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Radner W. Toward an internationally accepted standard for reading charts. Prog Retin Eye Res 2024; 101:101262. [PMID: 38574851 DOI: 10.1016/j.preteyeres.2024.101262] [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] [Received: 01/12/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
Patients who suffer from sight-threatening eye diseases share a desire to regain a comfortable reading ability. In light of the modern advances achieved in ophthalmic diagnosis and therapy, and because a significant lack of comparability between reading charts still exists, there is an increasing need for a worldwide standard in the form of a norm for diagnostic reading charts. Already, applied advancements such as digital print, which allow a calibration of the print sizes of reading charts in correctly progressing geometric proportions by using the actual height of a lower case "x" in millimeters (x-height), and psychophysically standardizing reading charts and their test items by applying modern statistical methods have significantly contributed to establishing a norm for reading charts. In 2020, a proposal of the British delegation was accepted by the International Organization for Standardization (ISO) group "Visual Optics and Optical Instruments," and a working group was established. Bearing in mind the efforts of the ISO with regard to an international norm, this review article is intended to (a) give an overview of the historical background and related normative approaches for diagnostic reading tests used in ophthalmology and optometry, (b) explain psychophysical and technical concerns, and (c) discuss the possibilities and limits of concepts that seem relevant to developing a modern standard for reading charts.
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Affiliation(s)
- Wolfgang Radner
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria; Department of Ophthalmology, University Hospital St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Austria; Austrian Academy of Ophthalmology, Mollgasse 11, 1180, Vienna, Austria.
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Ritter M, Hummer A, Pawloff M, Ledolter AA, Linhardt D, Woletz M, Deak GG, Sacu S, Ristl R, Ramazanova D, Holder GE, Windischberger C, Schmidt-Erfurth UM. Retinotopic cortical mapping in objective functional monitoring of macular therapy. Br J Ophthalmol 2024:bjophthalmol-2021-320723. [PMID: 38811051 DOI: 10.1136/bjo-2021-320723] [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: 11/06/2021] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND/AIMS To determine the suitability of functional MRI (fMRI) as an objective measure of macular function following therapeutic intervention; conventional psychophysical measures rely heavily on patient compliance. METHODS Twenty patients with neovascular age-related macular degeneration (nAMD) were studied with high-resolution fMRI, visual acuity, reading accuracy and speed, contrast sensitivity (CS) and microperimetry (MP) before and after 3 monthly intravitreal injections of ranibizumab. Population-receptive field retinotopic maps calculated from fMRI data were compared with psychophysical measures and optical coherence tomography. RESULTS Best-corrected visual acuity (BCVA) responders (≥5 letters) showed an increase of 29.5% in activated brain area, while non-responders showed a decrease of 0.8%. Radial histograms over eccentricity allowed quantification of the absolute number of significant voxels and thus differences before and after treatment. Responders showed increases in foveal (α<0.5°) activation, while non-responders did not. Absence of intraretinal fluid and preservation of outer retinal layers was associated with higher numbers of active V1 voxels and better BCVA. Higher voxel numbers were associated with improved reading performance and, less marked, with BCVA, CS and MP. CONCLUSION The data show that retinotopic mapping using fMRI can successfully be applied objectively to evaluate the therapeutic response in nAMD patients treated with anti-vascular endothelial growth factor therapy. This demonstrates the ability of retinotopic mapping to provide an objective assessment of functional recovery at a cortical level; the technique can therefore be applied, in other degenerative macular diseases, to the assessment of potential therapeutic interventions such as gene therapy or cell replacement therapy.
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Affiliation(s)
- Markus Ritter
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Allan Hummer
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Maximilian Pawloff
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Anna A Ledolter
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - David Linhardt
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Michael Woletz
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gabor Gyoergy Deak
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Dariga Ramazanova
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Graham E Holder
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- UCL Institute of Ophthalmology, London, UK
| | - Christian Windischberger
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Bygglin H, Immonen I, Luoma A, Hautamäki A. Exudative age-related macular degeneration lesion components predicting microperimetric retinal sensitivity during anti-vascular endothelial growth factor treatment. Acta Ophthalmol 2024; 102:107-115. [PMID: 37231616 DOI: 10.1111/aos.15707] [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] [Received: 12/30/2022] [Revised: 03/31/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE To analyse the effect of exudative age-related macular degeneration (eAMD) lesion components on retinal sensitivity during anti-vascular endothelial growth factor treatment. METHODS Visual acuity, fluorescein and indocyanine green (ICG) angiographies, autofluorescence images, microperimetries and optical coherence tomographies (OCTs) of 24 eyes of 24 patients were prospectively analysed in a 2-year study of pro-re-nata bevacizumab treatment for eAMD. Microperimetries were aligned with the OCTs, angiographies and autofluorescence images. Thicknesses of the neuroretina, pigment epithelial (RPE) elevation, neuroepithelial detachment (NED), subretinal tissue (SRT) and cystic intraretinal fluid were measured under each stimulus site, and areas of type 1 and type 2 macular neovascularizations (MNVs), ICG plaque, haemorrhage and RPE atrophy were identified. The effects and predictive values of lesion components on retinal sensitivity were analysed with multivariate mixed linear models for repeated measurements. RESULTS The overall microperimetric retinal sensitivity increased during the first year (from 10.1 dB at baseline to 11.9 dB at 1 year; p = 0.021, Wilcoxon signed ranks), but remained the same during the second year (11.5 dB, p = 0.301). The baseline lesion components most strongly predicting deteriorated sensitivity at 1 year were RPE atrophy, the area of Type 2 MNV, intraretinal cysts, haemorrhage, Type 1 MNV and retinal thickening >350 μm. NED and RPE elevation had only small effects. At 2 years, the predictive values of the baseline lesion components remained quite unchanged. CONCLUSION The most powerful predictors of retinal sensitivity loss during 2 years of treatment were RPE atrophy, areas of haemorrhage, the area of MNVs, intraretinal cysts and SRT. RPE elevation and NED had lesser effects.
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Affiliation(s)
- Henrik Bygglin
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Immonen
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arto Luoma
- Insurance Science, Tampere University, Tampere, Finland
| | - Asta Hautamäki
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Peterson CL, Yap CL, Tan TF, Tan LLY, Sim KT, Ong L, Tan ZK, Tan YW, Man R, Fenwick E, Cheung G, Lamoureux E, Tan ACS. Monocular and Binocular Visual Function Assessments and Activities of Daily Living Performance in Age-Related Macular Degeneration. Ophthalmol Retina 2024; 8:32-41. [PMID: 37648064 DOI: 10.1016/j.oret.2023.08.013] [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] [Received: 05/21/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the relationship between specific monocular and binocular visual function (VF) assessments with binocularly performed activities of daily living task tests (ADLTTs) in patients with age-related macular degeneration (AMD) and healthy controls. DESIGN Prospective case-control cohort study. SUBJECTS Thirty-six AMD patients and 36 controls. METHOD Visual field assessments included monocular and binocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), and monocular microperimetry testing for mean macula sensitivity, mean retina sensitivity (MRS), fixation area, and fixation distance from fovea (FDF). Age-related macular degeneration lesion area and sensitivity were measured on OCT and microperimetry, respectively. Participants performed 4 validated ADLTTs with binocular BCVA: (1) reading; (2) item-search; (3) money-counting; and (4) multi-step drink-making tasks. MAIN OUTCOME MEASURES Spearman correlations and multivariate regression analysis, adjusted for age, sex, and potential correlation between the 2 eyes, were used to assess the relationship between monocular and binocular VF assessments, and ADLTT performance in both groups. RESULTS Age-related macular degeneration patients had poorer VF (BCVA, CS, mean macula sensitivity, and MRS) compared with healthy controls. Monocular BCVA in both better- and worse-vision eyes was moderately correlated with the binocular reading speed and money-counting tasks in participants with AMD. In AMD, monocular worse eye CS, MRS, AMD lesion area on OCT, and lesion sensitivity on microperimetry showed moderate correlations to various ADLTTs, such as reading, money-counting, and drink-making. Similar findings were found in our AMD cohort on multivariate regression analysis. Fewer significant correlations were observed for the better-vision eye, whereas no correlations were observed for healthy controls between VF parameters and ADLTTs. In contrast, significant associations were observed between binocular BCVA and CS with binocular ADLTTs (reading and item-search tasks) but not in AMD patients. CONCLUSION Although monocular BCVA remains the most common measure of VF, CS and microperimetry testing also show significant correlations with ADLTTs performance in AMD patients, and should be considered as complimentary VF-outcome measures in both clinical and research settings. Unlike healthy subjects, AMD patients do not rely on binocular VF for ADLTT function, with the worse-vision eye impacting binocular ADLTT function more than the better-vision eye. Therefore, the worse-vision eye should not be neglected during the management of AMD. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Claire L Peterson
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | | | - Ting Fang Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore
| | | | | | - Lisa Ong
- Singapore National Eye Centre, Singapore
| | | | - Yan Wen Tan
- Department of Occupational Therapy, Singapore General Hospital, Singapore
| | - Ryan Man
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Eva Fenwick
- Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Gemmy Cheung
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Anna C S Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore.
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Dieke S, Wurche S, Ruebsam A, Wirbelauer C, Joussen AM, Winterhalter S. Impact of intravitreal injection therapy on contrast sensitivity in patients with nAMD and DME. Graefes Arch Clin Exp Ophthalmol 2023; 261:1823-1833. [PMID: 36622409 PMCID: PMC10272247 DOI: 10.1007/s00417-022-05944-8] [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: 07/29/2022] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The study aims to evaluate changes in contrast sensitivity (CS) during therapy with intravitreal vascular endothelial growth factor (VEGF) inhibitors in patients with neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). METHODS Prospective, uncontrolled, multicenter study on patients with neovascular AMD or DME who underwent intravitreal injection therapy with Ranibizumab, Aflibercept, or Bevacizumab was conducted. Best corrected visual acuity (BCVA) and CS measured by Mars Letter Contrast Sensitivity Test (MLCS) and Freiburg Visual Acuity and Contrast Test (FrACT) in logCS were evaluated before 3 consecutive VEGF inhibitor injections, which followed the pro renata regimen in treatment-naïve and pretreated eyes with a maximum of 9 injections. Correlation of MLCS and FrACT was calculated by the Spearman's rank correlation coefficient. RESULTS Eighty eyes of 74 patients (mean age 72.7; SD ± 9.96) were included. BCVA improved significantly from 0.44 (SD ± 0.21) logMAR to 0.38 (SD ± 0.23) logMAR by 0.06 (SD ± 0.14) logMAR values (p < 0.001). CS measured by MLCS increased significantly from 1.27 (SD ± 0.25) logCS to 1.39 (SD ± 0.22) logCS (p < 0.001). CS measured by FrACT also improved significantly from 1.22 (SD ± 0.32) logCS to 1.30 (SD ± 0.29) logCS (p = 0.035). A positive correlation between MLCS and FrACT was found (r = 0.389; p < 0.001). Despite statistical significance, results for BCVA, MLCS, and FrACT failed clinical significance. Overall best test results were achieved with MLCS. CONCLUSIONS Intravitreal injection therapy with VEGF inhibitors led to an improvement of BCVA and CS measured by MLCS and FrACT. MLCS was superior and more sensitive compared to FrACT and even BCVA to evaluate CS in elderly patients with macular pathology.
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Affiliation(s)
- Sebastian Dieke
- Beuth Hochschule for Technology Berlin, University of Applied Sciences, Berlin, Germany
| | - Stefanie Wurche
- Beuth Hochschule for Technology Berlin, University of Applied Sciences, Berlin, Germany
| | - Anne Ruebsam
- Department of Ophthalmology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | | | - Antonia M Joussen
- Department of Ophthalmology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Ferro Desideri L, Traverso CE, Nicolò M, Munk MR. Faricimab for the Treatment of Diabetic Macular Edema and Neovascular Age-Related Macular Degeneration. Pharmaceutics 2023; 15:pharmaceutics15051413. [PMID: 37242655 DOI: 10.3390/pharmaceutics15051413] [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: 03/10/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Nowadays; intravitreal anti-vascular endothelial growth factor (VEGF) drugs are considered the first-line therapeutic strategy for treating macular exudative diseases; including wet age-related macular degeneration (w-AMD) and diabetic macular edema (DME). Despite the important clinical achievements obtained by anti-VEGF drugs in the management of w-AMD and DME; some limits still remain; including high treatment burden; the presence of unsatisfactory results in a certain percentage of patients and long-term visual acuity decline due to complications such as macular atrophy and fibrosis. Targeting the angiopoietin/Tie (Ang/Tie) pathway beyond the VEGF pathway may be a possible therapeutic strategy; which may has the potential to solve some of the previous mentioned challenges. Faricimab is a new; bispecific antibody targeting both VEGF-A and the Ang-Tie/pathway. It was approved by FDA and; more recently; by EMA for treating w-AMD and DME. Results from phase III trials TENAYA and LUCERNE (w-AMD) and RHINE and YOSEMITE (DME) have shown the potential of faricimab to maintain clinical efficacy with more prolonged treatment regimens compared to aflibercept (12 or 16 weeks) with a a good safety profile.
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Affiliation(s)
- Lorenzo Ferro Desideri
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16126 Genoa, Italy
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Carlo Enrico Traverso
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16126 Genoa, Italy
| | - Massimo Nicolò
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16126 Genoa, Italy
| | - Marion R Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
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Horie S, Corradetti G, Esmaeilkhanian H, Sadda SR, Cheung CMG, Ham Y, Chang A, Takahashi T, Ohno-Matsui K. Microperimetry in Retinal Diseases. Asia Pac J Ophthalmol (Phila) 2023; 12:211-227. [PMID: 36971707 DOI: 10.1097/apo.0000000000000597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/06/2022] [Indexed: 03/29/2023] Open
Abstract
Retinal microperimetry (MP) is a procedure that assesses the retinal sensitivity while the fundus is directly observed, and an eye tracker system is active to compensate for involuntary eye movements during testing. With this system, the sensitivity of a small locus can be accurately determined, and it has become an established ophthalmic test for retinal specialists. Macular diseases are characterized by chorioretinal changes; therefore, the condition of the retina and choroid requires careful and detailed evaluations to perform effective therapy. Age-related macular degeneration is a representative retinal disease in which the macular function has been evaluated by the visual acuity throughout the course of the disease process. However, the visual acuity represents the physiological function of only the central fovea, and the function of the surrounding macular area has not been sufficiently evaluated throughout the different stages of the macula disease process. The new technique of MP can compensate for such limitations by being able to test the same sites of the macular area repeatedly. This is especially useful in the recent management of age-related macular degeneration or diabetic macular edema during anti-vascular endothelial growth factor treatments because MP can assess the effectiveness of the treatment. MP examinations are also valuable in diagnosing Stargardt disease as they can detect visual impairments before any abnormalities are found in the retinal images. The visual function needs to be carefully assessed along with morphologic observations by optical coherence tomography. In addition, the assessment of retinal sensitivity is useful in the presurgical or postsurgical evaluations.
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Affiliation(s)
- Shintaro Horie
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Giulia Corradetti
- Doheny Eye Institute, Pasadena, CA, US
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, US
| | - Houri Esmaeilkhanian
- Doheny Eye Institute, Pasadena, CA, US
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, US
| | - SriniVas R Sadda
- Doheny Eye Institute, Pasadena, CA, US
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, US
| | | | - Yeji Ham
- Sydney Retina Clinic and Day Surgery, Sydney, Australia
| | - Andrew Chang
- Sydney Eye Hospital, The University of Sydney, Sydney Retina Clinic and Day Surgery, Sydney, Australia
| | - Tomonari Takahashi
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
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Two-Photon Vision in Age-Related Macular Degeneration: A Translational Study. Diagnostics (Basel) 2022; 12:diagnostics12030760. [PMID: 35328313 PMCID: PMC8947013 DOI: 10.3390/diagnostics12030760] [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: 02/21/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
The recently introduced term “two-photon vision” relates to the visual perception resulting from a simultaneous absorption of two photons by photoreceptors. In this study, we determined two-photon retinal sensitivity in age-related macular degeneration (AMD) and compared it that in normal aging. Microperimetry was performed with visible (white) light and infrared (IR) light, which was perceived as green in the two-photon stimulation. In total, 45 subjects were included with one (better) eye studied. Furthermore, best-corrected visual acuity (VA) and ocular straylight were assessed. AMD resulted in decreased median (interquartile range) logMAR VA, i.e., 0.15 (0.05; 0.24), which in normal eyes was −0.02 (−0.06; 0.02). The two groups showed comparable straylight levels. Sensitivity to IR light was significantly lower in the AMD group (p < 0.001): 8.3 (7.4, 9.3) dB than in controls 10.7 (9.7, 11.2) dB. AMD also significantly affected visible light sensitivity (p < 0.001): 14.0 (11.0; 15.5) dB vs. 18.0 (16.3; 18.9) dB. Notably, the two-photon approach yielded a lower data spread. In conclusion, AMD considerably impairs retinal sensitivity measured in the single- and two-photon realm. However, two-photon-vision microperimetry may improve the testing accuracy and offer an additional diagnostic parameter (beyond VA measurements) for retinal function assessment.
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Pfau M, Sahu S, Rupnow RA, Romond K, Millet D, Holz FG, Schmitz-Valckenberg S, Fleckenstein M, Lim JI, de Sisternes L, Leng T, Rubin DL, Hallak JA. Probabilistic Forecasting of Anti-VEGF Treatment Frequency in Neovascular Age-Related Macular Degeneration. Transl Vis Sci Technol 2021; 10:30. [PMID: 34185055 PMCID: PMC8254013 DOI: 10.1167/tvst.10.7.30] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose To probabilistically forecast needed anti-vascular endothelial growth factor (anti-VEGF) treatment frequency using volumetric spectral domain-optical coherence tomography (SD-OCT) biomarkers in neovascular age-related macular degeneration from real-world settings. Methods SD-OCT volume scans were segmented with a custom deep-learning-based analysis pipeline. Retinal thickness and reflectivity values were extracted for the central and the four inner Early Treatment Diabetic Retinopathy Study (ETDRS) subfields for six retinal layers (inner retina, outer nuclear layer, inner segments [IS], outer segments [OS], retinal pigment epithelium-drusen complex [RPEDC] and the choroid). Machine-learning models were probed to predict the anti-VEGF treatment frequency within the next 12 months. Probabilistic forecasting was performed using natural gradient boosting (NGBoost), which outputs a full probability distribution. The mean absolute error (MAE) between the predicted versus actual anti-VEGF treatment frequency was the primary outcome measure. Results In a total of 138 visits of 99 eyes with neovascular AMD (96 patients) from two clinical centers, the prediction of future anti-VEGF treatment frequency was observed with an accuracy (MAE [95% confidence interval]) of 2.60 injections/year [2.25-2.96] (R2 = 0.390) using random forest regression and 2.66 injections/year [2.31-3.01] (R2 = 0.094) using NGBoost, respectively. Prediction intervals were well calibrated and reflected the true uncertainty of NGBoost-based predictions. Standard deviation of RPEDC-thickness in the central ETDRS-subfield constituted an important predictor across models. Conclusions The proposed, fully automated pipeline enables probabilistic forecasting of future anti-VEGF treatment frequency in real-world settings. Translational Relevance Prediction of a probability distribution allows the physician to inspect the underlying uncertainty. Predictive uncertainty estimates are essential to highlight cases where human-inspection and/or reversion to a fallback alternative is warranted.
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Affiliation(s)
- Maximilian Pfau
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Soumya Sahu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.,Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Rawan Allozi Rupnow
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.,Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen Romond
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Desiree Millet
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | | | - Jennifer I Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | - Joelle A Hallak
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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10
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An insight on the anatomical and functional consequences of aflibercept therapy in age-related macular degeneration. Photodiagnosis Photodyn Ther 2021; 34:102307. [PMID: 33945883 DOI: 10.1016/j.pdpdt.2021.102307] [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: 12/24/2020] [Revised: 04/10/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evaluation of anatomical and functional recovery of the retina after aflibercept therapy in neovascular age-related macular degeneration. MATERIALS AND METHODS This prospective study enrolled 33 eyes of 33 naive age-related macular degeneration patients with an average age of 69 (55-82) years. Following a thorough ophthalmological examination, baseline color fundus photography, optical coherence tomography and fluorescein angiography were used to assess the angiographic characteristics and classification of the lesions. Multifocal electroretinography and microperimetry were recorded. In the first three months, all patients received three consecutive intravitreal aflibercept injections on a monthly basis. After the initial three doses, non-responders received additional afibercept injections. The baseline, 3rd and 6th month data were recorded for analysis. RESULTS The baseline average best-corrected visual acuity (1.05 log MAR) improved dramatically to 0.9 log MAR in the 3rd and 6th months, respectively. The baseline average central macular thickness of 358.5 ± 232.1 μm decreased significantly to 273.0 ± 109.9 μm and 245.5 ± 109.3 μm in the 3rd and 6th months, respectively. The average thickness of the central 1 mm macular region decreased significantly from 349.5 ± 96.4 μm to the 3rd and 6th month values of 320.6 ± 101.9 and 290.5 ± 86.4 μm, respectively. While the mean retinal sensitivity increased significantly from 4.7 ± 3.0 dB to 6.9 ± 3.4 Db, local deficit decreased from -11.6 ± 4.6 dB to -9.4 ± 4.6 dB. Significant improvements were also observed in all rings of N1 and P1 waves. CONCLUSION Intravitreal aflibercept therapy resulted in significant morphological improvements that were easily identifiable during the 3rd month. Electrophysiological improvements were delayed only to become statistically significant in the 6th month. However, it has been shown that visual acuity and optical coherence tomography parameters alone may be insufficient for both the morphological and functional assessment of the retina.
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Moon TH, Lee S, Kim JH, Kim DY, Chae JB. Reading Speed after Anti-vascular Endothelial Growth Factor Therapy in Patients with Wet Age-related Macular Degeneration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.1.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Rossouw P, Guichard MM, Hatz K. Contrast sensitivity and binocular reading speed best correlating with near distance vision-related quality of life in bilateral nAMD. Ophthalmic Physiol Opt 2020; 40:760-769. [PMID: 32959926 PMCID: PMC7702040 DOI: 10.1111/opo.12736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 01/14/2023]
Abstract
Purpose Bilateral neovascular age‐related macular degeneration (nAMD) causes difficulties in daily life, especially with regard to near‐vision tasks, despite well preserved Early Treatment of Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA) at distance. Therefore, alternative visual function measures were evaluated in terms of their correlation with vision‐related quality of life scores (QoL). Methods A prospective cross‐sectional pilot study including patients with a diagnosis of bilateral nAMD having lesions within the central 1 mm ETDRS grid subfield. Standardised testing included a vision‐related QoL assessment (NEI‐VFQ25), best corrected visual acuity (BCVA), low luminance visual acuity (LLVA), Radner maximum reading speed and Pelli‐Robson contrast sensitivity (CS). Results N = 54. The mean better eye (range) BCVA was 79 (55–96) letters, median (range) LLVA 79.5 (58–97) letters and median (range) CS 1.35 (0–1.65) log units. Mean binocular maximum reading speed was 117.33 ± 28.42 wpm. The best correlations with the near subscale score were found for CS followed by binocular maximum reading speed (r = 0.59, p = 0.0001; r = 0.36, p = 0.008, respectively). A weaker correlation was observed for the BCVA in the better eye (r = 0.33, p = 0.02). The correlation between the NEI‐VFQ25 distance subscale and BCVA was weaker (r = 0.37, p = 0.005) than the correlations with CS (r = 0.67, p = 0.0001) and LLVA (r = 0.40, p = 0.003). Conclusions For patients with a bilateral centre‐involving nAMD, the best correlation with near QoL was the better eye CS followed by maximum binocular reading speed. These measures could be valuable in quantifying vision‐related QoL outcomes in AMD clinical trials.
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Affiliation(s)
- Petra Rossouw
- Department of Vision Science and Optometry, University of Aalen, Aalen, Germany.,Vista Klinik Binningen, Binningen, Switzerland
| | | | - Katja Hatz
- Vista Klinik Binningen, Binningen, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
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13
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Abstract
The MP-1 substudy of the OASIS trial evaluated the effects of ocriplasmin and symptomatic VMA resolution on visual fixation and macular sensitivity using microperimetry, identifying parameters that were distinct between patients with and without VMA resolution. Purpose: To evaluate the effects of ocriplasmin and symptomatic vitreomacular adhesion resolution on visual fixation and macular sensitivity using microperimetry. Methods: MP-1 parameters were analyzed from 3 OASIS sites after the use of standardized instruments and testing procedures over 24 months. Results: A total of 27 patients (19 ocriplasmin, 8 sham) were evaluated. Mean distance of the preferred fixation locus to the anatomical center was farther in the sham group at baseline and farther in the sham versus ocriplasmin group throughout the study. Retinal sensitivity values were consistently higher in the ocriplasmin versus sham group after Month 3. Fewer patients in the ocriplasmin group had predominantly eccentric fixation at study end compared with the sham group, which also had an increased number of patients with unstable fixation. Patients with vitreomacular adhesion resolution had lower bivariate contour area, fewer relative scotomas, and higher retinal sensitivity parameters at baseline than those with unresolved vitreomacular adhesion. Conclusion: Substudy results suggest that fixation and sensitivity parameters tended to be better in the ocriplasmin group than in the sham group over time. The substudy identified parameters that were distinct between patients with and without vitreomacular adhesion resolution, suggesting that microperimetry warrants further study as a relevant biomarker for visual function.
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Yang J, Cai L, Sun Z, Ye H, Fan Q, Zhang K, Lu W, Lu Y. Risk factors for and diagnosis of pseudophakic cystoid macular edema after cataract surgery in diabetic patients. J Cataract Refract Surg 2019; 43:207-214. [PMID: 28366368 DOI: 10.1016/j.jcrs.2016.11.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 10/31/2016] [Accepted: 11/14/2016] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the risk factors and potential diagnostic criteria for pseudophakic cystoid macular edema (CME) in diabetic patients after phacoemulsification. SETTING Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China. DESIGN Prospective nonrandomized study. METHODS Diabetic patients were followed for up to 6 months after cataract surgery and examined to evaluate their foveal thickness, macular sensitivity, and corrected distance visual acuity. Multiple statistical analyses were performed to determine risk factors and diagnostic criteria for pseudophakic CME. RESULTS The duration, type of diabetes, stage of diabetic retinopathy, nuclear opalescence grading, glycosylated hemoglobin A1c (HbA1c), and ultrasound time were correlated with the change in foveal thickness and macular sensitivity after cataract surgery. Unsupervised data analysis showed 3 groups of patients as follows: nonpseudophakic CME, level 1 pseudophakic CME, and level 2 pseudophakic CME. Subclinical level 1 patients had a 30% to 40% increase in foveal thickness 1 month postoperatively, while level 2 patients had at least a 40% increase in foveal thickness and a 20% decrease in macular sensitivity. The incidence of clinical pseudophakic CME was 3.2% in diabetic patients as per the diagnostic criteria. The change in macular sensitivity was more consistent and correlated with foveal thickness. CONCLUSIONS The duration, severity, type of diabetes, hardness of the lens, and HbA1c were risks for pseudophakic CME in diabetic patients after cataract surgery. A 40% or more increase in foveal thickness and 20% or more decrease in macular sensitivity offer an objective and reliable diagnostic standard to report pseudophakic CME in diabetics.
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Affiliation(s)
- Jin Yang
- From the Department of Ophthalmology (Yang, Cai, Sun, Ye, Fan, Zhang, W. Lu, Y. Lu), Eye and ENT Hospital of Fudan University, and the Myopia Key Laboratory of Health PR China (Yang, Cai, Sun, Ye, Fan, Zhang, Y. Lu), Shanghai, China
| | - Lei Cai
- From the Department of Ophthalmology (Yang, Cai, Sun, Ye, Fan, Zhang, W. Lu, Y. Lu), Eye and ENT Hospital of Fudan University, and the Myopia Key Laboratory of Health PR China (Yang, Cai, Sun, Ye, Fan, Zhang, Y. Lu), Shanghai, China
| | - Zhongcui Sun
- From the Department of Ophthalmology (Yang, Cai, Sun, Ye, Fan, Zhang, W. Lu, Y. Lu), Eye and ENT Hospital of Fudan University, and the Myopia Key Laboratory of Health PR China (Yang, Cai, Sun, Ye, Fan, Zhang, Y. Lu), Shanghai, China
| | - Hongfei Ye
- From the Department of Ophthalmology (Yang, Cai, Sun, Ye, Fan, Zhang, W. Lu, Y. Lu), Eye and ENT Hospital of Fudan University, and the Myopia Key Laboratory of Health PR China (Yang, Cai, Sun, Ye, Fan, Zhang, Y. Lu), Shanghai, China
| | - Qi Fan
- From the Department of Ophthalmology (Yang, Cai, Sun, Ye, Fan, Zhang, W. Lu, Y. Lu), Eye and ENT Hospital of Fudan University, and the Myopia Key Laboratory of Health PR China (Yang, Cai, Sun, Ye, Fan, Zhang, Y. Lu), Shanghai, China
| | - Keke Zhang
- From the Department of Ophthalmology (Yang, Cai, Sun, Ye, Fan, Zhang, W. Lu, Y. Lu), Eye and ENT Hospital of Fudan University, and the Myopia Key Laboratory of Health PR China (Yang, Cai, Sun, Ye, Fan, Zhang, Y. Lu), Shanghai, China
| | - Wenyi Lu
- From the Department of Ophthalmology (Yang, Cai, Sun, Ye, Fan, Zhang, W. Lu, Y. Lu), Eye and ENT Hospital of Fudan University, and the Myopia Key Laboratory of Health PR China (Yang, Cai, Sun, Ye, Fan, Zhang, Y. Lu), Shanghai, China
| | - Yi Lu
- From the Department of Ophthalmology (Yang, Cai, Sun, Ye, Fan, Zhang, W. Lu, Y. Lu), Eye and ENT Hospital of Fudan University, and the Myopia Key Laboratory of Health PR China (Yang, Cai, Sun, Ye, Fan, Zhang, Y. Lu), Shanghai, China.
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15
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Wightman AJ, Abbott CJ, McGuinness MB, Caruso E, Guymer RH, Luu CD. Presymptomatic Retinal Sensitivity Changes in Intermediate Age-Related Macular Degeneration Associated With New Retinal Fluid. Transl Vis Sci Technol 2019; 8:3. [PMID: 31737427 PMCID: PMC6855368 DOI: 10.1167/tvst.8.6.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/16/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose To determine whether change in retinal sensitivity in areas with subretinal or intraretinal fluid secondary to age-related macular degeneration (AMD) precedes visual symptoms. If confirmed, retinal sensitivity testing could be used for home monitoring in AMD. Methods Individuals with intermediate AMD enrolled in a longitudinal study were seen every 6 months and underwent best-corrected visual acuity testing (BCVA), spectral domain–optical coherence tomography (SD-OCT), and microperimetry. Asymptomatic individuals who developed incidental, reading center–determined retinal fluid detected on SD-OCT were identified. The point-wise sensitivity (PWS) at the time of fluid detection was compared with 6 and 12 months prior. Results Fourteen of 161 individuals developed fluid without symptoms. PWS over fluid areas at detection was reduced compared with 6 (difference −2.04 dB, P < 0.001) and 12 months (−2.27 dB, P < 0.001) prior. PWS over fluid areas was reduced compared with perifluid areas (difference −1.02 dB, P = 0.03), peripheral areas (−1.51 dB, P < 0.001), nonprogressed fellow eyes (−1.49 dB, P = 0.006), and nonprogressed age-matched intermediate AMD eyes (−2.29 dB, P = 0.001). No difference in BCVA was observed in eyes developing fluid compared to eyes that do not develop fluid (P = 0.76). Conclusions Retinal areas with fluid on SD-OCT had a corresponding reduction in retinal sensitivity at the time of fluid detection compared with 6 and 12 months prior, in asymptomatic intermediate AMD without change in BCVA. Translational Relevance Development of self-monitoring tools to detect changes in retinal sensitivity may be helpful for early detection of retinal fluid suggestive of progression to neovascular AMD before acuity is affected.
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Affiliation(s)
- Antony J Wightman
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Carla J Abbott
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Emily Caruso
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
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Michalska-Małecka K, Kałużny J, Nowak M, Gościniewicz P, Matysik-Woźniak A, Nowomiejska K, Karpe J, Rejdak R. Evaluation of retinal function improvement in neovascular age-related macular degeneration after intravitreal aflibercept injections with the use of the assessment of retinal sensitivity: The use of the assessment of retinal sensitivity in anti-VEGF treatment - a STROBE-compliant observational study. Medicine (Baltimore) 2019; 98:e17599. [PMID: 31689763 PMCID: PMC6946441 DOI: 10.1097/md.0000000000017599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study compares 2 methods of macular function evaluation: the microperimetric examination (mean central retinal sensitivity and fixation stability) and the distance best-corrected visual acuity (BCVA) examination, which is the most frequently used method of assessing macular function in patients with newly diagnosed wet age-related macular degeneration (AMD) who have been treated with anti-vascular endothelial growth factor (VEGF) drug (aflibercept).Prospective analysis was conducted on 44 eyes of 44 patients treated with intravitreal injection of anti-VEGF (aflibercept) because of newly diagnosed neovascular AMD. According to the research protocol, all patients had a 6-month follow-up. The response to treatment was monitored functionallybyMP-1 microperimetry, fixation, and distance BCVA assessment after injection. Improvement of retinal sensitivity and BCVA was found under aflibercept treatment. There was statistically significant improvement in retinal sensitivity in the MP-1 study 3 and 6 months from the beginning of anti-VEGF therapy. Moreover, a significant improvement in retinal sensitivity between 3 and 6 months of observation was demonstrated. At the same time, up to 3 months from the beginning of treatment, BCVA improved significantly compared to the baseline value. In the 6th month of the study BCVA remained stable without further significant improvement.Microperimetric examination with medium sensitivity and fixation stability assessment is a very valuable test determining the retinal function. It is clear that examining the macular morphology itself in modern diagnostics is not enough to assess retinal function. Microperimetry technique is a valuable tool for functional long-term evaluation of retinal function (also for a period of more than 3 months).
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Affiliation(s)
- Katarzyna Michalska-Małecka
- Department of Ophthalmology, School of Medicine in Katowice, Medical University of Silesia
- University Clinical Center, University Hospital Medical University of Silesia, Katowice
| | - Jakub Kałużny
- Department of Optometry, Collegium Medicum, Nicolaus Copernicus University
- Oftalmika Eye Hospital, Bydgoszcz
| | - Mariusz Nowak
- Pathophysiology Division, Department of Pathophysiology and Endocrinology, Medical University of Silesia, School of Medicine with Division of Density, Zabrze
| | - Poitr Gościniewicz
- University Clinical Center, University Hospital Medical University of Silesia, Katowice
| | | | | | - Jacek Karpe
- Department of Anaesthesiology and Intensive Therapy, Medical University of Silesia, School of Medicine with Division of Density, Zabrze, Poland
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University, Lublin
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17
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Guo MY, Cheng J, Etminan M, Zafari Z, Maberley D. One year effectiveness study of intravitreal aflibercept in neovascular age-related macular degeneration: a meta-analysis. Acta Ophthalmol 2019; 97:e1-e7. [PMID: 30030923 DOI: 10.1111/aos.13825] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 04/13/2018] [Indexed: 12/20/2022]
Abstract
The current body of evidence on the efficacy and safety of aflibercept for age-related macular degeneration (AMD) is steadily growing as large clinical trials and observational studies are continually completed. Our aim was to analyse 1-year visual acuity (VA) outcomes in response to aflibercept therapy and identify factors affecting treatment response using evidence generated from a pooled analysis of current studies. A literature review of multiple electronic databases (EMBASE, MEDLINE, MedMEME) revealed 12 studies meeting inclusion and exclusion criteria for statistical analysis. Treatment posology, baseline patient characteristics, study type, sample size and 12-month change in VA were pooled in a meta-analysis with VA change as the main outcome. Data were then stratified by study design and posology in subgroup analyses. A meta-regression was conducted to regress 12-month VA change against posology, baseline VA and age. Users of aflibercept experienced an overall increase of 7.37 letters (95% confidence interval: 6.27-8.48, p heterogeneity: <0.001) in VA at 12 months of follow-up. In subgroup analyses, mean VA change was higher for randomized control trials and cohorts following regular posology (>7 injections/year) compared to observational studies and irregular posology. The meta-regression showed larger VA gains with regular posology compared to an irregular posology, and decreased effect size as age increased. This meta-analysis strongly suggests improved VA outcomes at 12 months in patients with wet AMD for 2.0 mg aflibercept, comparable to but slightly lower than landmark trials. Increased injection frequency and younger age demonstrates a trend with improved outcomes.
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Affiliation(s)
- Michael Y. Guo
- Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Jasmine Cheng
- Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver BC Canada
| | - Zafar Zafari
- University of Maryland School of Pharmacy; Baltimore MD USA
| | - David Maberley
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver BC Canada
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18
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Sakai T, Okude S, Tsuneoka H. Foveal threshold and photoreceptor integrity for prediction of visual acuity after intravitreal aflibercept on age-related macular degeneration. Clin Ophthalmol 2018; 12:719-725. [PMID: 29713139 PMCID: PMC5907895 DOI: 10.2147/opth.s156162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine whether baseline foveal threshold and photoreceptor integrity can predict best-corrected visual acuity (BCVA) at 12 months after intravitreal aflibercept (IVA) therapy in eyes with neovascular age-related macular degeneration (AMD). Patients and methods We evaluated 25 eyes of 25 patients with treatment-naïve neovascular AMD who received IVA once a month for 3 months, followed by once every 2 months for 8 months. BCVA, integrity of the external limiting membrane (ELM) or the ellipsoid zone (EZ) of the photoreceptors, and retinal sensitivity were determined before (baseline) and at 6 and 12 months after initial IVA. The average threshold foveal sensitivity and mean deviation within the central 10° were determined by Humphrey central 10-2 perimetry. Correlations between BCVA at 12 months and integrity of the ELM or EZ, foveal threshold, and mean deviation at each visit were determined. Results At 12 months, BCVA improved significantly from 0.20±0.23 to 0.10±0.22 logMAR (logarithm of the minimum angle of resolution) units, and foveal threshold and mean deviation improved significantly from 29.0±5.1 and -3.38±3.10 dB to 32.6±3.2 and -1.64±2.10 dB, respectively (P=0.0009 and P=0.0021). At baseline, both foveal threshold and integrity of the ELM were significantly correlated with BCVA at 12 months (P=0.0428 and P=0.0275). Conclusion These results indicate that both integrity of the ELM and foveal threshold at baseline can predict BCVA after treatment for neovascular AMD. There is a possibility that these parameters can predict the efficacy of IVA in each case.
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Affiliation(s)
- Tsutomu Sakai
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
| | - Sachiyo Okude
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Tsuneoka
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
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Munk MR, Arendt P, Yu S, Ceklic L, Huf W, Ebneter A, Wolf S, Zinkernagel MS. The Impact of the Vitreomacular Interface in Neovascular Age-Related Macular Degeneration in a Treat-and-Extend Regimen with Exit Strategy. ACTA ACUST UNITED AC 2018; 2:288-294. [DOI: 10.1016/j.oret.2017.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 11/16/2022]
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20
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von der Emde L, Pfau M, Thiele S, Möller PT, Hassenrik R, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Mesopic and Dark-Adapted Two-Color Fundus-Controlled Perimetry in Choroidal Neovascularization Secondary to Age-Related Macular Degeneration. Transl Vis Sci Technol 2018; 8:7. [PMID: 30637177 PMCID: PMC6327348 DOI: 10.1167/tvst.8.1.7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/17/2018] [Indexed: 01/14/2023] Open
Abstract
Purpose To determine the retest variability of mesopic and two-color dark-adapted (DA) fundus-controlled perimetry (FCP), to evaluate the predictive value of patient reliability indices, and to analyze the extent of impairment of rod- and cone function in neovascular age-related macular degeneration (nAMD). Methods A total of 50 eyes of 50 patients with nAMD (mean age, 76.1 years) and 70 eyes of 70 age-similar normal subjects underwent multimodal imaging as well as mesopic and DA two-color perimetry using the S-MAIA device. A subset of patients (n = 28) underwent duplicate testing for retest reliability assessment. Mixed models were used for analysis of the hierarchical data. Results In eyes with nAMD, the coefficient of repeatability was (mean ± standard deviation [SD]) 5.99 ± 1.55 dB for mesopic, 6.14 ± 2.19 dB for DA cyan, and 6.06 ± 1.09 dB for DA red testing. “Patient reliability indices” explained 55%, 54.2%, and 64.2% of the variance in retest variability. The mean sensitivity loss was greater for DA cyan compared to DA red testing (cyan-red differences [mean ± SD] −2.63 ± 3.87 dB, P < 0.001). Conclusions The relatively greater degree of DA cyan versus DA red sensitivity loss indicates preferential rod vulnerability in nAMD, and qualifies rod function-based outcomes measures as potential sensitive and early markers of treatment response in nAMD. Translational Relevance The S-MAIA allows reliable testing of mesopic, DA cyan, and DA red sensitivity in patients with nAMD. Patient reliability indices may serve as eligibility criteria for clinical trials to identify patients with adequate retest reliability.
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Affiliation(s)
- Leon von der Emde
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Philipp T Möller
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Ruth Hassenrik
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
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Abstract
Microperimetry (MP) is a technology that allows the study of retinal sensitivity at different foveal and parafoveal areas as well as eye fixation. It is a technique of functional evaluation, providing a direct correlation between anatomical and functional outcomes. There are a great variety of studies which evaluate the repeatability or reliability of measurements obtained with this technology and also describe and explore different clinical applications. MP has been shown to be useful in the characterization of sensory and motor conditions, such as amblyopia or nystagmus. Concerning ocular pathology, several studies have confirmed the usefulness of MP for evaluating and analyzing different retinal pathological conditions, such as age-related macular degeneration or glaucoma, and for analyzing the effect of different medical or surgical treatments for these conditions. MP has also been shown to be useful for visual training or rehabilitation in some specific cases.
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Affiliation(s)
- Ainhoa Molina-Martín
- a Clínica Optométrica, Fundació Lluis Alcanyís , Universitat de València , València , Spain
| | - Rafael J Pérez-Cambrodí
- b Department of Ophthalmology (OFTALMAR) , Vithas Medimar International Hospital , Alicante , Spain
| | - David P Piñero
- b Department of Ophthalmology (OFTALMAR) , Vithas Medimar International Hospital , Alicante , Spain.,c Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy , University of Alicante , Alicante , Spain
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22
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Hong IH, Park SP. Quantitative physiological measurements to evaluate the response of antivascular endothelial growth factor treatment in patients with neovascular diseases. Indian J Ophthalmol 2017; 65:559-568. [PMID: 28724811 PMCID: PMC5549406 DOI: 10.4103/ijo.ijo_278_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Antivascular endothelial growth factor (VEGF) treatment is still used intravitreally worldwide for various neovascular diseases, despite other available, approved treatments. We performed a systematic search of the literature focused on visual physiology studies. We used the online biomedical search engine PubMed and searched key words including “M-chart,” “Preferential Hyperacuity Perimetry,” “microperimetry,” (MP) “electroretinography,” and “contrast sensitivity” to estimate treatment efficacy of anti-VEGF treatments in a quantitative manner. Many studies were identified which used a variety of methodologies, disease entities, injected agents, and patient populations, making it difficult to obtain a direct comparison of their results. However, favorable functional outcomes achieved using current quantitative methods would lend further confidence to the effectiveness of a treat-and-extend protocol using intravitreal anti-VEGF for the management of patients with neovascular diseases. Despite anti-VEGF's wide use, a well-designed longitudinal multicenter study to systematically evaluate and compare different physiological methods or parameters in patients with neovascular diseases is still lacking, though it would benefit therapeutic decisions.
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Affiliation(s)
- In Hwan Hong
- Department of Ophthalmology, Hallym University Medical Center, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Hallym University Medical Center, Kangdong Sacred Heart Hospital, Seoul, South Korea
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The use of microperimetry in assessing visual function in age-related macular degeneration. Surv Ophthalmol 2017; 63:40-55. [PMID: 28579549 DOI: 10.1016/j.survophthal.2017.05.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 11/23/2022]
Abstract
Microperimetry is a novel technique for assessing visual function that appears particularly suitable for age-related macular degeneration (AMD). Compared with standard automated perimetry, microperimetry offers several unique features. It simultaneously images the fundus, incorporates an eye-tracking system to correct the stimulus location for fixation loss, and identifies any preferred retinal loci. We identified 52 articles that met the inclusion criteria for a systematic review of microperimetry in the assessment of visual function in AMD. We discuss microperimetry and AMD in relation to disease severity, structural imaging outcomes, other measures of visual function, and evaluation of the efficacy of surgical and/or medical therapies in clinical trials. The evidence for the use of microperimetry in the functional assessment of AMD is encouraging. Disruptions of the ellipsoid zone band and retinal pigment epithelium are clearly associated with reduced differential light sensitivity despite the maintenance of good visual acuity. Reduced differential light sensitivity is also associated with outer segment thinning and retinal pigment epithelium thickening in early AMD and with both a thickening and a thinning of the whole retina in choroidal neovascularization. Microperimetry, however, lacks the robust diffuse and focal loss age-corrected probability analyses associated with standard automated perimetry, and the technique is currently limited by this omission.
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Radner W. Reading charts in ophthalmology. Graefes Arch Clin Exp Ophthalmol 2017; 255:1465-1482. [PMID: 28411305 PMCID: PMC5541099 DOI: 10.1007/s00417-017-3659-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/12/2017] [Accepted: 03/22/2017] [Indexed: 11/26/2022] Open
Abstract
A new generation of logarithmic reading charts has sparked interest in standardized reading performance analyses. Such reading charts have been developed according to the standards of the International Council of Ophthalmology. The print size progression in these calibrated charts is in accordance with the mathematical background of EN ISO 8596. These reading charts are: the Bailey–Lovie Word Reading Chart, the Colenbrander English Continuous Text Near Vision Cards, the Oculus Reading Probe II, the MNREAD Charts, the SKread Charts, and the RADNER Reading Charts. The test items used for these reading charts differ among the charts and are standardized to various extents. The Bailey–Lovie Charts, MNREAD Charts, SKread Charts, and RADNER Charts are also meant to measure reading speed and allow determination of further reading parameters such as reading acuity, reading speed based on reading acuity, critical print size, reading score, and logMAR/logRAD ratio. Such calibrated reading charts have already provided valuable insights into the reading performance of patients in many research studies. They are available in many languages and thus facilitate international communication about near visual performance. In the present review article, the backgrounds of these modern reading charts are presented, and their different levels of test-item standardization are discussed. Clinical research studies are mentioned, and a discussion about the immoderately high number of reading acuity notations is included. Using the logReading Acuity Determination ([logRAD] = reading acuity equivalent of logMAR) measure for research purposes would give reading acuity its own identity as a standardized reading parameter in ophthalmology.
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Affiliation(s)
- W Radner
- Austrian Academy of Ophthalmology, Mollgasse 11, 1180, Vienna, Austria.
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Radner W, Diendorfer G, Kainrath B, Kollmitzer C. The accuracy of reading speed measurement by stopwatch versus measurement with an automated computer program (rad-rd©). Acta Ophthalmol 2017; 95:211-216. [PMID: 27572996 DOI: 10.1111/aos.13201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 06/18/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the reading time and reading speed measurements obtained with a stopwatch with those of an automated computer program for measuring reading speed and acuity (rad-rd© ; patent: AT 504635B1/10-2006). METHODS The rad-rd© was used (in conjunction with a PC and microphone) for the computer-based measurements. In rotation, each of four examiners took a turn reading the 12 sentences from one of the four RADNER Reading Charts to three other examiners, who served as stoppers. The stoppers simultaneously measured the reading time with a stopwatch while a fifth investigator used the rad-rd© to obtain computerized measurements. The stopwatch measurements were then statistically compared with the rad-rd© measurements. RESULTS The mean reading time obtained with the stopwatch measurements was 4.34 ± 0.57 seconds (196.21 ± 21.79 wpm), versus 4.44 ± 0.59 seconds (192.24 ± 22.20 wpm) by computer measurement (r = 0.84). Of the 144 stopwatch measurements, 97 (67.36%) were shorter, and 47 (32.64%) were equal to (n = 5) or longer than the computer measurements. The mean difference for the shorter measurements was -0.17 ± 0.1 seconds (3.91% of the mean reading time), and the mean difference for the longer measurements was 0.11 ± 0.1 seconds (2.53% of the mean reading time). Most differences ranged from -0.1 to 0.1 seconds (42.36%). The results did not differ significantly among the four stoppers. CONCLUSION The rad-rd© is an accurate, automated computer program for measuring reading time. Stopwatch measurements, although subject to inaccuracy from several sources, remain a reliable and simple method for analysis of reading performance.
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Radner W, Radner S, Diendorfer G. Integrating a novel concept of sentence optotypes into the RADNER Reading Charts. Br J Ophthalmol 2016; 101:239-243. [PMID: 27881374 DOI: 10.1136/bjophthalmol-2016-309467] [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: 08/03/2016] [Revised: 09/23/2016] [Accepted: 10/26/2016] [Indexed: 11/04/2022]
Abstract
PURPOSE To add a new set of 24 sentence optotypes to the German version of the RADNER reading charts and to investigate whether sentences constructed based upon an optimised concept of sentence optotypes can be used together with the original 38 sentences. METHODS Twenty-eight optimised sentence optotypes were constructed based upon the concept of sentence optotypes as established for the RADNER Reading Charts, with words having the same number of characters and syllables being placed in the same positions. The best comparable sentences were statistically selected in 30 volunteers. Reading speed and the number of errors were determined. Validity was analysed in comparison to a 111-word long standardised paragraph and 7 of the 38 original sentence optotypes. RESULTS The mean reading speed obtained with the 28 sentences was 192.30±26.69 words per minute (wpm), as compared with 192.47±25.32 wpm for the 7 original sentence optotypes and 165.28±20.82 wpm for the long paragraph; 24 of the 28 optimised sentences met our selection criteria for reading speed/time (mean reading speed: 192.41±26.58). The mean number of reading errors was 0.10±0.30. The correlation between the 24 optimised sentence optotypes and the long paragraph was r=0.90. Reliability analyses yielded an overall Cronbach's α coefficient of 0.992. CONCLUSION The 24 new sentence optotypes can be integrated into the existing set of 38 original sentences. Since all the statistical results obtained were similar to those of the original sentences, the best possible reliability had apparently already been achieved with the original sentence optotypes.
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Radner W. Near vision examination in presbyopia patients: Do we need good homologated near vision charts? EYE AND VISION 2016; 3:29. [PMID: 27844022 PMCID: PMC5103453 DOI: 10.1186/s40662-016-0061-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022]
Abstract
Presbyopia correction is mainly concerned with the goal of regaining an uncorrected reading performance. Since historic reading charts do not provide a unique standard that is applicable for the analysis of clinical and scientific reading performance, new standardized reading charts have been developed, in order to provide reading performance analyses analogous to modern single-optotype distance acuity measurements: the Bailey-Lovie Word Reading Chart, the Colenbrander English Continuous Text Near Vision Cards, the MNREAD Charts, and the RADNER Reading Charts. The last three are also meant to measure reading speed, thus allowing detailed analysis of the reading capabilities of the patient’s functional vision. Furthermore, these reading charts can be declared homologated, based on the standards that were published for reading charts by the Visual Function Committee of the International Council of Ophthalmology (ICO) in 1988. Many research studies have shown that by analyzing the reading performance with homologated reading charts, valuable insight into the reading performance of patients suffering from various diseases can be obtained. These reading charts have also been successfully used in presbyopia research. It therefore seems evident that homologated, standardized reading charts facilitate not only research concerning functional vision in many fields of ophthalmology but also international communication about near visual performance. Homologated reading charts are available in almost all languages and have become a valuable tool in analyzing reading performance. We argue in this review that homologated reading charts are clearly a necessity for presbyopia research.
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Affiliation(s)
- Wolfgang Radner
- Austrian Academy of Ophthalmology, Mollgasse 11, A-1180 Vienna, Austria
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Sidman RL, Li J, Lawrence M, Hu W, Musso GF, Giordano RJ, Cardó-Vila M, Pasqualini R, Arap W. The peptidomimetic Vasotide targets two retinal VEGF receptors and reduces pathological angiogenesis in murine and nonhuman primate models of retinal disease. Sci Transl Med 2016; 7:309ra165. [PMID: 26468327 DOI: 10.1126/scitranslmed.aac4882] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Blood vessel growth from preexisting vessels (angiogenesis) underlies many severe diseases including major blinding retinal diseases such as retinopathy of prematurity (ROP) and aged macular degeneration (AMD). This observation has driven development of antibody inhibitors that block a central factor in AMD, vascular endothelial growth factor (VEGF), from binding to its receptors VEGFR-1 and mainly VEGFR-2. However, some patients are insensitive to current anti-VEGF drugs or develop resistance, and the required repeated intravitreal injection of these large molecules is costly and clinically problematic. We have evaluated a small cyclic retro-inverted peptidomimetic, D(Cys-Leu-Pro-Arg-Cys) [D(CLPRC)], and hereafter named Vasotide, that inhibits retinal angiogenesis by binding selectively to the VEGF receptors VEGFR-1 and neuropilin-1 (NRP-1). Delivery of Vasotide via either eye drops or intraperitoneal injection in a laser-induced monkey model of human wet AMD, a mouse genetic knockout model of the AMD subtype called retinal angiomatous proliferation (RAP), and a mouse oxygen-induced model of ROP decreased retinal angiogenesis in all three animal models. This prototype drug candidate is a promising new dual receptor inhibitor of the VEGF ligand with potential for translation into safer, less-invasive applications to combat pathological angiogenesis in retinal disorders.
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Affiliation(s)
- Richard L Sidman
- Harvard Medical School and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
| | - Jianxue Li
- Harvard Medical School and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Matthew Lawrence
- RxGen Inc., Hamden, CT 06517, USA. St. Kitts Biomedical Research Foundation, St. Kitts, West Indies
| | - Wenzheng Hu
- RxGen Inc., Hamden, CT 06517, USA. St. Kitts Biomedical Research Foundation, St. Kitts, West Indies
| | | | - Ricardo J Giordano
- Institute of Chemistry, University of São Paulo, São Paulo 05508, Brazil
| | - Marina Cardó-Vila
- University of New Mexico Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA. Division of Molecular Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Renata Pasqualini
- University of New Mexico Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA. Division of Molecular Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA.
| | - Wadih Arap
- University of New Mexico Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA. Division of Hematology/Oncology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA.
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Wong CW, Yanagi Y, Lee WK, Ogura Y, Yeo I, Wong TY, Cheung CMG. Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians. Prog Retin Eye Res 2016; 53:107-139. [PMID: 27094371 DOI: 10.1016/j.preteyeres.2016.04.002] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 12/12/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in elderly people globally. It is estimated that there will be more Asians with AMD than the rest of the world combined by 2050. In Asian populations, polypoidal choroidal vasculopathy (PCV) is a common subtype of exudative AMD, while choroidal neovascularization secondary to AMD (CNV-AMD) is the typical subtype in Western populations. The two subtypes share many common clinical features and risk factors, but also have different epidemiological and clinical characteristics, natural history and treatment outcomes that point to distinct pathophysiological processes. Recent research in the fields of genetics, proteomics and imaging has provided further clarification of differences between PCV and CNV-AMD. Importantly, these differences have manifested as disparity in response to intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) treatment between PCV and CNV-AMD, emphasizing the need for accurate diagnosis of PCV and in distinguishing PCV from CNV-AMD, particularly in Asian patients. Current clinical trials of intravitreal anti-VEGF therapy and photodynamic therapy will provide clearer perspectives of evidence-based management of PCV and may lead to paradigm shifts in therapeutic strategies away from those currently employed in the treatment of CNV-AMD. Further research is needed to clarify the relative contribution of specific pathways in inflammation, complement activation, extracellular matrix dysregulation, lipid metabolism and angiogenesis to the pathogenesis of PCV. Findings from this research, together with improved diagnostic technology and new therapeutics, will facilitate more optimal management of Asian AMD.
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Affiliation(s)
- Chee Wai Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Yasuo Yanagi
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Won-Ki Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yuichiro Ogura
- Department of Ophthalmology, Nagoya City University, Nagoya, Japan
| | - Ian Yeo
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
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Munch IC, Jørgensen AHR, Radner W. The Danish version of the Radner Reading Chart: design and empirical testing of sentence optotypes in subjects of varying educational background. Acta Ophthalmol 2016; 94:182-6. [PMID: 26408429 DOI: 10.1111/aos.12845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To develop 28 short texts to be used as sentence optotypes in a Danish version of the Radner Reading Chart for the measurement of reading acuity and speed. METHOD Forty-six short texts of comparable lexical and grammatical difficulty were constructed. The short texts were tested together with two longer reference texts in 100 persons with visual acuity 6/6, of which 50 were university students (age: 24.7 ± 3.1 years, 36% males) and 50 were blue-collar workers (37.2 ± 13.4 years, 54% males). Study parameters were mean reading speed and error rate per participant, and mean reading time, variance and number of errors per short text. RESULTS The students read the short texts faster than the blue-collar workers (184 ± 21.4 words per minute (wpm) versus 163 ± 26.3 wpm, p < 0.0001). There was a high correlation between the reference texts and the short texts [Pearson's correlation coefficient = 0.89 (95% CI 0.83-0.92)]. The mean reading time for each of the short texts ranged from 4.4 s to 5.8 s with a mean of 4.96 ± 0.35 s, and the median number of errors was eight. Twenty-eight short texts were selected for sentence optotypes with mean reading times between 4.6 s and 5.2 s, a mean standard deviation of 1.2 s or less and a number of errors of 17 per 100 persons or less. CONCLUSION Reading time uniformity in the Danish version of the Radner Reading Chart was comparable to that of the original German version. Education had an influence on reading performance that may warrant stratification for this parameter when reading tests are used in clinical trials.
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Affiliation(s)
- Inger Christine Munch
- Department of Ophthalmology; Roskilde Hospital; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | | | - Wolfgang Radner
- Austrian Academy of Ophthalmology and Optometry; Vienna Austria
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Radner W, Radner S, Diendorfer G. A new principle for the standardization of long paragraphs for reading speed analysis. Graefes Arch Clin Exp Ophthalmol 2015; 254:177-84. [DOI: 10.1007/s00417-015-3207-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/05/2015] [Accepted: 10/22/2015] [Indexed: 11/28/2022] Open
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Hou XR, Miao H, Tao Y, Li XX, Wong IY. Expression of cytokines on the iris of patients with neovascular glaucoma. Acta Ophthalmol 2015; 93:e100-4. [PMID: 25041566 DOI: 10.1111/aos.12510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 06/15/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine the expression levels of cytokines, including growth factors, inflammatory cytokines, and cell migration associated factors on the iris from subjects with neovascular glaucoma (NVG). METHODS After receiving formal consent from 12 subjects with NVG secondary to proliferative diabetic retinopathy and 12 subjects with primary open angle glaucoma (POAG), trabeculectomy was performed and iris specimens were collected during the surgery. Each subject with NVG received intravitreal injection of bevacizumab 1 week prior to the surgery. The mRNA level of vascular endothelial growth factor, basic fibroblastic growth factor, placental-induced growth factor, interleukin-2, interleukin 6, tumour necrosis factor α, intercellular adhesion molecule 1 (ICAM-1) and integrin subunit αV were determined by real-time polymerase chain reaction. The mRNA levels were compared between the two groups. RESULTS The mRNA levels of all inflammatory cytokines and integrin subunit αV were significantly increased in the NVG group compared with POAG controls. However, the mRNA level of growth factors and ICAM-1 did not show any difference between the two groups. CONCLUSIONS Inflammatory process maybe an important cause of iris neovascularization in subjects with NVG in addition to growth factors alone. Further studies should focus on the effect of growth factors in different phases in the pathogenesis of NVG.
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Affiliation(s)
- Xian-ru Hou
- Department of Ophthalmology; Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; People's Hospital; Peking University; Beijing China
| | - Heng Miao
- Department of Ophthalmology; Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; People's Hospital; Peking University; Beijing China
| | - Yong Tao
- Department of Ophthalmology; Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; People's Hospital; Peking University; Beijing China
| | - Xiao-xin Li
- Department of Ophthalmology; Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; People's Hospital; Peking University; Beijing China
| | - Ian Y. Wong
- Department of Ophthalmology; University of Hong Kong; Hong Kong
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Nishimura T, Machida S, Hashizume K, Kurosaka D. Structures affecting recovery of macular function in patients with age-related macular degeneration after intravitreal ranibizumab. Graefes Arch Clin Exp Ophthalmol 2014; 253:1201-9. [PMID: 25163415 DOI: 10.1007/s00417-014-2779-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/31/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To determine the retinal structures affecting the recovery of macular function in patients with exudative age-related macular degeneration (AMD) treated with intravitreal ranibizumab (IVR). METHOD Thirty eyes of 30 patients with exudative AMD who were treated with IVR at monthly intervals for 3 months were studied. Focal macular electroretinograms (fmERGs) and spectral-domain optical coherence tomography (SD-OCT) were performed before and 3 months after beginning the IVR injections. The fmERGs were elicited by a 15° white stimulus spot centered on the fovea. The thickness of different retinal layers, presence of a serous retinal detachment (SRD), and presence of a pigment epithelial detachment (PED) at the fovea was determined in the SD-OCT images. Measurements were made of the inner, middle, and outer layers of the retina and also of the SRD and PED in the horizontal and vertical meridians at 1.2 mm from the fovea (parafoveal regions). The significance of the correlations between these structural parameters and the a-wave amplitude of the fmERG was determined. RESULTS There was no significant correlation between the structural parameters of the fovea and the a-wave amplitude. In the parafoveal regions, the thickness of the outer retinal layer was significantly correlated with an increase of the a-wave amplitude (R = 0.56, P = 0.001). In addition, the SRD thickness was negatively and significantly correlated with the a-wave amplitude (R = -0.54, P = 0.002). The change in the parafoveal SRD thickness after IVRs was the only independent determinant of recovery of the a-wave amplitude after the treatments (P < 0.05). CONCLUSIONS The macular function measured by the fmERGs was determined by the parafoveal outer layer and SRD thickness in patients with exudative AMD. Of these, changes in the SRD thickness by IVRs most strongly affected the recovery of macular function.
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Affiliation(s)
- Tomoharu Nishimura
- Department of Ophthalmology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
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Systematic correlation of morphologic alterations and retinal function in eyes with uveitis-associated cystoid macular oedema during development, resolution and relapse. Br J Ophthalmol 2013; 97:1289-96. [DOI: 10.1136/bjophthalmol-2012-303052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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