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Artiaga JCM, Wong SW, Menon D, Kumar S, Dhoble P, Thottarath S, Nicholson L. Reactivation of stable neovascular age-related macular degeneration following treat-and-extend regimen discontinuation. Clin Exp Ophthalmol 2024. [PMID: 39354837 DOI: 10.1111/ceo.14444] [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: 04/10/2024] [Revised: 08/03/2024] [Accepted: 09/07/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND To describe the incidence and pattern of reactivation of neovascular age-related macular degeneration (nAMD) following successful treatment with treat-and-extend intravitreal anti-vascular endothelial growth factor therapy. METHODS Consecutive patients with treated nAMD who did not require further treatment over a 6-month period and who attended their 3-monthly optical coherence tomography monitoring clinic in Moorfields Eye Hospital from 1 November 2019 to 31 January 2020 were included. Patients with diagnoses of macular neovascularization other than AMD, and patients with incomplete data were excluded. Baseline demographics recorded were age, sex, race, laterality, cause of macular neovascularization, drug, number of injections, and duration of treatment. Date, setting, symptoms, and time to retreatment were collected among patients with disease reactivation. RESULTS The medical records of 286 patients were included. Most patients were female (64.3%), white (68.18%), and were receiving aflibercept monotherapy (55.2%). Mean number of injections at baseline was 17.79 ± 11.74 (range 3-62) with a mean treatment duration of 39.47 ± 30.68 months (range 2-139). Reactivation of AMD was identified in 32.2% of cases with 87% of recurrences identified via scheduled visit. The most common symptom was blurring of vision in 44.6%, while 39.1% were asymptomatic. Mean time from baseline to retreatment was 29.37 ± 22.40 months (range 5-104), with 20.7%, 73.9% and 88.04% of these patients requiring retreatment within 1, 3, and 5 years, respectively. CONCLUSIONS Despite prior treatment with no reactivation in 6 months, 32.2% reactivate, 73.9% of which within 3 years. A significant proportion, 39.1%, reactivated without symptoms necessitating regular monitoring in the first 5 years.
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Affiliation(s)
- Jose Carlo M Artiaga
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Shiao Wei Wong
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Deepthy Menon
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Swetha Kumar
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Pankaja Dhoble
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Sridevi Thottarath
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Luke Nicholson
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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2
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Terheyden JH, Mauschitz MM, Wintergerst MWM, Chang P, Herrmann P, Liegl R, Ach T, Finger RP, Holz FG. [Digital remote monitoring of chronic retinal conditions-A clinical future tool? : Remote monitoring of chronic retinal conditions]. DIE OPHTHALMOLOGIE 2024:10.1007/s00347-024-02109-2. [PMID: 39276227 DOI: 10.1007/s00347-024-02109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 08/09/2024] [Accepted: 08/15/2024] [Indexed: 09/16/2024]
Abstract
BACKGROUND In view of the predicted increase in incidence and prevalence of chronic retinal diseases and undersupply of care in the population, telemedicine could contribute to reducing access barriers to healthcare and improving the results of treatment. OBJECTIVE A literature review on remote monitoring of chronic retinal diseases was carried out. MATERIAL AND METHODS The medical literature was searched for publications on remote monitoring of chronic retinal diseases. The results were compiled in a narrative overview. RESULTS The four main topics in the literature are: validation studies, implementation strategies, acceptance/target group analyses and health economic analyses. Remote monitoring systems are based on visual function tests, imaging or patient reports and have been particularly investigated in age-related macular degeneration (AMD) and diabetic eye disease (DED). Studies indicate positive effects regarding an optimization of clinical care and a favorable safety profile but randomized controlled trials are lacking for the majority of monitoring tools. CONCLUSION Remote monitoring could complement existing care structures for patients with chronic retinal diseases, especially AMD and DED. Promising systems are based on hyperacuity or optical coherence tomography, while patient-reported data are not commonly used; however, there is currently insufficient evidence justifying the use of remote monitoring systems in chronic retinal diseases in Europe and more research on the validation of remote monitoring systems is needed.
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Affiliation(s)
| | | | - Maximilian W M Wintergerst
- Universitäts-Augenklinik Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
- Augenzentrum Grischun, Chur, Schweiz
| | - Petrus Chang
- Universitäts-Augenklinik Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Philipp Herrmann
- Universitäts-Augenklinik Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Raffael Liegl
- Universitäts-Augenklinik Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Thomas Ach
- Universitäts-Augenklinik Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Robert P Finger
- Universitäts-Augenklinik Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Frank G Holz
- Universitäts-Augenklinik Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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3
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Castillo-Valdez PF, Rodriguez-Salvador M, Ho YS. Scientific Production Dynamics in mHealth for Diabetes: Scientometric Analysis. JMIR Diabetes 2024; 9:e52196. [PMID: 39172508 PMCID: PMC11377915 DOI: 10.2196/52196] [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: 08/28/2023] [Revised: 03/23/2024] [Accepted: 06/04/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND The widespread use of mobile technologies in health care (mobile health; mHealth) has facilitated disease management, especially for chronic illnesses such as diabetes. mHealth for diabetes is an attractive alternative to reduce costs and overcome geographical and temporal barriers to improve patients' conditions. OBJECTIVE This study aims to reveal the dynamics of scientific publications on mHealth for diabetes to gain insights into who are the most prominent authors, countries, institutions, and journals and what are the most cited documents and current hot spots. METHODS A scientometric analysis based on a competitive technology intelligence methodology was conducted. An innovative 8-step methodology supported by experts was executed considering scientific documents published between 1998 and 2021 in the Science Citation Index Expanded database. Publication language, publication output characteristics, journals, countries and institutions, authors, and most cited and most impactful articles were identified. RESULTS The insights obtained show that a total of 1574 scientific articles were published by 7922 authors from 90 countries, with an average of 15 (SD 38) citations and 6.5 (SD 4.4) authors per article. These documents were published in 491 journals and 92 Web of Science categories. The most productive country was the United States, followed by the United Kingdom, China, Australia, and South Korea, and the top 3 most productive institutions came from the United States, whereas the top 3 most cited articles were published in 2016, 2009, and 2017 and the top 3 most impactful articles were published in 2016 and 2017. CONCLUSIONS This approach provides a comprehensive knowledge panorama of research productivity in mHealth for diabetes, identifying new insights and opportunities for research and development and innovation, including collaboration with other entities, new areas of specialization, and human resource development. The findings obtained are useful for decision-making in policy planning, resource allocation, and identification of research opportunities, benefiting researchers, health professionals, and decision makers in their efforts to make significant contributions to the advancement of diabetes science.
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4
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Samanta A, Santineau K, Park A, Nguyen D, Kim Cavdar I, Nelson P. Measuring Vision at Home in 2023. Telemed J E Health 2024; 30:e1606-e1614. [PMID: 38564179 DOI: 10.1089/tmj.2023.0368] [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: 04/04/2024] Open
Abstract
Introduction: The ability to measure a patient's visual acuity at home (HVA) is by far the most desired remote telemedicine capability sought by ophthalmologists. Methods: A systematic literature review was done using Pubmed to search for publications from 2010 to 2022 in English reporting on 10 studies that compared a patient's HVA to the clinic visual acuity (CVA). Results: Approaches to measuring HVA included using a phone-based application, a physical chart, a computer, and a website. The most accurate of these was the use of personal computers (COMPlog, Macustat, Web based test) at home with a bias of 1 letter. The most accessible and reliable was the use of a printable visual acuity chart, available in the public domain, which had adifference between HVA and CVA of 1 to 3.5 letters. Phone apps (Verana Vision) and stand-alone websites (Farsight.com) both had a greater mean difference of about 6 letters, respectively,with a moderate correlation coefficient. Discussion: Overall, all three methodologies demonstrated a good negative predictive value demonstrating their potential use as an effective screening tool to flag drastic vision decline between clinic visits.
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Affiliation(s)
- Anindya Samanta
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Kaitlyn Santineau
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Alexander Park
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Dang Nguyen
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Irina Kim Cavdar
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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5
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Leadbeater RJ, McGraw P, Ledgeway T. Assessing the reliability of web-based measurements of visual function. Behav Res Methods 2024; 56:406-416. [PMID: 36690890 PMCID: PMC10794459 DOI: 10.3758/s13428-022-02057-2] [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] [Accepted: 12/19/2022] [Indexed: 01/25/2023]
Abstract
Many behavioural phenomena have been replicated using web-based experiments, but evaluation of the agreement between objective measures of web- and lab-based performance is required if scientists and clinicians are to reap the benefits of web-based testing. In this study, we investigated the reliability of a task which assesses early visual cortical function by evaluating the well-known 'oblique effect' (we are better at seeing horizontal and vertical edges than tilted ones) and the levels of agreement between remote, web-based measures and lab-based measures. Sixty-nine young participants (mean age, 21.8 years) performed temporal and spatial versions of a web-based, two-alternative forced choice (2AFC) orientation-identification task. In each case, orientation-identification thresholds (the minimum orientation difference at which a standard orientation could be reliably distinguished from a rotated comparison) were measured for cardinal (horizontal and vertical) and oblique orientations. Reliability was assessed in a subsample of 18 participants who performed the same tasks under laboratory conditions. Robust oblique effects were found, such that thresholds were substantially lower for cardinal orientations compared to obliques, for both web- and lab-based measures of the temporal and spatial 2AFC tasks. Crucially, web- and lab-based orientation-identification thresholds showed high levels of agreement, demonstrating the suitability of web-based testing for assessments of early visual cortical function. Future studies should assess the reliability of similar web-based tasks in clinical populations to evaluate their adoption into clinical settings, either to screen for visual anomalies or to assess changes in performance associated with progression of disease severity.
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Affiliation(s)
- Richard J Leadbeater
- Visual Neuroscience Group, School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Paul McGraw
- Visual Neuroscience Group, School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Timothy Ledgeway
- Visual Neuroscience Group, School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
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Queguiner F, Bezirganyan K, Courjaret JC, Curel L, Penaranda G, Bonomini J, Righini Chossegros M. Reliability of self-measurement of visual acuity in AMD patients with two electronic devices based on the ETDRS chart: A randomized study. J Fr Ophtalmol 2024; 47:103911. [PMID: 37648551 DOI: 10.1016/j.jfo.2023.04.006] [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: 10/25/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Age-related macular degeneration (AMD) requires continuous visual acuity (VA) monitoring, increasing the burden on the health care system. Self-measurement VA tests are available on various devices. However, none of them have been based on an internationally validated benchmark chart, such as that of the Early Treatment Diabetic Retinopathy Study (ETDRS). The goal of this study was to assess the reliability of two digitized ETDRS charts adapted to two electronic devices for self-measurement of VA. MATERIAL AND METHODS A prospective, single-center, 1:1 randomized, two-arm, parallel group trial was conducted. The main objective was to compare VA variation as conventionally measured on a 4-m ETDRS chart versus self-measured with digitized ETDRS charts in patients treated for AMD. At each visit, conventional measurement and patient self-measurement, either on a computer at 80-cm (arm 1) or on a tablet at 40-cm (arm 2), were performed. RESULTS Eighty patients were included (25 men, 55 women, mean age 81.3±7.4 years). No significant differences were observed between VA variation, conventionally measured and self-measured on a computer (arm 1; P=0.914) or tablet (arm 2; P=0.913). CONCLUSION These results confirm the reliability of these two methods for self-measurement of VA, and will lead to the development of a wider "telemedicine" project extended to self-measurement of VA in various pathologies.
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Affiliation(s)
- F Queguiner
- Ophthalmology and Clinical Research departments, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France.
| | - K Bezirganyan
- Clinical Research department, Saint Joseph Hospital, 13008 Marseille, France
| | - J C Courjaret
- Ophthalmology and Clinical Research departments, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France
| | - L Curel
- Clinical Research department, Saint Joseph Hospital, 13008 Marseille, France
| | - G Penaranda
- Biostatistics department, AlphaBio Laboratory, 13003 Marseille, France
| | - J Bonomini
- Clinical Research department, Saint Joseph Hospital, 13008 Marseille, France
| | - M Righini Chossegros
- Ophthalmology and Clinical Research departments, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France
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Balaskas K, Drawnel F, Khanani AM, Knox PC, Mavromaras G, Wang YZ. Home vision monitoring in patients with maculopathy: current and future options for digital technologies. Eye (Lond) 2023; 37:3108-3120. [PMID: 36973405 PMCID: PMC10042418 DOI: 10.1038/s41433-023-02479-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/25/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023] Open
Abstract
Patients with macular pathology, including that caused by age-related macular degeneration and diabetic macular oedema, must attend frequent in-clinic monitoring appointments to detect onset of disease activity requiring treatment and to monitor progression of existing disease. In-person clinical monitoring places a significant burden on patients, caregivers and healthcare systems and is limited in that it only provides clinicians with a snapshot of the patient's disease status. The advent of remote monitoring technologies offers the potential for patients to test their own retinal health at home in collaboration with clinicians, reducing the need for in-clinic appointments. In this review we discuss visual function tests, both existing and novel, that have the potential for remote use and consider their suitability for discriminating the presence of disease and progression of disease. We then review the clinical evidence supporting the use of mobile applications for monitoring of visual function from clinical development through to validation studies and real-world implementation. This review identified seven app-based visual function tests: four that have already received some form of regulatory clearance and three under development. The evidence included in this review shows that remote monitoring offers great potential for patients with macular pathology to monitor their condition from home, reducing the need for burdensome clinic visits and expanding clinicians' understanding of patients' retinal health beyond traditional clinical monitoring. In order to instil confidence in the use of remote monitoring in both patients and clinicians further longitudinal real-world studies are now warranted.
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Affiliation(s)
- Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Institute of Ophthalmology, University College London, London, UK.
| | | | - Arshad M Khanani
- The University of Nevada, Reno School of Medicine, Reno, NV, USA
- Sierra Eye Associates, Reno, NV, USA
| | - Paul C Knox
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | | | - Yi-Zhong Wang
- Retina Foundation of the Southwest, Dallas, TX, USA
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA
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Selvan K, Abuzaitoun R, Abalem MF, Vincent A, Andrews CA, Lacy GD, Farjo R, Kao K, Kao K, Dagnelie G, Musch DC, Jayasundera KT, Héon E. The validation of inherited retinal disease-specific patient-reported outcome measures in adolescent patients. Ophthalmic Genet 2023; 44:218-225. [PMID: 36974468 PMCID: PMC10198816 DOI: 10.1080/13816810.2023.2179074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/09/2023] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To determine the validity of the validate the adult patient-reported outcome measure tools, the Michigan Retinal Degeneration Questionnaire (MRDQ) and Michigan Vision-Related Anxiety Questionnaire (MVAQ), in adolescent patients with inherited retinal diseases (IRDs). METHODS Ninety-one adolescent patients diagnosed with IRDs were recruited at the Hospital for Sick Children (University of Toronto) and the Kellogg Eye Center (University of Michigan). The patients were administered the MRDQ, MVAQ, and Patient Health Questionnaire-4 (PHQ-4). Test-retest variability was assessed in eighteen patients within 14 days of the initial administration. Adolescent responses were analyzed for validity and reliability. As a further validation step, comparisons were made to adult data from the original MRDQ and MVAQ studies to ensure consistency in response ranges. RESULTS The existing MRDQ and MVAQ content and format could accurately detect the impact of IRD on activities of daily living in adolescents with IRDs. No floor/ceiling effects were identified, test-retest reliability was established (r = 0.73-0.86), and no items were excluded after differential item functioning analysis. Domain and trait associations with visual acuity and IRD phenotypes were similar between adolescents and adults. CONCLUSIONS The MRDQ and MVAQ are psychometrically validated questionnaires for which we have shown validity for use in adolescent patients with IRDs.
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Affiliation(s)
- Kavin Selvan
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebhi Abuzaitoun
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Maria Fernanda Abalem
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Ophthalmology and Otolaryngology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Ajoy Vincent
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chris A. Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Gabrielle D. Lacy
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rafid Farjo
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Karissa Kao
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Krystal Kao
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Gislin Dagnelie
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - K. Thiran Jayasundera
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Elise Héon
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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9
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Land MR, Patel PA, Bui T, Jiao C, Ali A, Ibnamasud S, Patel PN, Sheth V. Examining the Role of Telemedicine in Diabetic Retinopathy. J Clin Med 2023; 12:jcm12103537. [PMID: 37240642 DOI: 10.3390/jcm12103537] [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: 03/15/2023] [Revised: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
With the increasing prevalence of diabetic retinopathy (DR), screening is of the utmost importance to prevent vision loss for patients and reduce financial costs for the healthcare system. Unfortunately, it appears that the capacity of optometrists and ophthalmologists to adequately perform in-person screenings of DR will be insufficient within the coming years. Telemedicine offers the opportunity to expand access to screening while reducing the economic and temporal burden associated with current in-person protocols. The present literature review summarizes the latest developments in telemedicine for DR screening, considerations for stakeholders, barriers to implementation, and future directions in this area. As the role of telemedicine in DR screening continues to expand, further work will be necessary to continually optimize practices and improve long-term patient outcomes.
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Affiliation(s)
- Matthew R Land
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Parth A Patel
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Tommy Bui
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Cheng Jiao
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Arsalan Ali
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76129, USA
| | - Shadman Ibnamasud
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Prem N Patel
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Veeral Sheth
- Department of Ophthalmology, University Retina and Macula Associates, Oak Forest, IL 60452, USA
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10
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Khurana RN, Li C, Lum F. Loss to Follow up in Patients with Neovascular Age Related Macular Degeneration treated with Anti-VEGF therapy in the United States in the IRIS® Registry. Ophthalmology 2023:S0161-6420(23)00132-X. [PMID: 36858288 DOI: 10.1016/j.ophtha.2023.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE To determine the incidence of loss to follow up (LTFU) and nonpersistence in patients with neovascular age related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (VEGF) injections in the United States. DESIGN Retrospective cohort study using IRIS (Intelligent Research in Sight) Registry data. SUBJECTS 156,327 treatment-naïve neovascular AMD patients who were subsequently treated with anti-VEGF therapy from 2013 to 2015 and followed through 2019. METHODS Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) MAIN OUTCOME MEASURES: LTFU was defined as no follow up within 12 months from last intravitreal injection. Nonpersistence was defined as no follow up within 6 months from last intravitreal injection. RESULTS For neovascular AMD, 11.6% (95% CI, 11.4-11.7) of patients were LTFU and 88.4% of patients had a follow up within 12 months. The rate of LTFU is generally higher with increasing age, with odds of LTFU greatest for patients between 81-84 years of age (OR, 2.51; 95% CI, 2.31-2.74; p<0.001) compared with patients 70 years of age and younger. Odds of LTFU for Black or African-American patients (OR, 1.32; 95% CI, 1.08-1.61; p=0.007) were greater than for white patients. Odds of LTFU were higher for patients with Medicaid insurance (OR, 1.27; 95% CI, 1.01-1.60; p=0.04) and lower for patients with Medicare Fee-for-Service insurance (OR, 0.69; 95% CI, 0.64-0.74; p<0.001) compared to patients with Private insurance. 14.3% (95% CI, 14.1-14.4) of patients were nonpersistent and 85.7% of patients had a follow up within 6 months. Odds of nonpersistence were also greatest among patients between 81-84 years of age (OR, 2.13; 95% CI, 1.98-2.29; p<0.001) compared with patients 70 years of age or younger. Odds of nonpersistence for Black or African American patients (OR, 1.38; 95% CI, 1.15-1.65; p<0.001) and Hispanic patients (OR, 1.13; 95% CI, 1.03-1.24; p=0.009) were greater than odds for white patients. CONCLUSIONS Nearly one out of nine neovascular AMD patients treated with anti-VEGF injections are LTFU while one out of seven patients are nonpersistent. Risk factors identified included increasing age, male sex, unilateral involvement, diabetes, Medicaid insurance and race/ethnicity.
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Affiliation(s)
- Rahul N Khurana
- Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
| | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
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11
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O’Connor SR, Treanor C, Ward E, Wickens RA, O’Connell A, Culliford LA, Rogers CA, Gidman EA, Peto T, Knox PC, Burton BJL, Lotery AJ, Sivaprasad S, Reeves BC, Hogg RE, Donnelly M. Patient Acceptability of Home Monitoring for Neovascular Age-Related Macular Degeneration Reactivation: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13714. [PMID: 36294292 PMCID: PMC9603709 DOI: 10.3390/ijerph192013714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Neovascular age-related macular degeneration (nAMD) is a chronic, progressive condition and the commonest cause of visual disability in older adults. This study formed part of a diagnostic test accuracy study to quantify the ability of three index home monitoring (HM) tests (one paper-based and two digital tests) to identify reactivation in nAMD. The aim of this qualitative research was to investigate patients' or participants' views about acceptability and explore adherence to weekly HM. Semi-structured interviews were held with 78/297 participants (26%), with close family members (n = 11) and with healthcare professionals involved in training participants in HM procedures (n = 9) (n = 98 in total). A directed thematic analytical approach was applied to the data using a deductive and inductive coding framework informed by theories of technology acceptance. Five themes emerged related to: 1. The role of HM; 2. Suitability of procedures and instruments; 3. Experience of HM; 4. Feasibility of HM in usual practice; and 5. Impediments to patient acceptability of HM. Various factors influenced acceptability including a patient's understanding about the purpose of monitoring. While initial training and ongoing support were regarded as essential for overcoming unfamiliarity with use of digital technology, patients viewed HM as relatively straightforward and non-burdensome. There is a need for further research about how use of performance feedback, level of support and nature of tailoring might facilitate further the implementation of routinely conducted HM. Home monitoring was acceptable to patients and they recognised its potential to reduce clinic visits during non-active treatment phases. Findings have implications for implementation of digital HM in the care of older people with nAMD and other long-term conditions.
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Affiliation(s)
- Seán R. O’Connor
- School of Psychology, Queen’s University of Belfast, Belfast BT7 1NN, UK
| | - Charlene Treanor
- Centre for Public Health, Queen’s University of Belfast, Belfast BT12 6BA, UK
| | - Elizabeth Ward
- Bristol Trials Centre (CTEU), University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Robin A. Wickens
- Bristol Trials Centre (CTEU), University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, UK
- Southampton Clinical Trials Unit, University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Abby O’Connell
- Exeter Clinical Trials Unit (EXECTU), University of Exeter, St. Lukes Campus, Exeter EX1 2LT, UK
| | - Lucy A. Culliford
- Bristol Trials Centre (CTEU), University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Chris A. Rogers
- Bristol Trials Centre (CTEU), University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Eleanor A. Gidman
- Bristol Trials Centre (CTEU), University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Tunde Peto
- Centre for Public Health, Queen’s University of Belfast, Belfast BT12 6BA, UK
| | - Paul C. Knox
- Department of Eye and Vision Science, University of Liverpool, Liverpool L7 8TX, UK
| | | | - Andrew J. Lotery
- Department of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| | - Barnaby C. Reeves
- Bristol Trials Centre (CTEU), University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Ruth E. Hogg
- Centre for Public Health, Queen’s University of Belfast, Belfast BT12 6BA, UK
| | - Michael Donnelly
- Centre for Public Health, Queen’s University of Belfast, Belfast BT12 6BA, UK
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12
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Cardiovascular Risk Stratification in Diabetic Retinopathy via Atherosclerotic Pathway in COVID-19/non-COVID-19 Frameworks using Artificial Intelligence Paradigm: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12051234. [PMID: 35626389 PMCID: PMC9140106 DOI: 10.3390/diagnostics12051234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Abstract
Diabetes is one of the main causes of the rising cases of blindness in adults. This microvascular complication of diabetes is termed diabetic retinopathy (DR) and is associated with an expanding risk of cardiovascular events in diabetes patients. DR, in its various forms, is seen to be a powerful indicator of atherosclerosis. Further, the macrovascular complication of diabetes leads to coronary artery disease (CAD). Thus, the timely identification of cardiovascular disease (CVD) complications in DR patients is of utmost importance. Since CAD risk assessment is expensive for low-income countries, it is important to look for surrogate biomarkers for risk stratification of CVD in DR patients. Due to the common genetic makeup between the coronary and carotid arteries, low-cost, high-resolution imaging such as carotid B-mode ultrasound (US) can be used for arterial tissue characterization and risk stratification in DR patients. The advent of artificial intelligence (AI) techniques has facilitated the handling of large cohorts in a big data framework to identify atherosclerotic plaque features in arterial ultrasound. This enables timely CVD risk assessment and risk stratification of patients with DR. Thus, this review focuses on understanding the pathophysiology of DR, retinal and CAD imaging, the role of surrogate markers for CVD, and finally, the CVD risk stratification of DR patients. The review shows a step-by-step cyclic activity of how diabetes and atherosclerotic disease cause DR, leading to the worsening of CVD. We propose a solution to how AI can help in the identification of CVD risk. Lastly, we analyze the role of DR/CVD in the COVID-19 framework.
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13
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Bellsmith KN, Gale MJ, Yang S, Nguyen IB, Prentiss CJ, Nguyen LT, Mershon S, Summers AI, Thomas M. Validation of Home Visual Acuity Tests for Telehealth in the COVID-19 Era. JAMA Ophthalmol 2022; 140:465-471. [PMID: 35357405 PMCID: PMC8972145 DOI: 10.1001/jamaophthalmol.2022.0396] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/01/2022] [Indexed: 12/11/2022]
Abstract
Importance Visual acuity (VA) is one of the most important clinical data points in ophthalmology. However, few options for validated at-home VA assessments are currently available. Objective To validate 3 at-home visual acuity tests in comparison with in-office visual acuity. Design, Setting, and Participants Between July 2020 and April 2021, eligible participants with VA of 20/200 or better were recruited from 4 university-based ophthalmology clinics (comprehensive, cornea, glaucoma, and retina clinics). Participants were prospectively randomized to self-administer 2 of 3 at-home VA tests (printed chart, mobile phone app, and website) within 3 days before their standard-of-care clinic visit. Participants completed a survey assessing usability of the at-home tests. At the clinic visit, best-corrected Snellen distance acuity was measured as the reference standard. Main Outcomes and Measures The at-home VA test results were compared with the in-office VA test results using paired and unpaired t tests, Pearson correlation coefficients, analysis of variance, χ2 tests, and Cohen κ agreement. The sensitivity, specificity, positive predictive value, and negative predictive value of each at-home test were calculated to detect significant VA changes (≥0.2 logMAR) from the in-office baseline. Results A total of 121 participants with a mean (SD) age of 63.8 (13.0) years completed the study. The mean in-office VA was 0.11 logMAR (Snellen equivalent 20/25) with similar numbers of participants from the 4 clinics. Mean difference (logMAR) between the at-home test and in-office acuity was -0.07 (95% CI, -0.10 to -0.04) for the printed chart, -0.12 (95% CI, -0.15 to -0.09) for the mobile phone app, and -0.13 (95% CI, -0.16 to -0.10) for the website test. The Pearson correlation coefficient for the printed chart was 0.72 (95% CI, 0.62-0.79), mobile phone app was 0.58 (95% CI, 0.46-0.69), and website test was 0.64 (95% CI, 0.53-0.73). Conclusions and Relevance The 3 at-home VA test results (printed chart, mobile phone app, and website) appeared comparable within 1 line to in-office VA measurements. Older participants were more likely to have limited access to digital tools. Further development and validation of at-home VA testing modalities is needed with the expansion of teleophthalmology care.
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Affiliation(s)
| | - Michael J. Gale
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Sen Yang
- Casey Eye Institute, Oregon Health & Science University, Portland
| | | | | | - Luan T. Nguyen
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Sam Mershon
- Casey Eye Institute, Oregon Health & Science University, Portland
| | | | - Merina Thomas
- Casey Eye Institute, Oregon Health & Science University, Portland
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14
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The Age-Related Macular Degeneration (AMD)-Preventing Mechanism of Natural Products. Processes (Basel) 2022. [DOI: 10.3390/pr10040678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Age-related macular degeneration (AMD) is related to central visual loss in elderly people and, based on the increment in the percentage of the aging population, the number of people suffering from AMD could increase. AMD is initiated by retinal pigment epithelium (RPE) cell death, finally leading to neovascularization in the macula lutea. AMD is an uncurable disease, but the symptom can be suppressed. The current therapy of AMD can be classified into four types: device-based treatment, anti-inflammatory drug treatment, anti-vascular endothelial growth factor treatment, and natural product treatment. All these therapies have adverse effects, however early AMD therapy used with products has several advantages, as it can prevent RPE cell apoptosis in safe doses. Cell death (apoptosis) is caused by various factors, such as oxidative stress, inflammation, carbonyl stress, and a deficiency in essential components for cells, and RPE cell death is related to oxidative stress, inflammation, and carbonyl stress. Some natural products have anti-oxidative effects, anti-inflammation effects, and/or anti-carbonylation effects. The AMD preventive mechanism of natural products varies, with some natural products activating one or more anti-apoptotic pathways, such as the Nrf2/HO-1 anti-oxidative pathway, the anti-inflammasome pathway, and the anti-carbonyl pathway. As AMD drug candidates from natural products effectively inhibit RPE cell death, they have the potential to be developed as drugs for preventing early (dry) AMD.
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15
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Kim DG, Webel AD, Blumenkranz MS, Kim Y, Yang JH, Yu SY, Kwak HW, Palanker D, Toy B, Myung D. A Smartphone-Based Near-Vision Testing System: Design, Accuracy, and Reproducibility Compared With Standard Clinical Measures. Ophthalmic Surg Lasers Imaging Retina 2022; 53:79-84. [PMID: 35148218 PMCID: PMC10637325 DOI: 10.3928/23258160-20220121-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Ophthalmologic telemedicine has emerged during the COVID-19 pandemic. The objective of this study is to assess the accuracy and reproducibility of a smartphone-based home vision monitoring system (Sightbook) and to compare it with existing clinical standards. PATIENTS AND METHODS Near Snellen visual acuity (VA) was measured with Sightbook and compared with conventional measurements for distance and near VA at an academic medical center ophthalmology clinic in 200 patients with a variety of different specified preexisting ocular conditions. Measurements of contrast sensitivity were also compared by using an existing commercially available chart system in 15 normal patients and 15 patients with age-related macular degeneration. RESULTS Sightbook VA tests were reproducible (SD = ±0.054 logMAR), and correlation with standard VA methods was significant (R > 0.87 and P < .001). Sightbook contrast sensitivity measurements were reproducible (SD/mean ratio, 0.02 to 0.04), yielding results similar to those of standard tests (R2 > 0.87 and P < .001). CONCLUSIONS Smartphone-based VA and contrast sensitivity are highly correlated with standard charts and may be useful in augmenting limited inoffice care. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:79-84.].
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16
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Leung EH, Fan J, Flynn HW, Albini TA. Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare. Clin Ophthalmol 2022; 16:1-13. [PMID: 35018092 PMCID: PMC8742614 DOI: 10.2147/opth.s336963] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022] Open
Abstract
There is increasing information available about the effects of the SARS-CoV-2 virus on the systemic and ocular health of patients, as well as the effects of delayed health care. This mini-review summarizes the potential complications and treatments of COVID-19. Systemic findings include respiratory illness, risk of thromboembolic events, and neurologic findings. Some patients may develop persistent symptoms even after the infection resolves. Effective treatment options include glucocorticoids, antivirals, interleukin-6 antagonists, monoclonal antibodies, Janus kinase inhibitors and vaccines. Potential ocular findings of COVID-19 include conjunctivitis, cranial nerve palsies, and microvascular changes in the retina; most symptoms resolved over time. During the lockdown periods, teleophthalmology was utilized to triage non-urgent issues; patients who did present to emergency departments tended to have more severe disease with worse visual prognoses. While transient delays in outpatient ophthalmic care may be tolerated in some patients, others experienced significant vision loss with interruptions in treatments. Resumption of ophthalmic care as soon as possible may help mitigate the effects of delayed care due to the pandemic.
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Affiliation(s)
| | - Jason Fan
- Bascom Palmer Eye Institute/University of Miami, Miami, FL, USA
| | - Harry W Flynn
- Bascom Palmer Eye Institute/University of Miami, Miami, FL, USA
| | - Thomas A Albini
- Bascom Palmer Eye Institute/University of Miami, Miami, FL, USA
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