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Park JG, Chen XD, Clontz M, Begaj T, Runner MM, Wolfe JD. Coding of Geographic Atrophy and Exudative Age-related Macular Degeneration. Ophthalmol Retina 2023:S2468-6530(23)00125-2. [PMID: 36966949 DOI: 10.1016/j.oret.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Jong G Park
- Oakland University, William Beaumont School of Medicine, Auburn Hills, Michigan; Associated Retinal Consultants, Royal Oak, Michigan
| | - Xing D Chen
- Oakland University, William Beaumont School of Medicine, Auburn Hills, Michigan; Associated Retinal Consultants, Royal Oak, Michigan
| | - Megan Clontz
- Oakland University, William Beaumont School of Medicine, Auburn Hills, Michigan
| | - Tedi Begaj
- Oakland University, William Beaumont School of Medicine, Auburn Hills, Michigan; Associated Retinal Consultants, Royal Oak, Michigan
| | - Margaret M Runner
- Oakland University, William Beaumont School of Medicine, Auburn Hills, Michigan; Associated Retinal Consultants, Royal Oak, Michigan
| | - Jeremy D Wolfe
- Oakland University, William Beaumont School of Medicine, Auburn Hills, Michigan; Associated Retinal Consultants, Royal Oak, Michigan.
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Foster MJ, Shaia J, Maatouk CM, Urbano CA, Bui MT, Hom GL, Kuo BL, Singh RP, Talcott KE. Long-Term Visual Outcomes in Neovascular Age-Related Macular Degeneration Eyes With Baseline Macular Atrophy on Anti-Vascular Endothelial Growth Factor Treatment. Ophthalmic Surg Lasers Imaging Retina 2023; 54:223-230. [PMID: 36884230 DOI: 10.3928/23258160-20230223-01] [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: 03/09/2023]
Abstract
BACKGROUND AND OBJECTIVE This study explores the connection between macular atrophy (MA) status at baseline and best visual acuity (BVA) after 5 to 7 years of anti-vascular endothelial growth factor (anti-VEGF) injections on eyes with neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS This retrospective study included patients with neovascular age-related macular degeneration receiving anti-VEGF injections at least twice-yearly for 5+ years at Cole Eye Institute. Analyses of variance and linear regressions explored the connection between MA status, baseline MA intensity, and 5-year BVA change. RESULTS Of 223 included patients, 5-year BVA change was not statistically significant between MA status groups or from baseline. The population's average 7-year BVA change was -6.3 Early Treatment Diabetic Retinopathy Study letters. Type and frequency of anti-VEGF injections were comparable between MA status groups (P > .05). CONCLUSION Regardless of MA status, 5- and 7-year BVA change lacked clinical relevance. If receiving regular treatment for 5+ years, patients with baseline MA achieve comparable visual outcomes to those without MA, with similar treatment and visit burdens. [Ophthalmic Surg Lasers Imaging Retina 2023;54(X):X-X.].
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Li Q, Wang N, Liu Z, Li L, Liu Z, Long X, Yang H, Song H. Approach to glaucoma diagnosis and prediction based on multiparameter neural network. Int Ophthalmol 2022; 43:837-845. [PMID: 36083563 DOI: 10.1007/s10792-022-02485-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the effect of comprehensive factor analysis on the relationship between glaucoma assessment and combined parameters including trans-laminar cribrosa pressure difference (TLCPD) and fractional pressure reserve (FPR). METHODS The clinical data of 1029 patients with 15 indicators from the medical records of Beijing Tongren Hospital and 600 cases with 1322 indicators from Beijing Eye Research were collected. The doc2vec method was used to vectorize. The multivariate imputation by chained equations (MICE) method was used to interpolate. The original data combined with TLCPD, combined with FPR, and not combined parameters were respectively applied to train the neural network based on VGG16 and autoencoder to predict glaucoma and to evaluate the effect of combined parameters. RESULTS The accuracy rates used to classify the glaucoma of the two sets reach over 0.90, and the precision rates reach 0.70 and 0.80 respectively. After using TLCPD and FPR for the autoencoder method, the accuracy rates are both close to 1.0, and the precision rates are 0.90 and 0.70 respectively. CONCLUSION Using the combined parameters of FPR and TLCPD can effectively improve the diagnosis and prediction of glaucoma. Compared with TLCPD, FPR is more suitable for improving the effect of neural network for glaucoma classification.
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Affiliation(s)
- Qi Li
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.,Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Zhicheng Liu
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Lin Li
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Zhicheng Liu
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Xiaoxue Long
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Hongyu Yang
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Hongfang Song
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China. .,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.
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Elnahry AG, Noureldine AM, Abdel-Kader AA, Sorour OA, Ramsey DJ. Optical Coherence Tomography Angiography Biomarkers Predict Anatomical Response to Bevacizumab in Diabetic Macular Edema. Diabetes Metab Syndr Obes 2022; 15:395-405. [PMID: 35177916 PMCID: PMC8843414 DOI: 10.2147/dmso.s351618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To identify biomarkers that may predict an early anatomical response to the treatment of diabetic macular edema (DME) with intravitreal bevacizumab (IVB) by means of optical coherence tomography angiography (OCTA). METHODS This study is a retrospective study of treatment-naïve patients with DME who underwent 6 × 6 mm OCTA imaging of the macula at baseline and after three monthly IVB injections. Thirty-six eyes of 23 patients were included. Eyes that demonstrated evidence of an early anatomical response, consisting of a >10% decrease in central macular thickness (CMT) (n = 18), were compared with those eyes that failed to show such an improvement (n = 18). RESULTS At baseline, early-response eyes had worse starting best-corrected visual acuity (BCVA, LogMAR 0.84 ± 0.41 versus LogMAR 0.51 ± 0.15, p = 0.004) and a larger CMT (490 ± 135 µm versus 356 ± 33 µm, p = 0.001), but smaller foveal avascular zones (FAZ) (0.309 ± 0.098mm versus 0.413 ± 0.095 mm, p = 0.003) compared with eyes that proved refractory to three monthly injections of IVB. The vascular density (VD) in both the foveal superficial and deep capillary plexuses was significantly greater in eyes that showed an early-treatment response compared with eyes that were non-responders (24.86 ± 6.90% versus 19.98 ± 7.13%, p = 0.045 and 32.30 ± 4.88% versus 26.95 ± 7.25%, p = 0.028, respectively). Early-treatment response to IVB was predicted by starting CMT (r 2= 0.266, p = 0.001), FAZ size (r 2= 0.234, p = 0.003), and VD in the superficial parafovea (r 2= 0.217, p = 0.004) and deep fovea (r 2= 0.157, p = 0.037). CONCLUSION Projection-resolved OCTA may be useful in predicting an early anatomical response of DME to treatment with IVB.
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Affiliation(s)
- Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Correspondence: Ayman G Elnahry, Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, 11956, Egypt, Tel +20 1224927604, Fax +20 223682030, Email
| | - Alia M Noureldine
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A Abdel-Kader
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Osama A Sorour
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - David J Ramsey
- Division of Ophthalmology, Lahey Hospital & Medical Center, Tufts University School of Medicine, Boston, MA, USA
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Blazaki S, Blavakis E, Smoustopoulos G, Bontzos G, Stavrakakis A, Chlouverakis G, Kabanarou S, Xirou T, Tsilimbaris M. Progression of macular atrophy in patients receiving long-term anti-VEGF therapy for age-related macular degeneration; Real Life Data. Ophthalmologica 2021; 245:152-160. [PMID: 34818657 DOI: 10.1159/000520595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022]
Abstract
Purpose To evaluate the progression of macular atrophy (MA) based on near-infrared reflectance (NIR) and optical coherence tomography (OCT) images, in patients with age-related macular degeneration (AMD), receiving anti-vascular endothelial growth factor (anti-VEGF) treatment for at least a 6-year period. Materials and Methods This retrospective study included 53 naïve patients (53 eyes) with neovascular AMD from two centers, who were treated with anti-VEGF intravitreal injections and had no MA at baseline. MA was evaluated in an annual basis using NIR images, while all available OCT images were used to confirm that the atrophic area fulfilled the criteria proposed by the Classification of Atrophy Meetings (CAM) group for complete retinal pigment epithelium RPE and outer retinal atrophy (cRORA). Incidence and progression of MA were evaluated. Associations with best-corrected visual acuity (BCVA) and total number of injections were also studied. Results Treatment duration of our patients was 7.34 ± 1.54 years. The mean number of anti-VEGF injections was 24.4 ± 13.6. BCVA at baseline was 0.38 ± 0.27 logMAR while at final visit it was 0.60 ± 0.35 logMAR (p=0.731). The cumulative incidence of new MA at years 1, 2, 3, 4, 5, and 6 was 1.89%, 18.87% 32.08%, 39.62%, 49.06% and 50.94% respectively. In patients who developed MA, mean MA area increased from zero at baseline to 5.66 ± 7.18 mm2 at final visit. The estimated annual enlargement of MA was 0.45 mm/year based on square root transformation (1.12 mm2/year, untransformed data). MA progression does not appear to be significantly associated with age (R=0.055; p=0.784), gender (R=0.113; p=0.576), BCVA (R=0.168; p=0.404) and total number of injections (R=0.133; p=0.255). Conclusion In this real-life setting, half of neovascular AMD patients under anti-VEGF treatment, without MA at therapy initiation, developed MA over a period of at least 6 years. In this work, the number of injections did not seem to have a significant association with MA progression.
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Affiliation(s)
- Styliani Blazaki
- Department of Ophthalmology, University Ηospital of Heraklion, Heraklion, Greece
| | - Emmanouil Blavakis
- Department of Ophthalmology, University Ηospital of Heraklion, Heraklion, Greece
| | | | - Georgios Bontzos
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | | | - Gregory Chlouverakis
- Biostatistics Laboratory, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Stamatina Kabanarou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
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Ramsey DJ, Poulin SJ, LaMonica LC, Blaha GR, Barouch FC, Chang J, Marx JL. Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs. Clin Ophthalmol 2021; 15:31-39. [PMID: 33447009 PMCID: PMC7802895 DOI: 10.2147/opth.s286665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/17/2020] [Indexed: 01/24/2023] Open
Abstract
Purpose To evaluate the functional and anatomic outcomes, as well as cost-effectiveness, of the timing of conversion to intravitreal aflibercept (IVA) in patients with treatment-resistant diabetic macular edema (DME). Methods Thirty consecutive eyes (25 patients) were identified that were treated with ≥3 intravitreal bevacizumab (IVB) and/or ranibizumab (IVR) injections prior to treatment with ≥3 IVA injections. Eyes that received ≤6 IVB and/or IVR injections (early-switch) were compared to those that received ≥7 injections (late-switch) prior to conversion to IVA. Treatment effectiveness was measured in quality-adjusted life years (QALYs). A micro-simulation model examined the impact of treatment duration on outcomes. Results Early- (n=18) and late- (n=12) switch eyes had similar vision prior to conversion to IVA. Despite improvements in retinal thickness, only the early-switch eyes maintained vision gains after conversion to IVA through the end of follow-up (p=0.027). Early switch saved $22,884/eye and produced an additional 0.027 QALYs. Conclusion Early conversion to IVA optimizes vision outcomes and results in lower overall treatment expenditures.
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Affiliation(s)
- David J Ramsey
- Division of Ophthalmology, Lahey Hospital & Medical Center, Tufts University School of Medicine, Peabody, MA 01960, USA
| | - Samuel J Poulin
- Division of Ophthalmology, Lahey Hospital & Medical Center, Tufts University School of Medicine, Peabody, MA 01960, USA
| | | | - Gregory R Blaha
- Division of Ophthalmology, Lahey Hospital & Medical Center, Tufts University School of Medicine, Peabody, MA 01960, USA
| | - Fina C Barouch
- Division of Ophthalmology, Lahey Hospital & Medical Center, Tufts University School of Medicine, Peabody, MA 01960, USA
| | - Jeffrey Chang
- Division of Ophthalmology, Lahey Hospital & Medical Center, Tufts University School of Medicine, Peabody, MA 01960, USA
| | - Jeffrey L Marx
- Division of Ophthalmology, Lahey Hospital & Medical Center, Tufts University School of Medicine, Peabody, MA 01960, USA
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Impact of Sub-Retinal Fluid on the Long-Term Incidence of Macular Atrophy in Neovascular Age-related Macular Degeneration under Treat & Extend Anti-Vascular Endothelial Growth Factor Inhibitors. Sci Rep 2020; 10:8036. [PMID: 32415240 PMCID: PMC7229002 DOI: 10.1038/s41598-020-64901-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
Sub-retinal fluid (SRF) has been discussed as a protective factor against macular atrophy in eyes with neovascular age-related macular degeneration (nAMD).To gauge the impact of SRF on macular atrophy, a database of 310 nAMD eyes was screened for eyes manifesting an SRF-only phenotype under treat & extend anti-VEGF treatment, defined as nAMD expressing CNV exudation beyond the three monthly anti-VEGF loading doses by SRF only without any signs of exudative intra-retinal fluid (IRF) for ≥3 years. Incidence of macular atrophy and treatment responses were evaluated on multimodal imaging, including optical coherence tomography (OCT), blue autofluorescence (BAF) and near-infrared (NIR) confocal scanning laser ophthalmoscopy and fluorescence and indocyanine green angiography (FAG/ICGA). In total, 27 eyes (8.7%) of 26 patients with a mean follow-up of 4.2 ± 0.9 (3–5) years met the inclusion criteria. Mean age was 72 ± 6 (range: 61–86) years. The SRF only phenotype was seen from baseline in 14 eyes (52%), and in 13 eyes (48%) after a mean 1.0 ± 1.3 (1–3) injections. In years 1 to 5, mean 7.5, 5.9, 6.1, 6.1 and 7.0 anti-VEGF injections were given (p = 0.33). Cumulative macular atrophy incidence was 11.5% at year 1, 15.4% throughout years 2 to 4, and 22.4% at year 5. In conclusion, eyes manifesting activity by SRF only in treat & extend anti-VEGF regimen for nAMD seem to exhibit rather low rates of macular atrophy during long-term follow-up. SRF might be an indicator of a more benign form of nAMD.
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Horani M, Mahmood S, Aslam TM. A Review of Macular Atrophy of the Retinal Pigment Epithelium in Patients with Neovascular Age-Related Macular Degeneration: What is the Link? Part II. Ophthalmol Ther 2020; 9:35-75. [PMID: 31907843 PMCID: PMC7054566 DOI: 10.1007/s40123-019-00227-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction To explore the potential link between macular atrophy (MA) of the retinal pigment epithelium (RPE) in patients with neovascular age-related macular degeneration (nAMD) and anti-vascular endothelial growth factor (anti-VEGF) treatment. Methods Through a balanced overview of the field from a largely clinical perspective, we looked at available evidence on the topic of MA correlation with anti-VEGF therapy and examined possible risk factors for MA development in the context of nAMD treatment with anti-VEGF. Results Links have been reported to connect both MA incidence and progression to treatment frequency and to the anti-VEGF drug type. Conclusions All reports agree on the fact that de novo development of MA in anti-VEGF-treated eyes is frequent and multifactorial. Research data shows an expansion of atrophy during anti-VEGF treatment. There are mixed conclusions about the correlation of MA incidence or progression with treatment-related risk factors. It mostly appears that there is no straightforward link. More clinical research is still needed to further understand this association.
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Affiliation(s)
- Mania Horani
- Manchester Royal Eye Hospital, Manchester University Foundation NHS Trust, Manchester, UK.
| | - Sajjad Mahmood
- Manchester Royal Eye Hospital, Manchester University Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Tariq M Aslam
- Manchester Royal Eye Hospital, Manchester University Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
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Yu S, Rückert R, Munk MR. Treat-and-extend regimens with anti-vascular endothelial growth factor agents in age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1698948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Siqing Yu
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Marion R. Munk
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Călugăru D, Călugăru M. Re: Li et al.: Long-term Assessment of Macular Atrophy in Patients with Age-Related Macular Degeneration Receiving Anti-Vascular Endothelial Growth Factor (Ophthalmol Retina. 2018;2:550-557). Ophthalmol Retina 2018; 2:e13-e14. [PMID: 31047504 DOI: 10.1016/j.oret.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/21/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Dan Călugăru
- Department of Ophthalmology, University of Medicine, Cluj-Napoca, Romania
| | - Mihai Călugăru
- Department of Ophthalmology, University of Medicine, Cluj-Napoca, Romania
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