M, Aitoku Y. Recent daily life burdens associated with neovascular age-related macular degeneration involve difficulties in use of electronic devices. Sci Rep 2024; 14:14181. [PMID: 38898138 PMCID: PMC11187225 DOI: 10.1038/s41598-024-65089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/17/2024] [Indexed: 06/21/2024] Open
Abstract
Neovascular age-related macular degeneration (nAMD) is a prevalent cause of permanent vision loss and blindness in the elderly worldwide, with a significant impact on patients' daily lives. However, burdens related to nAMD from the patients' perspective have not been well documented. Here we developed a new questionnaire after eliciting nAMD patients' daily challenges followed by a pilot survey. Seven daily life burden domains were identified, and a quantitative survey was conducted using the questionnaire in the real-world clinic. Of the total 153 participants (mean age, 76.3 ± 8.3 years), 67 (43.8%) had bilateral nAMD, and 79 (52.7%) were classified into severe nAMD according to the best-corrected visual acuity with cut-off value of 0.52 in logMAR. Patients with bilateral and severe nAMD had significantly higher burden scores across all domains. Network models for the bilateral and severe disease subgroups identified the interactions between "activity of daily living" and "hand-eye coordination" and between "use of electronic devices" and "face recognition" domains, which were considered to be important burdens for the patients. These results can advance ophthalmologists' understanding of the impact of nAMD on patients' daily lives and the importance of active and continuing treatment for patients with nAMD.
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Affiliation(s)
- Yoko Ozawa
- Department of Clinical Regenerative Medicine, Fujita Medical Innovation Center Tokyo, 1-1-4, Hanedakuko, Ota-ku, Haneda Innovation City Zone A, Tokyo, 144-0041, Japan.
- Eye Center, Haneda Clinic, Fujita Health University, Tokyo, Japan.
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
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2
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Andoh JE, Ezekwesili AC, Nwanyanwu K, Elam A. Disparities in Eye Care Access and Utilization: A Narrative Review. Annu Rev Vis Sci 2023; 9:15-37. [PMID: 37254050 DOI: 10.1146/annurev-vision-112122-020934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This narrative review summarizes the literature on factors related to eye care access and utilization in the United States. Using the Healthy People 2030 framework, this review investigates social determinants of health associated with general and follow-up engagement, screenings, diagnostic visits, treatment, technology, and teleophthalmology. We provide hypotheses for these documented eye care disparities, featuring qualitative, patient-centered research. Lastly, we provide recommendations in the hopes of appropriately eliminating these disparities and reimagining eye care.
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Affiliation(s)
- Joana E Andoh
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Agnes C Ezekwesili
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Angela Elam
- Department of Ophthalmology, WK Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA;
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Sun KX, Chen YY, Li Z, Zheng SJ, Wan WJ, Ji Y, Hu K. Genipin relieves diabetic retinopathy by down-regulation of advanced glycation end products via the mitochondrial metabolism related signaling pathway. World J Diabetes 2023; 14:1349-1368. [PMID: 37771331 PMCID: PMC10523227 DOI: 10.4239/wjd.v14.i9.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/04/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Glycation is an important step in aging and oxidative stress, which can lead to endothelial dysfunction and cause severe damage to the eyes or kidneys of diabetics. Inhibition of the formation of advanced glycation end products (AGEs) and their cell toxicity can be a useful therapeutic strategy in the prevention of diabetic retinopathy (DR). Gardenia jasminoides Ellis (GJE) fruit is a selective inhibitor of AGEs. Genipin is an active compound of GJE fruit, which can be employed to treat diabetes. AIM To confirm the effect of genipin, a vital component of GJE fruit, in preventing human retinal microvascular endothelial cells (hRMECs) from AGEs damage in DR, to investigate the effect of genipin in the down-regulation of AGEs expression, and to explore the role of the CHGA/UCP2/glucose transporter 1 (GLUT1) signal pathway in this process. METHODS In vitro, cell viability was tested to determine the effects of different doses of glucose and genipin in hRMECs. Cell Counting Kit-8 (CCK-8), colony formation assay, flow cytometry, immunofluorescence, wound healing assay, transwell assay, and tube-forming assay were used to detect the effect of genipin on hRMECs cultured in high glucose conditions. In vivo, streptozotocin (STZ) induced mice were used, and genipin was administered by intraocular injection (IOI). To explore the effect and mechanism of genipin in diabetic-induced retinal dysfunction, reactive oxygen species (ROS), mitochondrial membrane potential (MMP), and 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl) amino]-2-deoxy-d-glucose (2-NBDG) assays were performed to explore energy metabolism and oxidative stress damage in high glucose-induced hRMECs and STZ mouse retinas. Immunofluorescence and Western blot were used to investigate the expression of inflammatory cytokines [vascular endothelial growth factor (VEGF), SCG3, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-18, and nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing 3 (NLRP3)]. The protein expression of the receptor of AGEs (RAGE) and the mitochondria-related signal molecules CHGA, GLUT1, and UCP2 in high glucose-induced hRMECs and STZ mouse retinas were measured and compared with the genipin-treated group. RESULTS The results of CCK-8 and colony formation assay showed that genipin promoted cell viability in high glucose (30 mmol/L D-Glucose)-induced hRMECs, especially at a 0.4 μmol/L dose for 7 d. Flow cytometry results showed that high glucose can increase apoptosis rate by 30%, and genipin alleviated cell apoptosis in AGEs-induced hRMECs. A high glucose environment promoted ATP, ROS, MMP, and 2-NBDG levels, while genipin inhibited these phenotypic abnormalities in AGEs-induced hRMECs. Furthermore, genipin remarkably reduced the levels of the pro-inflammatory cytokines TNF-α, IL-1β, IL-18, and NLRP3 and impeded the expression of VEGF and SCG3 in AGEs-damaged hRMECs. These results showed that genipin can reverse high glucose induced damage with regard to cell proliferation and apoptosis in vitro, while reducing energy metabolism, oxidative stress, and inflammatory injury caused by high glucose. In addition, ROS levels and glucose uptake levels were higher in the retina from the untreated eye than in the genipin-treated eye of STZ mice. The expression of inflammatory cytokines and pathway protein in the untreated eye compared with the genipin-treated eye was significantly increased, as measured by Western blot. These results showed that IOI of genipin reduced the expression of CHGA, UCP2, and GLUT1, maintained the retinal structure, and decreased ROS, glucose uptake, and inflammation levels in vivo. In addition, we found that SCG3 expression might have a higher sensitivity in DR than VEGF as a diagnostic marker at the protein level. CONCLUSION Our study suggested that genipin ameliorates AGEs-induced hRMECs proliferation, apoptosis, energy metabolism, oxidative stress, and inflammatory injury, partially via the CHGA/UCP2/GLUT1 pathway. Control of advanced glycation by IOI of genipin may represent a strategy to prevent severe retinopathy and vision loss.
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Affiliation(s)
- Ke-Xin Sun
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yan-Yi Chen
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhen Li
- Department of Ophthalmology, The People’s Hospital of Leshan, Leshan 400000, Sichuan Province, China
| | - Shi-Jie Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wen-Juan Wan
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yan Ji
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ke Hu
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Claessens D, Krüger RV, Grötzinger L. Change in Sub-aspects of Vision-Related Quality of Life after Three Months of Using an App to Categorize Metamorphopsia. Klin Monbl Augenheilkd 2023; 240:1091-1097. [PMID: 35426105 DOI: 10.1055/a-1809-5125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Distorted vision (metamorphopsia) is a leading symptom in retinal disease and can be categorized with the app MacuFix. This prospective controlled pilot study examined the influence of the app MacuFix as a method to assess metamorphopsia on vision-related quality of life. METHODS Forty-five patients suffering from metamorphopsia in at least one eye were recruited for the study. Vision-related quality of life before and after 3 months of optional home monitoring using the app MacuFix were compared with the questionnaire National Eye Institute Visual Function Questionnaire-25. RESULTS The 45 participants (18 women, 27 men) were, on average, 68 years old (SD ± 9.7) and had a mean best-corrected visual acuity of 0.6 (SD ± 0.25). Of 90 eyes, 18 revealed no maculopathy. Age-related macular degeneration existed in 52 eyes, epiretinal gliosis in 6, and macular hole in 1 eye. Macular edema was present in two eyes due to diabetes, four eyes due to uveitis, one eye after retinal venous thrombosis, four eyes because of an Irvine Gass syndrome, and two eyes caused by central serous thrombosis. After 3 months, 35 persons used the app for home monitoring, 8 persons applied the Amsler Grid, and 2 did not use any test. App users showed a highly significant improvement in vision-related quality of life in questions on mental health and concern about vision, and a significant improvement in performance, dejection, control, and embarrassing situations. CONCLUSION The results suggest that MacuFix can possibly ameliorate partial aspects of vision-related quality of life.
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Affiliation(s)
- Daniela Claessens
- Augenheilkunde, Gemeinschaftspraxis Augenheilkunde Lindenthal, Köln, Deutschland
| | | | - Lilly Grötzinger
- Gesundheitsökonomie, Hochschule Ravensburg-Weingarten, Deutschland
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Shahzad H, Mahmood S, McGee S, Hubbard J, Haque S, Paudyal V, Denniston AK, Hill LJ, Jalal Z. Non-adherence and non-persistence to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy: a systematic review and meta-analysis. Syst Rev 2023; 12:92. [PMID: 37269003 DOI: 10.1186/s13643-023-02261-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections play a key role in treating a range of macular diseases. The effectiveness of these therapies is dependent on patients' adherence (the extent to which a patient takes their medicines as per agreed recommendations from the healthcare provider) and persistence (continuation of the treatment for the prescribed duration) to their prescribed treatment regimens. The aim of this systematic review was to demonstrate the need for further investigation into the prevalence of, and factors contributing to, patient-led non-adherence and non-persistence, thus facilitating improved clinical outcomes. METHODS Systematic searches were conducted in Google Scholar, Web of Science, PubMed, MEDLINE, and the Cochrane Library. Studies in English conducted before February 2023 that reported the level of, and/or barriers to, non-adherence or non-persistence to intravitreal anti-VEGF ocular disease therapy were included. Duplicate papers, literature reviews, expert opinion articles, case studies, and case series were excluded following screening by two independent authors. RESULTS Data from a total of 409,215 patients across 52 studies were analysed. Treatment regimens included pro re nata, monthly and treat-and-extend protocols; study durations ranged from 4 months to 8 years. Of the 52 studies, 22 included a breakdown of reasons for patient non-adherence/non-persistence. Patient-led non-adherence varied between 17.5 and 35.0% depending on the definition used. Overall pooled prevalence of patient-led treatment non-persistence was 30.0% (P = 0.000). Reasons for non-adherence/non-persistence included dissatisfaction with treatment results (29.9%), financial burden (19%), older age/comorbidities (15.5%), difficulty booking appointments (8.5%), travel distance/social isolation (7.9%), lack of time (5.8%), satisfaction with the perceived improvement in their condition (4.4%), fear of injection (4.0%), loss of motivation (4.0%), apathy towards eyesight (2.5%), dissatisfaction with facilities 2.3%, and discomfort/pain (0.3%). Three studies found non-adherence rates between 51.6 and 68.8% during the COVID-19 pandemic, in part due to fear of exposure to COVID-19 and difficulties travelling during lockdown. DISCUSSION Results suggest high levels of patient-led non-adherence/non-persistence to anti-VEGF therapy, mostly due to dissatisfaction with treatment results, a combination of comorbidities, loss of motivation and the burden of travel. This study provides key information on prevalence and factors contributing to non-adherence/non-persistence in anti-VEGF treatment for macular diseases, aiding identification of at-risk individuals to improve real-world visual outcomes. Improvements in the literature can be achieved by establishing uniform definitions and standard timescales for what constitutes non-adherence/non-persistence. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020216205.
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Affiliation(s)
- Haris Shahzad
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Sajid Mahmood
- Deputy Drugs Controller, Specialized Healthcare and Medical Education Department, Punjab, Lahore, Pakistan
| | - Sean McGee
- School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jessica Hubbard
- School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sayeed Haque
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Vibhu Paudyal
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, UK
| | - Lisa J Hill
- School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Nassisi M, Pozzo Giuffrida F, Milella P, Ganci S, Aretti A, Mainetti C, Dell'Arti L, Mapelli C, Viola F. Delaying anti-VEGF therapy during the COVID-19 pandemic: long-term impact on visual outcomes in patients with neovascular age-related macular degeneration. BMC Ophthalmol 2023; 23:156. [PMID: 37069537 PMCID: PMC10107548 DOI: 10.1186/s12886-023-02864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/17/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES To evaluate the outcomes of delayed intravitreal injections (IVIs) caused by the outbreak of coronavirus disease 2019 (COVID-19), in patients with neovascular age-related macular degeneration (nAMD). METHODS nAMD patients with scheduled IVIs between March 1st and April 30th, 2020 were stratified through a risk-based selection into a non-adherent group (NA-group) if they skipped at least one IVI and an adherent group (A-group) if they followed their treatment schedule. During the pandemic visit (v0), if a significant worsening of the disease was detected, a rescue therapy of three-monthly IVIs was performed. Multimodal imaging and best-corrected visual acuity (BCVA) findings were evaluated after 6 months (v6), compared between groups and with the visit prior the lockdown (v-1). RESULTS Two hundred fifteen patients (132 females, mean age: 81.89 ± 5.98 years) delayed their scheduled IVI while 83 (53 females, mean age: 77.92 ± 6.06 years) adhered to their protocol. For both groups, BCVA at v0 was significantly worse than v-1 (mean 4.15 ± 7.24 ETDRS letters reduction for the NA-group and 3 ± 7.96 for the A-group) but remained stable at v6. The two groups did not significantly differ in BCVA trends after 6 months and neither for development of atrophy nor fibrosis. CONCLUSIONS A risk-based selection strategy and a rescue therapy may limit the long-term outcomes of an interruption of the treatment protocol in patients with nAMD.
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Affiliation(s)
- Marco Nassisi
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan, 20122, Italy
| | - Francesco Pozzo Giuffrida
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan, 20122, Italy
| | - Paolo Milella
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan, 20122, Italy
| | - Simone Ganci
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Aretti
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan, 20122, Italy
| | - Claudia Mainetti
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Dell'Arti
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Mapelli
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan, 20122, Italy.
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Cai CX, Tran D, Tang T, Liou W, Harrigian K, Scott E, Nagy P, Kharrazi H, Crews DC, Zeger SL. Health Disparities in Lapses in Diabetic Retinopathy Care. OPHTHALMOLOGY SCIENCE 2023; 3:100295. [PMID: 37063252 PMCID: PMC10090804 DOI: 10.1016/j.xops.2023.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/10/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Objective To develop a novel methodology to identify lapses in diabetic retinopathy care in electronic health records (EHRs) and evaluate health disparities by race and ethnicity. Design Retrospective cohort study. Subjects Adult patients with diabetes mellitus who were evaluated at the Wilmer Eye Institute from January 1, 2013 to April 2, 2022. Methods The methodology to identify lapses in care first identified diabetic retinopathy screening or treatment visits and then compared the providers' recommended follow-up timeframe with the patient's actual time to next encounter. The association of race and ethnicity with odds of lapses in care was evaluated using a mixed-effects logistic regression model controlling for age, sex, insurance, severity of diabetic retinopathy, presence of other retinal disorders, and glaucoma. Main Outcome Measures Lapses in diabetic retinopathy care. Results The methodology to identify diabetic retinopathy-related visits had a 95.0% (95% confidence interval, 93.0-96.6) sensitivity and 98.8% (98.1-99.3) specificity as compared with a gold standard grader. The methodology resulted in a 97.3% (96.2-98.4) sensitivity and 98.1% (97.3-98.9) specificity for detecting a follow-up recommendation, with an average error of -0.05 (-0.31 to 0.21) weeks in extracting the precise timeframe. A total of 39 561 patients with 91 104 office visits were included in the analysis. The average age was 61.4 years. More than 3 (77.6%) in 4 patients had a lapse in care. In multivariable analysis, non-Hispanic Black patients had 1.24 (1.19-1.30) odds and Hispanic patients had 1.26 (1.13-1.40) odds of ever having a lapse in care compared with non-Hispanic White patients (P < 0.001, respectively). Conclusions We have developed a reliable methodology for identifying lapses in diabetic retinopathy care that is tailored to a provider's recommended follow-up. Using this approach, we find that 3 in 4 patients experience a lapse in diabetic retinopathy care and that these rates are higher among non-Hispanic Black and Hispanic patients. Deploying this methodology in the EHR is one potential means by which to identify and mitigate lapses in critical ophthalmic care in patients with diabetes. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Cindy X. Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
- Correspondence: Cindy X. Cai, MD, 1800 Orleans St, Maumenee Building, Room 711, Baltimore, MD 21287.
| | - Diep Tran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tina Tang
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Wilson Liou
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Keith Harrigian
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Emily Scott
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Paul Nagy
- Department of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Hadi Kharrazi
- Center for Population Health Information Technology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Scott L. Zeger
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Korobelnik JF, Daien V, Faure C, Tadayoni R, Giocanti-Aurégan A, Dot C, Kodjikian L, Massin P. Two-year outcomes of the APOLLON observational study of intravitreal aflibercept monotherapy in France in patients with diabetic macular edema. Sci Rep 2022; 12:18242. [PMID: 36309572 PMCID: PMC9617874 DOI: 10.1038/s41598-022-22838-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/19/2022] [Indexed: 12/31/2022] Open
Abstract
APOLLON (NCT02924311) was a prospective observational study to evaluate the effectiveness of intravitreal aflibercept (IVT-AFL) treatment of diabetic macular edema (DME) over 24 months in routine clinical practice in France. The primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study letters) by 12 months, and safety was monitored throughout the study. Of 402 patients enrolled across 61 participating clinics and hospitals in France, 168 patients were followed for at least 24 months and included in the effectiveness analyses (79 treatment-naïve and 89 previously treated). After 24 months of IVT-AFL treatment, the mean (± standard deviation [SD]) change in BCVA from baseline was + 6.5 (± 10.7) letters in treatment-naïve patients (p < 0.001) and + 1.6 (± 17.0) letters in previously treated patients (p = 0.415) from a baseline of 63.8 (± 13.6) and 60.5 (± 16.5) letters. The mean number of IVT-AFL treatments over 24 months was 11.3 (± 4.9) and 11.9 (± 4.7) for treatment-naïve and previously treated patients. This final analysis of the APOLLON study indicated that following 24 months of IVT-AFL treatment in routine clinical practice in France, treatment-naïve patients with DME achieved significant gains in visual acuity and previously treated patients maintained prior visual acuity gains.Trial registration number: NCT02924311.
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Affiliation(s)
- Jean-François Korobelnik
- grid.414263.6Service d’Ophtalmologie, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France ,grid.412041.20000 0001 2106 639XINSERM, Bordeaux Population Health Research Center, UMR1219, Université de Bordeaux, Bordeaux, France
| | - Vincent Daien
- grid.414130.30000 0001 2151 3479Hôpital Gui De Chauliac, Montpellier, France ,grid.121334.60000 0001 2097 0141INSERM, Université de Montpellier, Montpellier, France
| | - Céline Faure
- Hôpital Privé Saint Martin, Ramsay Générale de Santé, Caen, France
| | - Ramin Tadayoni
- Hôpital Lariboisière, Université de Paris, Hôpital I, AP-HP, Hôpital Fondation Rothschild, Paris, France
| | | | - Corinne Dot
- grid.414010.00000 0000 8943 5457HIA Desgenettes, Lyon, France ,grid.414014.4École du Val de Grâce, Paris, France
| | - Laurent Kodjikian
- grid.413306.30000 0004 4685 6736Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France ,grid.7849.20000 0001 2150 7757UMR-CNRS 5510 Matéis, University of Lyon, Villeurbanne, France
| | - Pascale Massin
- grid.411296.90000 0000 9725 279XCUDC, Hôpital Lariboisière, Paris, France ,Present Address: Centre d’Ophtalmologie Paris, Breteuil, France
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Abou-Jaoude MM, Crawford J, Kryscio RJ, Moore DB. Accuracy of Ophthalmology Clinic Follow-Up in the Incarcerated Patient Population. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0042-1758562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Purpose Incarcerated patients represent a uniquely vulnerable population in the outpatient ophthalmology setting, and the reliability of follow-up in this group is undetermined.
Methods This was a retrospective, observational chart review of consecutive incarcerated patients evaluated at the ophthalmology clinic of a single academic medical center between July 2012 and September 2016. For each encounter the following were recorded: patient age, gender, incarcerated status at the time of encounter (a subset of patients had encounters before/after incarceration), interventions performed, follow-up interval requested, urgency of follow-up, and actual time to subsequent follow-up. Primary outcome measures were no-show rate and timeliness, which was defined as follow-up within 1.5× the requested period.
Results There were 489 patients included during the study period, representing a total of 2,014 clinical encounters. Of the 489 patients, 189 (38.7%) were seen once. Of the remaining 300 patients with more than one encounter, 184 (61.3%) ultimately did not return and only 24 (8%) were always on time for every encounter. Of 1,747 encounters with specific follow-up requested, 1,072 were considered timely (61.3%). Factors significantly associated with subsequent loss to follow-up include whether a procedure was performed (p < 0.0001), urgency of follow-up (p < 0.0001), incarcerated status (p = 0.0408), and whether follow-up was requested (p < 0.0001).
Conclusion Almost two-thirds of incarcerated patients in our population requiring repeat examination were lost to follow-up, particularly those who underwent an intervention or required more urgent follow-up. Patients entering and exiting the penal system were less likely to follow-up while incarcerated. Further work is needed to understand how these gaps compare to those in the general population and to identify means of improving these outcomes.
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Affiliation(s)
- Michelle M. Abou-Jaoude
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Jessica Crawford
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky
| | | | - Daniel B. Moore
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky
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10
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Zhou Y, Xuan Y, Liu Y, Zheng J, Jiang X, Zhang Y, Zhao J, Liu Y, An M. Transcription factor FOXP1 mediates vascular endothelial dysfunction in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:3857-3867. [PMID: 35695913 DOI: 10.1007/s00417-022-05698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/15/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is still the fastest growing cause of blindness in working aged adults, and its typical characteristics are endothelial cell dysfunction and pericytes loss. Transcription factor fork head box P1 (FOXP1) is a member of FOX family involved in diabetes progression and is expressed in endothelial cells. The purpose of this study was to investigate the role and mechanism of FOXP1 in DR. METHODS The vitreous of DR patients and non-DR patients were collected, and the expression of FOXP1 was detected by real-time polymerase chain reaction (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA). Human umbilical vein endothelial cells (HUVECs) cultured in high glucose simulated DR environment, and the expressions of FOXP1, vascular endothelial growth factor (VEGF), and pigment epithelium derived factor (PEDF) were detected by RT-qPCR and western blot (WB) after transfection of small interfering RNA (siRNA) to knock out FOXP1. At the same time, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay (MTT), 5-ethynyl-2'-deoxyuridine assay (EDU), flow cytometry, Transwell assay, and tube-forming experiment were performed to determine cell proliferation, migration, and tube-forming ability. RESULTS We found that FOXP1 was highly expressed in the vitreous of DR patients and HUVECs under high glucose condition. After FOXP1 was decreased, the activation of VEGF expression and inhibition of PEDF expression in HUVECs induced by high glucose were reversed; meanwhile, cell proliferation, migration, and tube formation decreased, and apoptosis was promoted. CONCLUSION Generally, FOXP1 is highly expressed in the vitreous of DR patients, and its silence prevented VEGF/PEDF signaling pathway stimulated by high glucose and also reduced the proliferation, migration, and tube formation of endothelial cell, thus improving vascular endothelial dysfunction caused by DR. The results indicate that FOXP1 may be a therapeutic target of DR.
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Affiliation(s)
- Yekai Zhou
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yaling Xuan
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yi Liu
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Jiaxuan Zheng
- The Second Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyun Jiang
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yun Zhang
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Jian Zhao
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yanli Liu
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China. .,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China.
| | - Meixia An
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China. .,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China.
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11
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Increased Distance from Clinic Leads to Higher Loss to Follow-up after Pars Plana Vitrectomy in Diabetic Patients. Retina 2022; 42:1921-1925. [DOI: 10.1097/iae.0000000000003540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Delayed follow-up in patients with neovascular age-related macular degeneration treated under universal health coverage: risk factors and visual outcomes. Retina 2022; 42:1693-1701. [PMID: 35504012 DOI: 10.1097/iae.0000000000003512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the rate of delayed follow-up visits (DFU), to identify risk factors of DFU and to assess the impact of DFU on outcomes in neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS This retrospective study included all nAMD patients (n=1291) treated with anti-vascular endothelial growth factor (VEGF) injections between January 2013 and December 2020 in two centers in Quebec, Canada. A DFU was defined as a delay of ≥4 weeks than scheduled. Visual outcomes, especially ≥15 letters loss, were reported. RESULTS A total of 351 patients (27.2%) experienced ≥1 DFU. Odds were greater among older patients (P=0.005), patients treated at the hospital rather than the clinic (P<0.001), and patients with worse initial visual acuity (VA) (P=0.024). A DFU was associated with a mean VA loss of 4.2±13.4 letters (P<0.001), and an increased incidence of intraretinal (IRF) and subretinal fluid (SRF) (P=0.001, P=0.005) at six months despite resumption of injections. Central foveal thickness (CFT) increased after DFU but returned to pre-DFU visit at 6 months. CONCLUSIONS The DFU rate in nAMD patients treated under a universal healthcare system was around 27%. DFU caused significant decreases in VA and increases in IRF and SRF on OCT that did not recover following injections resumption despite normalization of CFT.
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13
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Douglas VP, Douglas KAA, Vavvas DG, Miller JW, Miller JB. Short- and Long-Term Visual Outcomes in Patients Receiving Intravitreal Injections: The Impact of the Coronavirus 2019 Disease (COVID-19)-Related Lockdown. J Clin Med 2022; 11:jcm11082097. [PMID: 35456189 PMCID: PMC9029849 DOI: 10.3390/jcm11082097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/10/2022] Open
Abstract
Purpose: To investigate the short- and long-term impact of COVID-19—related lockdown on the vision of patients requiring intravitreal injections (IVI) for neovascular Age-related Macular degeneration (nvAMD), diabetic retinopathy (DR), central retinal vein occlusion (CRVO), or branch retinal vein occlusion (BRVO). Methods: This is a retrospective study from the Retina department of three Mass Eye and Ear centers. Charts of patients age of ≥ 18 years with any of the abovementioned diagnoses who had a scheduled appointment anytime between 17 March 2020 until 18 May 2020 (lockdown period in Boston, Massachusetts) were reviewed at baseline (up to 12 weeks before the lockdown), at first available follow-up (=actual f/u) during or after the lockdown period, at 3 months, 6 months, and at last available completed appointment of 2020. Results: A total of 1001 patients met the inclusion criteria. Of those patients, 479 (47.9%) completed their intended f/u appointment, while 522 missed it (canceled and “no show”). The delay in care of those who missed it was 59.15 days [standard deviation (SD) ± 49.6]. In these patients, significant loss of vision was noted at actual f/u [Best corrected visual acuity (BCVA) in LogMAR (Logarithm of the Minimum Angle of Resolution)—mean (±SD)—completed: 0.45 (±0.46), missed: 0.53 (±0.55); p = 0.01], which was more prominent in the DR group [Visual acuity (VA) change in LogMAR—mean (±SD); completed: 0.04 (±0.28), missed: 0.18 (±0.44); p = 0.02] and CRVO [completed: −0.06 (±0.27), missed: 0.11 (±0.35); p = <0.001] groups followed by nvAMD [completed: 0.006 (±0.16), missed: 0.06 (±0.27); p = 0.004] and BRVO [completed: −0.02 (±0.1), missed: 0.03 (±0.14); p = 0.02] ones. Overall, a higher percent of people who missed their intended f/u experienced vision loss of more than 15 letters at last f/u compared to those who completed it [missed vs. completed; 13.4% vs. 7.4% in nvAMD (p = 0.72), 7.8% vs. 6.3% in DR (0.84), 15.5% vs. 9.9% in CRVO (p < 0.001) and 9.6% vs. 2% in BRVO (p = 0.48)]. Conclusions: Delay in care of about 8.45 weeks can lead to loss of vision in patients who receive IVI with DR and CRVO patients being more vulnerable in the short-term, whereas in the long-term, CRVO patients followed by the nvAMD patients demonstrating the least vision recovery. BRVO patients were less likely to be affected by the delay in care. Adherence to treatment is key for maintaining and improving visual outcomes in patients who require IVI.
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Affiliation(s)
| | | | | | | | - John B. Miller
- Correspondence: ; Tel.: +1-(617)-573-3750; Fax: +1-(617)-573-3698
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14
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Angermann R, Hofer M, Huber AL, Rauchegger T, Nowosielski Y, Casazza M, Falanga V, Zehetner C. The impact of compliance among patients with diabetic macular oedema treated with intravitreal aflibercept: a 48-month follow-up study. Acta Ophthalmol 2022; 100:e546-e552. [PMID: 34145756 PMCID: PMC9291031 DOI: 10.1111/aos.14946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022]
Abstract
Purpose This study aimed to compare anatomical and functional outcomes between patients with non‐proliferative diabetic retinopathy (NPDR) with diabetic macular oedema (DME) who adhered to intravitreal aflibercept therapy and patients lost to follow‐up (LTFU). Methods We enrolled 200 patients and recorded the interval between each procedure and the subsequent follow‐up visit. Moreover, visual acuity (VA) and anatomical outcomes were measured at each follow‐up examination. Results Among the patients, 103 (51%) patients adhered to intravitreal aflibercept therapy and follow‐up examination while 97 (49%) patients were LTFU. Forty‐six (47%) patients LTFU who returned for further treatment showed a significant decrease in VA from 0.51 (±0.46) to 0.89 (±0.38) logarithm of the minimum angle of resolution (logMAR) after 48 months (p = 0.004). Compared with the adherent group, the return group showed a worse VA at 48 months (p = 0.036). Further, 1 (1%) patient in the adherent group and 8 (17%) patients in the return group developed a proliferative DR. Patients who were LTFU had a 13.0 times greater chance to develop a proliferative DR (p = 0.022). Conclusions Patients who did not adhere to intravitreal aflibercept therapy for DME showed significantly worse visual outcomes compared to patients with good therapy adherence. Moreover, patients with LTFU had a 13 times higher risk of developing a proliferative DR. Considering the potential disease progress, better strategies should be applied to optimize the functional outcome of patients at risk of reduced adherence.
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Affiliation(s)
- Reinhard Angermann
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
- Department of Ophthalmology Paracelsus Medical University Salzburg Salzburg Austria
| | - Markus Hofer
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Anna Lena Huber
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Teresa Rauchegger
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Yvonne Nowosielski
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Marina Casazza
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Valeria Falanga
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Claus Zehetner
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
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15
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Intravitreal Aflibercept Therapy and Treatment Outcomes of Eyes with Neovascular Age-Related Macular Degeneration in a Real-Life Setting: A Five-Year Follow-Up Investigation. Ophthalmol Ther 2022; 11:559-571. [PMID: 35048330 PMCID: PMC8769092 DOI: 10.1007/s40123-022-00452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction We aimed to evaluate visual and anatomical outcomes among eyes with neovascular age-related macular degeneration (nAMD) that were persistent to intravitreal aflibercept therapy compared to those that were nonpersistent to therapy. Methods We audited 648 treatment-naïve eyes of 559 patients regarding visual acuity (VA) given as the logarithm of the minimum angle of resolution (logMAR) and anatomic outcomes at baseline and at each subsequent follow-up visit for up to 5 years. Nonpersistence was defined as a visit-free interval of > 6 months. Results Among the enrolled eyes, 405 were persistent to the therapy and 243 (37%) were nonpersistent, of which 161 (66%) eyes returned for further therapy after a gap of clinical care. In the nonpersistent group, we observed a decline from 0.58 ± 0.35 to 0.92 ± 0.57 logMAR (p = 0.01) after 60 months. Compared with the persistent group, the nonpersistent group had worse visual outcomes at their 33-month (p = 0.03), 42-month (p = 0.01), 51-month (p = 0.001) and 60-month (p = 0.01) visits. Additionally, 5/405 (1.2%) eyes in the persistent group and 8/161 (5.0%) eyes in the nonpersistent group developed an end-stage disease with a subfoveal fibrosis during the observational period (p = 0.013). Conclusion We found that eyes with nAMD that were nonpersistent to intravitreal aflibercept therapy experienced statistically significantly worse VA compared to eyes persistent to therapy within 3 years. Moreover, eyes in the nonpersistent group had a four-fold higher risk of developing a fovea-involving fibrosis. Considering the potential irreversible deterioration with respect to best-corrected VA within nAMD, strategies need to be developed for patients at risk of nonpersistence to therapy.
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16
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Korot E, Pontikos N, Drawnel FM, Jaber A, Fu DJ, Zhang G, Miranda MA, Liefers B, Glinton S, Wagner SK, Struyven R, Kilduff C, Moshfeghi DM, Keane PA, Sim DA, Thomas PBM, Balaskas K. Enablers and Barriers to Deployment of Smartphone-Based Home Vision Monitoring in Clinical Practice Settings. JAMA Ophthalmol 2021; 140:153-160. [PMID: 34913967 PMCID: PMC8678899 DOI: 10.1001/jamaophthalmol.2021.5269] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Question What are the enablers and barriers of patient engagement for app-based home vision monitoring at scale? Findings In this cohort and survey study including 417 adults, 258 patients were active users (61.9%) of whom 166 patients (64.3%) were compliant users. Engagement was positively associated with higher comfort with technology, White British ethnicity, visual acuity, neovascular age-related macular degeneration diagnosis, and the number of intravitreal injections and was negatively associated with increased age. Meaning These findings suggest effective smartphone app-based home vision monitoring should address the risk factors for low engagement and digital exclusion during clinical practice setting deployment. Importance Telemedicine is accelerating the remote detection and monitoring of medical conditions, such as vision-threatening diseases. Meaningful deployment of smartphone apps for home vision monitoring should consider the barriers to patient uptake and engagement and address issues around digital exclusion in vulnerable patient populations. Objective To quantify the associations between patient characteristics and clinical measures with vision monitoring app uptake and engagement. Design, Setting, and Participants In this cohort and survey study, consecutive adult patients attending Moorfields Eye Hospital receiving intravitreal injections for retinal disease between May 2020 and February 2021 were included. Exposures Patients were offered the Home Vision Monitor (HVM) smartphone app to self-test their vision. A patient survey was conducted to capture their experience. App data, demographic characteristics, survey results, and clinical data from the electronic health record were analyzed via regression and machine learning. Main Outcomes and Measures Associations of patient uptake, compliance, and use rate measured in odds ratios (ORs). Results Of 417 included patients, 236 (56.6%) were female, and the mean (SD) age was 72.8 (12.8) years. A total of 258 patients (61.9%) were active users. Uptake was negatively associated with age (OR, 0.98; 95% CI, 0.97-0.998; P = .02) and positively associated with both visual acuity in the better-seeing eye (OR, 1.02; 95% CI, 1.00-1.03; P = .01) and baseline number of intravitreal injections (OR, 1.01; 95% CI, 1.00-1.02; P = .02). Of 258 active patients, 166 (64.3%) fulfilled the definition of compliance. Compliance was associated with patients diagnosed with neovascular age-related macular degeneration (OR, 1.94; 95% CI, 1.07-3.53; P = .002), White British ethnicity (OR, 1.69; 95% CI, 0.96-3.01; P = .02), and visual acuity in the better-seeing eye at baseline (OR, 1.02; 95% CI, 1.01-1.04; P = .04). Use rate was higher with increasing levels of comfort with use of modern technologies (β = 0.031; 95% CI, 0.007-0.055; P = .02). A total of 119 patients (98.4%) found the app either easy or very easy to use, while 96 (82.1%) experienced increased reassurance from using the app. Conclusions and Relevance This evaluation of home vision monitoring for patients with common vision-threatening disease within a clinical practice setting revealed demographic, clinical, and patient-related factors associated with patient uptake and engagement. These insights inform targeted interventions to address risks of digital exclusion with smartphone-based medical devices.
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Affiliation(s)
- Edward Korot
- Byers Eye Institute, Stanford University, Palo Alto, California.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Nikolas Pontikos
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Faye M Drawnel
- Personalised Healthcare Ophthalmology, F. Hoffmann La Roche AG, Basel, Switzerland
| | - Aljazy Jaber
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom
| | - Dun Jack Fu
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Gongyu Zhang
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Marco A Miranda
- UCL Institute of Ophthalmology, London, United Kingdom.,Personalised Healthcare Ophthalmology, Roche Products, Welwyn Gardens City, United Kingdom
| | - Bart Liefers
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Sophie Glinton
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Siegfried K Wagner
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Robbert Struyven
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Caroline Kilduff
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | | | - Pearse A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Dawn A Sim
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Peter B M Thomas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
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17
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Maguire MG, Liu D, Bressler SB, Friedman SM, Melia M, Stockdale CR, Glassman AR, Sun JK. Lapses in Care Among Patients Assigned to Ranibizumab for Proliferative Diabetic Retinopathy: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Ophthalmol 2021; 139:1266-1273. [PMID: 34673898 DOI: 10.1001/jamaophthalmol.2021.4103] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The follow-up schedule for individuals with eyes treated with anti-vascular endothelial growth factor agents for proliferative diabetic retinopathy (PDR) requires that patients return frequently for monitoring and repeated treatment. The likelihood that a patient will comply should be a consideration in choosing a treatment approach. Objective To describe completion of scheduled examinations among participants assigned to intravitreous injections of ranibizumab for PDR in a multicenter randomized clinical trial. Design, Setting, and Participants This post hoc analysis evaluates data from a randomized clinical trial conducted at 55 US sites among 305 adults with proliferative diabetic retinopathy enrolled between February and December 2012. Both eyes were enrolled for 89 participants (1 eye to each study group), with a total of 394 study eyes. The final 2-year visit was completed in January 2015. Data were analyzed from April 2019 to July 2021. Interventions Ranibizumab injections for PDR or macular edema. Main Outcomes and Measures A long lapse in care of 8 or more weeks past a scheduled examination, dropout from follow-up, visual acuity at 5 years. Results Among 170 participants, the median age was 51 years, and 44.7% were female. Through 5 years of follow-up, 94 of 170 participants (55.3%) had 1 or more long lapse in care. Median time to the first long lapse was 210 weeks, and 69 of 94 participants (73.4%) returned for examination after the first long lapse. Fifty of 170 participants (29.4%) dropped out of follow-up by 5 years. Among the 120 participants who completed the 5-year examination, median change from baseline in visual acuity was -2 letters for participants who had 1 or more long lapse compared with +5 letters for those without a long lapse (P = .02). After multivariable adjustment, the odds ratio (95% CI) for baseline associations with 1 or more long lapse was 1.21 (1.03-1.43) for each 5-letter decrement in visual acuity score, 2.19 (1.09-4.38) for neovascularization of the disc and elsewhere, and 3.48 (1.38-8.78) for no prior laser treatment for diabetic macular edema. Conclusions and Relevance Over 5 years, approximately half of the participants assigned to ranibizumab for PDR had a long lapse in care despite substantial effort by the DRCR Retina Network to facilitate timely completion of examinations. The likelihood of a long lapse in care during long-term follow-up needs to be considered when choosing treatment for PDR. Trial Registration ClinicalTrials.gov Identifier: NCT01489189.
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Affiliation(s)
- Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Danni Liu
- Jaeb Center for Health Research, Tampa, Florida
| | - Susan B Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology, Boston, Massachusetts.,CME Editor, JAMA Ophthalmology
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18
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Kirthi V, Jackson TL. Black eyes matter-do we treat Black patients differently in ophthalmology? Eye (Lond) 2021; 35:2662-2664. [PMID: 33958735 PMCID: PMC8100735 DOI: 10.1038/s41433-021-01567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Varo Kirthi
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK ,grid.429705.d0000 0004 0489 4320King’s College Hospital NHS Foundation Trust, London, UK
| | - Timothy L. Jackson
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK ,grid.429705.d0000 0004 0489 4320King’s College Hospital NHS Foundation Trust, London, UK
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19
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Visual/anatomical outcome of diabetic macular edema patients lost to follow-up for more than 1 year. Sci Rep 2021; 11:18353. [PMID: 34526548 PMCID: PMC8443734 DOI: 10.1038/s41598-021-97644-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/23/2021] [Indexed: 12/22/2022] Open
Abstract
To investigate the visual/anatomical outcome of diabetic macular edema (DME) patients lost to follow-up (LTFU) for more than 1 year during intravitreal anti-VEGF treatment. A retrospective review of 182 treatment-naïve DME patients was performed. Among them, we identified patients LTFU for more than 1 year during anti-VEGF treatment. Visual acuity and anatomic outcomes at the first visit, last visit before being LTFU, return visit, and after re-treatment were analyzed and compared with those of DME patients with regular follow-up. Patients who had continuous follow-up visits were assigned to the control group. Sixty patients (33%) with DME were LTFU for more than 1 year during anti-VEGF treatment. Multivariate analysis revealed that the ratio of male (p = 0.004), diabetes mellitus (DM) duration less than 5 years (p = 0.015), and poor early anatomic response (p = 0.012) were higher compared to the control group. Eighteen patients returned to the clinic and received re-treatment. After re-treatment with anti-VEGF, central subfield thickness (CST) was significantly improved to the CST of before LTFU. However, visual acuity did not recover to the level before LTFU (0.63 ± 0.26 vs. 0.45 ± 0.28, p = 0.003). About thirty percent of DME patients were LTFU for more than 1 year. Permanent visual loss was observed in these LTFU patients. Patients with a high risk of LTFU such as male, early DM, and poor response after initial injections should be treated more aggressively to improve the visual outcomes.
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20
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Claessens D, Ichhpujani P, Singh RB. MacuFix® versus Amsler grid for metamorphopsia categorization for macular diseases. Int Ophthalmol 2021; 42:229-238. [PMID: 34420124 PMCID: PMC8380298 DOI: 10.1007/s10792-021-02017-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/13/2021] [Indexed: 12/04/2022]
Abstract
Purpose Macular diseases often lead to metamorphopsia, which is traditionally tested using the Amsler grid. This study evaluates a novel method for assessing metamorphopsia, based on the software AMD-A Metamorphopsia Detector, application MacuFix®. Methods In this observational study, the usability of a new smartphone-based testing method to assess metamorphopsia was evaluated in 45 patients experiencing metamorphopsia in at least one eye using the questionnaire “System Usability Score (SUS).” Additionally, the diagnostic adherence of self-monitoring with the Amsler grid was compared to self-monitoring with the novel software MacuFix®. Results The average score of the SUS questionnaire in this study was 76.7 ± 15.5, corresponding to the “good” score on the grading scale. The average interval between two home administered tests was significantly shorter (6 days) when the application was used as compared to using the Amsler grid (19 days). The odds ratio of the frequency of patients using the application to the patients using the home test was 4.
Conclusion MacuFix® application can help in effective home monitoring of macular function as high user satisfaction and increased testing frequency was observed in its use in patients with macular diseases.
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Affiliation(s)
- Daniela Claessens
- Augenheilkunde Lindenthal, Dürener Str. 251, 50931, Cologne, Germany.
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College & Hospital, Chandigarh, India
| | - Rohan Bir Singh
- Department of Ophthalmology, Massachusetts and Ear and Ear, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
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21
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Discontinuation and loss to follow-up rates in clinical trials of intravitreal anti-vascular endothelial growth factor injections. Graefes Arch Clin Exp Ophthalmol 2021; 260:93-100. [PMID: 34415363 DOI: 10.1007/s00417-021-05246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Clinical trials are often designed to include homogenous, highly specific patient populations with many resources to reduce patient dropout. Results may not translate to real-world settings. We evaluated discontinuation and loss to follow-up (LTFU) rates in clinical trials of anti-vascular endothelial growth factor (anti-VEGF) injections for diabetic macular edema (DME), age-related macular degeneration (AMD), and retinal vein occlusion (RVO). METHODS Retrospective meta-epidemiological study. The authors queried ClinicalTrials.gov for all completed trials of anti-VEGF injections for DME, AMD, or RVO. Of 658 trials identified, 582 were excluded for being non-interventional, <100 patients, terminating early, or missing study results. The remaining 76 trials of 27,823 patients were analyzed for discontinuation and LTFU rates. RESULTS Mean discontinuation rate was 12.44% (SD 8.12%, range 0-54.12%), with higher rates among control (18.87%) than treatment arms (10.78%, p = .006). Mean LTFU rate was 1.84% (SD 1.78%, range 0-7.76%), with no differences by disease, treatment type, or treatment frequency. CONCLUSION Discontinuation rates of major intravitreal anti-VEGF clinical trials were highly variable, suggesting even trials struggle with overall patient retention. Though trial LTFU rates were low, real-world outcomes may differ due to higher reported LTFU rates, which should be considered when extrapolating trial results to clinical practice.
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22
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Lommatzsch A, Eter N, Ehlken C, Lanzl I, Kaymak H, Schuster AK, Ziemssen F. [Adherence to anti-VEGF treatment-Considerations and practical recommendations]. Ophthalmologe 2021; 118:801-809. [PMID: 33270147 PMCID: PMC8342348 DOI: 10.1007/s00347-020-01273-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Numerous studies have identified a lack of treatment adherence as an important factor that often conflicts with the necessary number of anti-VEGF injections and therefore a better functional result. OBJECTIVE This article discusses approaches and possible measures to reduce the risk of late and infrequent intravitreal injections leading to the major issue of undertreatment. MATERIAL AND METHOD In the course of an expert dialogue, relevant parameters of treatment adherence and variables were identified. Meaningful processes were structured and assigned to organizational areas. RESULTS The compilation of meaningful measures enables practitioners to optimize their own implementation in different areas. Regular monitoring measures can identify the extent of treatment interruption and discontinuation. For specific indicators (treatments per time interval, longest pause interval, minimum coverage per unit time, delay) an effect on the development of visual function was demonstrated. Organizational measures, training of teams and referring physicians, redundant and iterative information transfer to patients have been proven in the experience of experts. The firm integration of these processes into the structures is facilitated by working with checklists. CONCLUSION An optimization of the processes is possible to improve the adherence and the functional results; however, interventional studies showing how adherence and persistence can be increased in the German treatment setting are still lacking.
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Affiliation(s)
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
| | - Christoph Ehlken
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Ines Lanzl
- Chiemsee Augen Tagesklinik, Prien, Deutschland
| | - Hakan Kaymak
- Makula-Netzhaut-Zentrum, Düsseldorf-Oberkassel, Deutschland
| | | | - Focke Ziemssen
- Department für Augenheilkunde Tübingen, Universitäts-Augenklinik, Elfriede-Aulhorn-Str. 7, 72076, Tübingen, Deutschland.
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23
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Leley SP, Ciulla TA, Bhatwadekar AD. Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment. Clin Interv Aging 2021; 16:1367-1378. [PMID: 34290499 PMCID: PMC8289197 DOI: 10.2147/cia.s297494] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/04/2021] [Indexed: 12/24/2022] Open
Abstract
The elderly population in the United States is projected to almost double by the year 2050. In addition, the numbers of diabetics are rising, along with its most common complication, diabetic retinopathy (DR). To effectively treat DR within the elderly population, it is essential first to consider the retinal changes that occur due to aging, such as decreased blood flow, retinal thinning, and microglial changes, and understand that these changes can render the retina more vulnerable to oxidative and ischemic damage. Given these considerations, as well as the pathogenesis of DR, specific pathways could play a heightened role in DR progression in elderly patients, such as the polyol pathway and the vascular endothelial growth factor (VEGF) axis. Current ocular treatments include intravitreal corticosteroids, intravitreal anti-VEGF agents, laser photocoagulation and surgical interventions, in addition to better control of underlying diabetes with an expanding range of systemic treatments. While using therapeutics, it is also essential to consider how pharmacokinetics and pharmacodynamics change with aging; oral drug absorption can decrease, and ocular drug metabolism might affect the dosing and delivery methods. Also, elderly patients may more likely be nonadherent to their medication regimen or appointments than younger patients, and undertreatment with anti-VEGF drugs often leads to suboptimal outcomes. With a rising number of elderly DR patients, understanding how aging affects disease progression, pharmacological metabolism, and adherence are crucial to ensuring that this population receives adequate care.
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Affiliation(s)
- Sameer P Leley
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas A Ciulla
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University, Indianapolis, IN, USA
- Clearside Biomedical, Inc., Alpharetta, GA, USA
- Midwest Eye Institute, Indianapolis, IN, USA
| | - Ashay D Bhatwadekar
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University, Indianapolis, IN, USA
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24
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Cuadros J. The Real-World Impact of Artificial Intelligence on Diabetic Retinopathy Screening in Primary Care. J Diabetes Sci Technol 2021; 15:664-665. [PMID: 32329352 PMCID: PMC8120063 DOI: 10.1177/1932296820914287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study by Shah et al published in this issue of the Journal of Diabetes Science and Technology validates the IDx autonomous diabetic retinopathy (DR) screening program in a real-world setting. The study found high sensitivity (100%) but low specificity (82%) for referable DR. The resulting positive predictive value of 19% means that four out of five patients without referable DR would be referred to ophthalmology causing a significant burden to ophthalmologists, primary care clinics, and patients. Artificial intelligence programs that provide better specificity, multiple levels of DR, and annotations of where lesions are located in the retina may function better than a simple referral/no referral output. This will allow for better engagement of patients through the difficult process of adhering to treatment recommendations and control their diabetes.
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Affiliation(s)
- Jorge Cuadros
- Meredith Morgan Eye Center, University of
California, Berkeley, USA
- EyePACS LLC, Santa Cruz, CA, USA
- Jorge Cuadros, OD, PhD, Meredith Morgan Eye Center,
University of California, Minor Hall, Room 110C, Berkeley, CA 94720, USA.
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Kirthi V, Reed KI, Gunawardena R, Alattar K, Bunce C, Jackson TL. Do Black and Asian individuals wait longer for treatment? A survival analysis investigating the effect of ethnicity on time-to-clinic and time-to-treatment for diabetic eye disease. Diabetologia 2021; 64:749-757. [PMID: 33496821 PMCID: PMC7940160 DOI: 10.1007/s00125-020-05364-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS This study explored the impact of ethnicity on time-to-clinic, time-to-treatment and rates of vision loss in people referred to hospital with diabetic eye disease. METHODS A survival analysis was performed on all referrals from an inner-city diabetic eye screening programme to a tertiary hospital eye service between 1 October 2013 and 31 December 2017. Exclusion criteria were failure to attend hospital, distance visual acuity in both eyes too low to quantify with the Early Treatment Diabetic Retinopathy Study (ETDRS) letter chart and treatment received prior to referral. Demographic and screening grade data were collected at the point of referral. Small-area statistics and census data were used to calculate indices of multiple deprivation. The main outcome measures were time taken from the date of referral for an individual to achieve the following: (1) attend the first hospital clinic appointment; (2) receive the first macular laser, intravitreal anti-vascular endothelial growth factor injection or pan-retinal photocoagulation treatment, in either eye; and (3) lose at least ten ETDRS letters of distance visual acuity, in either eye. RESULTS Of 2062 referrals, 1676 individuals were included. Mean age (± SD) was 57.6 ± 14.7 years, with 52% male sex and 86% with type 2 diabetes. The ethnicity profile was 52% Black, 30% White, 10% Asian and 9% mixed/other, with similar disease severity at the time of referral. Time-to-clinic was significantly longer for Asian people than for Black people (p = 0.03) or White people (p = 0.001). Time-to-treatment was significantly longer for Black people than for White people (p = 0.02). Social deprivation did not significantly influence time-to-treatment. There were no significant differences in the rates of vision loss between ethnic groups. CONCLUSIONS/INTERPRETATION Black people wait longer for hospital eye treatment compared with their White counterparts. The reasons for this delay in treatment warrant further investigation.
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Affiliation(s)
- Varo Kirthi
- Faculty of Life Sciences and Medicine, King's College London, London, UK.
- King's College Hospital NHS Foundation Trust, London, UK.
| | - Kate I Reed
- King's College Hospital NHS Foundation Trust, London, UK
| | - Ramith Gunawardena
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Komeil Alattar
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catey Bunce
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Timothy L Jackson
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
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Agarwal D, Udeh B, Campbell J, Bena J, Rachitskaya A. Follow-Up Appointment Delay in Diabetic Macular Edema Patients. Ophthalmic Surg Lasers Imaging Retina 2021; 52:200-206. [PMID: 34039185 DOI: 10.3928/23258160-20210330-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate a novel measure of compliance, follow-up appointment delay, and assess its relationship with clinical and sociodemographic factors in patients undergoing treatment for diabetic macular edema (DME). PATIENTS AND METHODS This is a comparative case series of patients treated for DME. The novel measure of compliance - the time in days from the intended day of return and actual day of return, or follow-up appointment delay - was studied and compared to a traditional measure: the percentage of visits missed. These were correlated with clinical and sociodemographic characteristics: best-corrected visual acuity, hemoglobin A1C percent (HbA1c), median household income, smoking status, type of insurance held, marital status, gender, and age. Univariate and multivariable analyses were conducted. RESULTS One hundred fifty-five patients (212 eyes) were included in the study. The median times between recommended and actual appointments was 5.0 days (range: 2.0-14.0 days). The mean percentage of visits missed was 31.7% (± 13.3%). The two measures of compliance were positively associated, but the correlation was moderate (r = 0.44). Non-white race, lack of bilateral injections, and higher baseline HBA1c were significant predictors of a median time greater than 7 days between the intended and actual follow-up dates. CONCLUSIONS The current study identified a novel method of measuring compliance of DME patients seen by retina specialists and has identified non-white race, lack for bilateral treatment, and poorer glycemic control as risk factors for noncompliance. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:200-206.].
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27
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The Relationship of Travel Distance to Postoperative Follow-up Care on Glaucoma Surgery Outcomes. J Glaucoma 2021; 29:1056-1064. [PMID: 32694285 DOI: 10.1097/ijg.0000000000001609] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRéCIS:: This study addresses the paucity of literature examining glaucoma patients' distance from clinic on postoperative follow-up outcomes. Greater distance from clinic was associated with higher likelihood of loss to follow-up and missed appointments. PURPOSE To investigate the relationship of patient travel distance and interstate access to glaucoma surgery postoperative follow-up visit attendance. METHODS AND PARTICIPANTS Retrospective longitudinal chart review of all noninstitutionalized adult glaucoma patients with initial trabeculectomies or drainage device implantations between April 4, 2014 and December 31, 2018. Patients were stratified into groups on the basis of straight-line distance from residence to University of North Carolina at Chapel Hill's Kittner Eye Center and distance from residence to interstate access. Corrective procedures, visual acuity, appointment cancellations, no-shows, and insurance data were recorded. Means were compared using 2-tailed Student t-test, Pearson χ, analysis of variance, and multivariate logistical regression determined odds ratios for loss to follow-up. RESULTS In total, 199 patients met all inclusion criteria. Six-month postoperatively, patients >50 miles from clinic had greater odds of loss to follow-up compared with patients <25 miles (odds ratios, 3.47; 95% confidence interval, 1.24-4.12; P<0.05). Patients >50 miles from clinic had significantly more missed appointments than patients 25 to 50 miles away, and patients <25 miles away (P=0.008). Patients >20 miles from interstate access had greater loss to follow-up than those <10 miles (t(150)=2.05; P<0.05). Mean distance from clinic was 12.59 miles farther for patients lost to follow-up (t(197)=3.29; P<0.01). Patients with Medicaid coverage had more missed appointments than those with Medicare plans (t(144)=-2.193; P<0.05). CONCLUSIONS Increased distance from clinic and interstate access are associated with increased missed appointments and loss to follow-up. Glaucoma specialists should consider these factors when choosing surgical interventions requiring frequent postoperative evaluations.
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Okada M, Mitchell P, Finger RP, Eldem B, Talks SJ, Hirst C, Paladini L, Barratt J, Wong TY, Loewenstein A. Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age-Related Macular Degeneration: A Mixed-Methods Systematic Review. Ophthalmology 2021; 128:234-247. [PMID: 32763265 PMCID: PMC7403101 DOI: 10.1016/j.ophtha.2020.07.060] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
TOPIC Systematic review of risk factors for nonadherence and nonpersistence to intravitreal anti-vascular endothelial growth factor (VEGF) injection therapy for neovascular age-related macular degeneration (nAMD). CLINICAL RELEVANCE Lack of adherence (nonadherence) or undertreatment (nonpersistence) with respect to evidence from clinical trials remains a significant barrier to optimizing real-world outcomes for patients with nAMD. Contributing factors and strategies to address this are poorly understood. METHODS Studies that reported factors for nonadherence and nonpersistence to anti-VEGF therapy as well as studies examining strategies to improve this were included. Trial eligibility and data extraction were conducted according to Cochrane review methods. Risk of bias was assessed using the Mixed Method Assessment Tool and certainty of evidence evaluated according to the GRADE Confidence in the Evidence from Reviews of Qualitative Research tool. Data were collated descriptively. RESULTS Of the 1284 abstract results screened, 124 articles were assessed in full and 37 studies met the inclusion criteria. Definitions of nonadherence and nonpersistence varied or were not reported. Nonpersistence occurred early, with up to 50% of patients stopping treatment by 24 months. High rates of nonadherence were similarly reported, occurring in 32% to 95% of patients. Certainty of this finding was downgraded to a moderate level because of the heterogeneity in definitions used across studies. Multiple factors determine nonadherence and nonpersistence, including at the condition, therapy, patient, social/economic, and health systems/healthcare team levels. Moderate quality evidence points to lower baseline vision and poorer response to treatment as condition-related variables. The effects of other factors were of lower certainty, predominantly due to small numbers and potential biases in retrospective assessment. Although many factors are not modifiable (e.g., patient comorbidity), other factors are potentially correctable (e.g., lack of transport or mismatched patient expectations). Evidence on strategies to improve adherence and persistence is limited, but where available, these have proven effective. CONCLUSIONS Awareness of factors related to poor patient adherence and persistence in nAMD could help identify at-risk populations and improve real-world outcomes. Further work is required to develop uniform definitions and establish high-quality evidence on interventions that can be easily implemented.
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Affiliation(s)
- Mali Okada
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | - Paul Mitchell
- Department of Ophthalmology, University of Sydney, Sydney, Australia
| | | | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - S. James Talks
- The Newcastle upon Tyne Hospitals NHS Foundation, Newcastle upon Tyne, United Kingdom
| | | | | | - Jane Barratt
- International Federation on Ageing, Toronto, Canada
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bascaran C, Mwangi N, D’Esposito F, Cleland C, Gordon I, Ulloa JAL, Maswadi R, Mdala S, Ramke J, Evans JR, Burton M. Effectiveness of interventions to increase uptake and completion of treatment for diabetic retinopathy in low- and middle-income countries: a rapid review protocol. Syst Rev 2021; 10:27. [PMID: 33446272 PMCID: PMC7809874 DOI: 10.1186/s13643-020-01562-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vision loss due to diabetic retinopathy can largely be prevented or delayed through treatment. Patients with vision-threatening diabetic retinopathy are typically offered laser or intravitreal injections which often require more than one treatment cycle. However, treatment is not always initiated, or it is not completed, resulting in poor visual outcomes. Interventions aimed at improving the uptake or completion of treatment for diabetic retinopathy can potentially help prevent or delay visual loss in people with diabetes. METHODS We will search MEDLINE, Embase, Global Health and Cochrane Register of Studies for studies reporting interventions to improve the uptake of treatment for diabetic retinopathy (DR) and/or diabetic macular oedema (DMO), compared with usual care, in adults with diabetes. The review will include studies published in the last 20 years in the English language. We will include any study design that measured any of the following outcomes in relation to treatment uptake and completion for DR and/or DMO: (1) proportion of patients initiating treatment for DR and/or DMO among those to whom it is recommended, (2) proportion of patients completing treatment for DR and/or DMO among those to whom it is recommended, (3) proportion of patients completing treatment for DR and/or DMO among those initiating treatment and (4) number and proportion of DR and/or DMO rounds of treatment completed per patient, as dictated by the treatment protocol. For included studies, we will also report any measures of cost-effectiveness when available. Two reviewers will screen search results independently. Risk of bias assessment will be done by two reviewers, and data extraction will be done by one reviewer with verification of 10% of the papers by a second reviewer. The results will be synthesised narratively. DISCUSSION This rapid review aims to identify and synthesise the peer-reviewed literature on the effectiveness of interventions to increase uptake and completion of treatment for DR and/or DMO in LMICs. The rapid review methodology was chosen in order to rapidly synthesise the available evidence to support programme implementers and policy-makers in designing evidence-based health programmes and public health policy and inform the allocation of resources. SYSTEMATIC REVIEW REGISTRATION OSF osf.io/h5wgr.
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Affiliation(s)
- Covadonga Bascaran
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nyawira Mwangi
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Kenya Medical Training College, Nairobi, Kenya
| | | | - Charles Cleland
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Iris Gordon
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | | | - Ranad Maswadi
- St Thomas’s Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Shaffi Mdala
- Queen Elizabeth Central Hospital, P.O.Box 95, Blantyre, Malawi
| | - Jacqueline Ramke
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Jennifer R. Evans
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Matthew Burton
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Moorfields Eye Hospital, London, UK
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Chang A, Stokes J, Priestman L, Holmes C, Said P. Impact of a Patient Support Program on Patient Beliefs About Neovascular Age-Related Macular Degeneration and Persistence to Anti-Vascular Endothelial Growth Factor Therapy. Patient Prefer Adherence 2021; 15:511-521. [PMID: 33688173 PMCID: PMC7937371 DOI: 10.2147/ppa.s293941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/06/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study aimed to compare persistence between patients prescribed intravitreal aflibercept (IVT-AFL) for neovascular age-related macular degeneration (nAMD) in Australia enrolled on a patient support program (PSP) with that of a sample of patients from the Australian Pharmaceutical Benefits Scheme (PBS) dataset (10% PBS sample); explore predictors of persistence; describe changes in patient beliefs over the course of their enrollment in a PSP for patients treated with IVT-AFL for nAMD; and assess patient satisfaction. PARTICIPANTS AND METHODS Participants prescribed IVT-AFL for the treatment of nAMD were invited to participate in the PSP. The PSP provided tailored support to patients through provision of a welcome pack, structured telephone calls, and information booklets. Persistence was defined in the PSP as the time from the start date in the program, until discontinuation from the program; and as the time from initial prescription until 6-months after the date of last prescription in the 10% PBS set. Persistence on the program and risk of discontinuation were modeled using Kaplan-Meier methods and Cox proportional hazards. In addition, persistence was compared between patients on the PSP and a 10% PBS sample of patients prescribed IVT-AFL for nAMD. RESULTS Persistence on treatment at 24 months was significantly higher in patients enrolled on the PSP compared to the PBS cohort (88% vs 64%, p<0.05). The risk of discontinuation in patients enrolled on the PSP was higher in patients identified at screening as "high-risk", those who were younger, or those with significant distance to travel for treatment. During the PSP, patients reported significant increase in their belief that they had control over their condition (6.1 ± 3.5 to 6.8 ± 3.7; p=0.0034) and a reduction in concerns about treatment. Satisfaction with the PSP was high. CONCLUSION Patients provided with access to a PSP showed better persistence on treatment and improved beliefs about nAMD disease and its treatment compared to those in the PBS sample. Improved persistence rates may translate into better outcomes for the patient and the healthcare system, however, further research is required to determine which elements of the program are most beneficial, particularly to those at high risk of discontinuation.
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Affiliation(s)
- Andrew Chang
- Sydney Retina Clinic, Sydney Institute of Vision Science, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- Correspondence: Andrew Chang Sydney Retina Clinic, 187 Macquarie Street, Sydney, New South Wales, 2000, AustraliaTel + 61 2 92213755Fax + 61 2 92211637 Email
| | - John Stokes
- Inservio, Sydney, New South Wales, Australia
- Department of Biomedical Sciences, Charles Sturt University, Orange, New South Wales, Australia
| | - Lindy Priestman
- Atlantis Healthcare Pty Ltd, Sydney, New South Wales, Australia
| | - Connor Holmes
- Atlantis Healthcare Pty Ltd, Sydney, New South Wales, Australia
| | - Peter Said
- Medical Affairs, Bayer Australia Ltd, Sydney, New South Wales, Australia
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Abstract
Intravitreal injections (IVI) of anti–vascular endothelial growth factor (anti–VEGF) agents have become the most prevalent intraocular procedure as they represent the major therapeutic modality for prevalent retinal conditions such as age-related macular degeneration (AMD) and diabetic retinopathy. Effective therapy requires adherence to a schedule of iterative IVI as well as routine clinic appointments. The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in the reduction of attendance at scheduled clinic visits and IVI. In this study, we attempted to analyze the effect of COVID-19 on compliance with anti–VEGF therapy. A total of 636 eyes received injections during a 4-week period of the COVID-19 outbreak in the Retina Clinic. The number of clinic visits for IVI during 1 month from March 15 to April 14 of 2020 was compared to a similar time period in each of the last 4 years. The study demonstrates a decrease in clinic visits for IVI when compared with the same 4-week interval in the four previous years. Based on the trend of the previous 4 years, 10.2% of the year’s total was expected for this time period. Using this model, the 636 reported number of injections for the March–April 2020 period was ~ 5%. This represents a decrease of ~ 50% of the expected IVI for this time period. The COVID-19 outbreak in Israel severely impacted compliance with anti–VEGF treatments.
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Green M, Tien T, Ness S. Predictors of Lost to Follow-Up in Patients Being Treated for Proliferative Diabetic Retinopathy. Am J Ophthalmol 2020; 216:18-27. [PMID: 32243878 DOI: 10.1016/j.ajo.2020.03.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To identify risk factors for patients with proliferative diabetic retinopathy (PDR) who are lost to follow-up (LTFU) while undergoing intravitreal injections of anti-VEGF (IVIs) and/or panretinal photocoagulation (PRP) at an urban institution. DESIGN Retrospective cohort study. METHODS A chart review was performed in a total of 418 adult patients with PDR who received IVI and/or PRP between January 1, 2014, and June 1, 2018, at the authors' institution. Rates of LTFU, risk factors associated with LTFU, and vision outcomes were assessed. RESULTS Of a total of 418 patients, 256 patients (61%) were LTFU. Risk factors positively associated with LTFU on multivariate analysis included non-English as the primary language (odds ratio [OR], 1.83; P = .006); age 56-65 years old (OR, 1.86; P = .014); age older than 65 years (OR, 1.94; P = .027) compared to age 55 years or younger; living 20 miles or less from the institution (OR, 2.68; P = .009); having greater than 5 comorbidities (OR, 2.38; P = .034); seeing 20 or more distinct departments (OR, 4.66; P = .007); missing more than 10% of non-eye care appointments (OR, 1.61; P = .038); and receiving only PRP compared to only IVIs (OR, 1.93; P = .031). CONCLUSIONS A high percentage of patients treated for PDR at the authors' institution were LTFU over a 4-year time span. Identifying patients at high risk for being LTFU may help in choosing treatment modality and appropriate patient counseling.
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Bresnick G, Cuadros JA, Khan M, Fleischmann S, Wolff G, Limon A, Chang J, Jiang L, Cuadros P, Pedersen ER. Adherence to ophthalmology referral, treatment and follow-up after diabetic retinopathy screening in the primary care setting. BMJ Open Diabetes Res Care 2020; 8:8/1/e001154. [PMID: 32576560 PMCID: PMC7312438 DOI: 10.1136/bmjdrc-2019-001154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/07/2020] [Accepted: 05/24/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Telemedicine-based diabetic retinopathy screening (DRS) in primary care settings has increased the screening rates of patients with diabetes. However, blindness from vision-threatening diabetic retinopathy (VTDR) is a persistent problem. This study examined the extent of patients' adherence to postscreening recommendations. RESEARCH DESIGN/METHODS A retrospective record review was conducted in primary care clinics of a large county hospital in the USA. All patients with diabetes detected with VTDR in two time periods, differing in record type used, were included in the study: 2012-2014, paper charts only; 2015-2017, combined paper charts/electronic medical records (EMRs), or EMRs only. Adherence rates for keeping initial ophthalmology appointments, starting recommended treatments, and keeping follow-up appointments were determined. RESULTS Adequate records were available for 6046 patients; 408 (7%) were detected with VTDR and recommended for referral to ophthalmology. Only 5% completed a first ophthalmology appointment within recommended referral interval, 15% within twice the recommended interval, and 51% within 1 year of DRS. Patients screened in 2015-2017 were more likely to complete a first ophthalmology appointment than those in 2012-2014. Ophthalmic treatment was recommended in half of the patients, of whom 94% initiated treatment. A smaller percentage (41%) adhered completely to post-treatment follow-up. Overall, 28% of referred patients: (1) kept a first ophthalmology appointment; (2) were recommended for treatment; and (3) initiated the treatment. Most patients failing to keep first ophthalmology appointments continued non-ophthalmic medical care at the institution. EMRs provided more complete information than paper charts. CONCLUSIONS Reducing vision impairment from VTDR requires greater emphasis on timely adherence to ophthalmology referral and follow-up. Prevention of visual loss from VTDR starts with retinopathy screening, but must include patient engagement, adherence monitoring, and streamlining ophthalmic referral and management. Revision of these processes has already been implemented at the study site, incorporating lessons from this investigation.
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Affiliation(s)
- George Bresnick
- University of California Berkeley School of Optometry, Berkeley, California, USA
- EyePACS, Santa Cruz, California, USA
| | - Jorge A Cuadros
- University of California Berkeley School of Optometry, Berkeley, California, USA
- EyePACS, Santa Cruz, California, USA
| | - Mahbuba Khan
- Family Medicine, Riverside University Health System, Riverside, California, USA
| | | | | | | | - Jenny Chang
- Medicine, University of California Irvine College of Medicine, Irvine, California, USA
| | - Luohua Jiang
- Epidemiology, University of California Irvine, Irvine, California, USA
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