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Mathis T, Holz FG, Sivaprasad S, Yoon YH, Eter N, Chen LJ, Koh A, Cunha de Souza E, Staurenghi G. Characterisation of macular neovascularisation subtypes in age-related macular degeneration to optimise treatment outcomes. Eye (Lond) 2022:10.1038/s41433-022-02231-y. [DOI: 10.1038/s41433-022-02231-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/24/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe aim of this review is to identify the common characteristics and prognoses of different subtypes of neovascular age-related macular degeneration (nAMD). We also propose recommendations on how to tailor treatments to the subtype of neovessels to optimise patient outcomes. The authors, selected members of the Vision Academy, met to discuss treatment outcomes in nAMD according to macular neovascularisation (MNV) subtypes, using evidence from a literature search conducted on the PubMed database (cut-off date: March 2019). This review article summarises the recommendations of the Vision Academy on how the characterisation of MNV subtypes can optimise treatment outcomes in nAMD. The identification of MNV subtypes has been facilitated by the advent of multimodal imaging. Findings from fluorescein angiography, indocyanine green angiography and spectral-domain optical coherence tomography collectively help refine and standardise the determination of the MNV subtype. To date, three subtypes have been described in the literature and have specific characteristics, as identified by imaging. Type 1 MNV is associated with better long-term outcomes but usually requires more intense anti-vascular endothelial growth factor dosing. Type 2 MNV typically responds quickly to treatment but is more prone to the development of fibrotic scars, which may be associated with poorer outcomes. Type 3 MNV tends to be highly sensitive to anti-vascular endothelial growth factor treatment but may be associated with a higher incidence of outer retinal atrophy, compared with other subtypes. Accurately assessing the MNV subtype provides information on prognosis and helps to optimise the management of patients with nAMD.
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Morphologic Predictors and Temporal Characteristics of Conversion from Nonexudative to Exudative Age-Related Macular Degeneration in the Fellow Eye. ACTA ACUST UNITED AC 2021; 5:126-140. [DOI: 10.1016/j.oret.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/18/2020] [Accepted: 07/08/2020] [Indexed: 01/01/2023]
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Fu DJ, Keenan TD, Faes L, Lim E, Wagner SK, Moraes G, Huemer J, Kern C, Patel PJ, Balaskas K, Sim DA, Bunce C, Stratton I, Keane PA. Insights From Survival Analyses During 12 Years of Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration. JAMA Ophthalmol 2021; 139:57-67. [PMID: 33211064 PMCID: PMC7677877 DOI: 10.1001/jamaophthalmol.2020.5044] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/05/2020] [Indexed: 01/01/2023]
Abstract
Importance Although multiple imputation models for missing data and the use of mixed-effects models generally provide better outcome estimates than using only observed data or last observation carried forward in clinical trials, such approaches usually cannot be applied to visual outcomes from retrospective analyses of clinical practice settings, also called real-world outcomes. Objective To explore the potential usefulness of survival analysis techniques for retrospective clinical practice visual outcomes. Design, Setting, and Participants This retrospective cohort study covered a 12-year observation period at a tertiary eye center. Of 10 744 eyes with neovascular age-related macular degeneration receiving anti-vascular endothelial growth factor (VEGF) therapy between October 28, 2008, and February 1, 2020, 7802 eyes met study criteria (treatment-naive, first-treated eyes starting anti-VEGF therapy). Eyes were excluded from the analysis if they received photodynamic therapy or macular laser, any previous anti-VEGF therapy, treatment with anti-VEGF agents other than ranibizumab or aflibercept, or had an unknown date or visual acuity (VA) value at first injection. Main Outcomes and Measures Kaplan-Meier estimates and Cox proportional hazards modeling were used to consider VA reaching an Early Treatment Diabetic Retinopathy Study (ETDRS) letter score of 70 (Snellen equivalent, 20/40) or better, duration of VA sustained at or better than 70 (20/40), and VA declining to 35 (20/200) or worse. Results A total of 7802 patients (mean [SD] age, 78.7 [8.8] years; 4776 women [61.2%]; and 4785 White [61.3%]) were included in the study. The median time to attaining a VA letter score greater than or equal to 70 (20/40) was 2.0 years (95% CI, 1.87-2.32) after the first anti-VEGF injection. Predictive features were baseline VA (hazard ratio [HR], 1.43 per 5 ETDRS letter score or 1 line; 95% CI, 1.40-1.46), baseline age (HR, 0.88 per 5 years; 95% CI, 0.86-0.90), and injection number (HR, 1.12; 95% CI, 1.10-1.15). Of the 4439 of 7802 patients (57%) attaining this outcome, median time sustained at an ETDRS letter score of 70 (20/40) or better was 1.1 years (95% CI, 1.1-1.2). Conclusions and Relevance In this cohort study, patients with neovascular age-related macular degeneration beginning anti-VEGF therapy were more likely to experience positive visual outcomes within the first 2.0 years after treatment, typically maintaining this outcome for 1.1 years but then deteriorating to poor vision within 8.7 years. These findings demonstrate the potential usefulness of the proposed analyses. This data set, combined with the statistical approach for retrospective analyses, may provide long-term prognostic information for patients newly diagnosed with this condition.
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Affiliation(s)
- Dun Jack Fu
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | - Tiarnan D. Keenan
- Department of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Livia Faes
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
- Eye Clinic of the Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Ernest Lim
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | - Siegfried K. Wagner
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | - Gabriella Moraes
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | - Josef Huemer
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
- Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Christoph Kern
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
- Department of Ophthalmology, University Hospital of Munich, Munich, Germany
| | - Praveen J. Patel
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | - Konstantinos Balaskas
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | - Dawn A. Sim
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Catey Bunce
- Gloucestershire Retinal Research Group, Gloucester, United Kingdom
| | - Irene Stratton
- National Institute for Health and Research Biomedical Center, Moorfields Eye Hospital, London, United Kingdom
| | - Pearse A. Keane
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
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Brown GC, Brown MM, Rapuano S, Boyer D. Cost-Utility Analysis of VEGF Inhibitors for Treating Neovascular Age-Related Macular Degeneration. Am J Ophthalmol 2020; 218:225-241. [PMID: 32565050 DOI: 10.1016/j.ajo.2020.05.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To perform 11- and 2-year health care sector (ophthalmic) and societal cost perspective reference case, cost-utility analyses comparing bevacizumab, ranibizumab, and aflibercept monotherapies for neovascular age-related macular degeneration (NVAMD). DESIGN Cost-utility analysis. METHODS The authors performed 11-year and 2-year ophthalmic and societal cost perspective, cost-utility analyses comparing bevacizumab, ranibizumab, and aflibercept monotherapies for neovascular age-related macular degeneration (NVAMD). We employed patient utilities, bilateral outcomes, 2018 U.S. dollars, vision-related mortality, a Medicare fee schedule, and CATT (Comparison of Age-Related Macular Degeneration Treatments) study and VIEW (VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD) trial. Cochrane data were also used. SETTING Center for Value-Based Medicine. Patient/study population: patients with NVAMD. INTERVENTION Cost-utility analyses using published data. Data-modeled 10-year vision outcomes were modeled forward to year 11. MAIN OUTCOME MEASUREMENT These included cost-utility ratios (CURs), costs, and quality-adjusted life-years (QALYs) gained. $100,00/QALY was considered the US cost-effectiveness upper limit. RESULTS Bevacizumab and ranibizumab each conferred an 11-year, 1.339 QALY gain versus observation. Aflibercept conferred a 1.380 QALY gain. Aflibercept conferred greater QALY gain for less cost than ranibizumab but was not cost-effective compared to bevacizumab ($1,151,451/QALY incremental CUR). The average ophthalmic cost perspective CUR for bevacizumab was $11,033/QALY, $79,600/QALY for ranibizumab, and $44,801/QALY for aflibercept. Eleven-year therapies saved a 1.0 year-of-life loss without treatment from the 11.0-year life expectancy. Early treatment was 138%-149% more cost-effective than late treatment. Two-year therapy prevented a 1-month-of-life loss, and revealed bevacizumab, ranibizumab, and aflibercept conferred 0.141, 0.141, and 0.164 QALY gains, respectively, with corresponding average CURs of $40,371/QALY, $335,726/QALY, and $168,006/QALY, respectively. CONCLUSIONS From an ophthalmic (medical) cost perspective, bevacizumab, ranibizumab, and aflibercept NVAMD monotherapies were all cost-effective over 11 years, with bevacizumab 6.21× more cost-effective than ranibizumab and 3.06× more cost-effective than aflibercept. Two-year modeling revealed bevacizumab was cost-effective, whereas ranibizumab and aflibercept were not. Early treatment was critical for obtaining optimal vision and cost-effectiveness, as is long-term follow-up and adherence to treatment.
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Sahoo NK, Mandadi SKR, Singh SR, Sacconi R, Iovino C, Peiretti E, Querques G, Chhablani J. Longitudinal changes in fellow eyes of choroidal neovascularization associated with central serous chorioretinopathy: Optical coherence tomography angiography study. Eur J Ophthalmol 2020; 31:1892-1898. [PMID: 32847399 DOI: 10.1177/1120672120952678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report longitudinal changes in fellow eyes of chronic central serous chorioretinopathy (CSCR) associated choroidal neovascularization (CNV) using optical coherence tomography angiography (OCTA) and determine factors affecting neovascular conversion. METHODS Medical records of patients with chronic CSCR complicated by CNV and a minimum follow up of 6 months were reviewed. OCT and OCTA features were analyzed at baseline and final follow up. Baseline factors were assessed for predictive value against presence of CNV at follow up and conversion to exudative form. RESULTS Twenty-six subjects (26 CNV and 26 fellow eyes) were included in the study and followed up for a mean period of 26 ± 17 months. Nine eyes had CNV network in fellow eye at baseline, out of which three (33%) had a conversion to exudative CNV. Among the remaining 17 eyes, one eye developed a new network during a period of 44 months. An increase in the size of network was seen from 0.886 ± 0.945 mm2 at baseline to 1.326 ± 1.263 mm2 at follow up. Baseline choroidal thickness at sub-fovea was 345.4 ± 74.9 microns in eyes having network at last visit, compared to 440.1 ± 73.7 microns in eyes having no network.(p < 0.001) None of the baseline variables were found to be significantly associated with conversion to exudative form or presence of CNV on follow up in multivariate analysis. CONCLUSION A conversion rate to exudative form was seen in 33% of fellow eyes with CNV. Relatively thinner choroid at baseline was associated with exudative conversion during follow up.
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Affiliation(s)
- Niroj Kumar Sahoo
- Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | | | - Sumit Randhir Singh
- Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Riccardo Sacconi
- Ospedale San Raffaele, Ophthalmology, Via Olgettina, Milano, Italy
| | - Claudio Iovino
- Department of Surgical Science, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Enrico Peiretti
- Department of Surgical Science, Eye Clinic, University of Cagliari, Cagliari, Italy
| | | | - Jay Chhablani
- Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA
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Chu C, Yu J, Ren E, Ou S, Zhang Y, Wu Y, Wu H, Zhang Y, Zhu J, Dai Q, Wang X, Zhao Q, Li W, Liu Z, Chen X, Liu G. Multimodal Photoacoustic Imaging-Guided Regression of Corneal Neovascularization: A Non-Invasive and Safe Strategy. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:2000346. [PMID: 32714751 PMCID: PMC7375239 DOI: 10.1002/advs.202000346] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/04/2020] [Indexed: 05/04/2023]
Abstract
Corneal neovascularization (CNV) is one of the main factors that induce blindness worldwide. However, current medical treatments cannot achieve non-invasive and safe inhibition of CNV. A noninvasive photoacoustic imaging (PAI)-guided method is purposed for the regression of CNV. PAI can monitor the oxygen saturation of cornea blood vessels through the endogenous contrast of hemoglobin and trace administrated drugs by themselves as exogenous contrast agents. An indocyanine green (ICG)-based nanocomposite (R-s-ICG) is prepared for CNV treatment via eye drops and subconjunctival injections. It is demonstrated that R-s-ICG can enrich corneal tissues and pathological blood vessels rapidly with minor residua in normal eyeball tissues. Anti-CNV treatment-driven changes in the blood vessels are assessed by real-time multimodal PAI in vivo, and then a safe laser irradiation strategy through the canthus is developed for phototherapy and gene therapy synergistic treatment. The treatment leads to the efficient inhibition of CNV with faint damages to normal tissues.
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Affiliation(s)
- Chengchao Chu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
| | - Jingwen Yu
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceSchool of MedicineXiamen UniversityXiamen361102China
| | - En Ren
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
| | - Shangkun Ou
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceSchool of MedicineXiamen UniversityXiamen361102China
| | - Yunming Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
| | - Yiming Wu
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceSchool of MedicineXiamen UniversityXiamen361102China
| | - Han Wu
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceSchool of MedicineXiamen UniversityXiamen361102China
| | - Yang Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
| | - Jing Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
| | - Qixuan Dai
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
| | - Xiaoyong Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
| | - Qingliang Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
| | - Wei Li
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceSchool of MedicineXiamen UniversityXiamen361102China
| | - Zuguo Liu
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceSchool of MedicineXiamen UniversityXiamen361102China
| | - Xiaoyuan Chen
- Laboratory of Molecular Imaging and NanomedicineNational Institute of Biomedical Imaging and Bioengineering (NIBIB)National Institutes of Health (NIH)BethesdaMD20892USA
| | - Gang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational MedicineSchool of Public HealthXiamen UniversityXiamen361102China
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Longitudinal Changes in Ganglion Cell-Inner Plexiform Layer of Fellow Eyes in Unilateral Neovascular Age-Related Macular Degeneration. Am J Ophthalmol 2020; 212:17-25. [PMID: 31830437 DOI: 10.1016/j.ajo.2019.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE To determine longitudinal changes in the ganglion cell-inner plexiform layer (GC-IPL) thickness of the fellow eyes of patients with neovascular age-related macular degeneration (AMD). DESIGN Prospective cohort study. METHODS Patients with unilateral neovascular AMD, unilateral polypoidal choroidal vasculopathy (PCV), and control subjects were included. After the initial visit, GC-IPL thickness was measured twice more with at least a 1-year interval between examinations using spectral domain optical coherence tomography. RESULTS Twenty-seven fellow eyes of patients with unilateral choroidal neovascularization (CNV), 33 fellow eyes of patients with unilateral PCV, and 35 eyes of control subjects were enrolled. The GC-IPL thickness of the fellow eyes was 78.41 ± 9.23, 81.20 ± 5.52, and 81.60 ± 3.83 μm in the CNV, PCV, and control groups, respectively, and they showed a significant change over time (P < .001, P = .001, and P = .003, respectively). The reduction rate of GC-IPL thickness was -0.88, -0.41, and -0.31 μm per year in the fellow eyes of the CNV, PCV, and control groups, respectively (CNV > PCV, control, P < .001). In a linear mixed model determination of factors associated with GC-IPL reduction in the fellow eyes of the CNV group, the interaction between baseline GC-IPL thickness and duration showed a significant result (P < .001). CONCLUSIONS The fellow eyes of patients with neovascular AMD showed a greater reduction rate of GC-IPL thickness compared with fellow eyes of patients with unilateral PCV and control subjects. In patients with unilateral neovascular AMD, fellow eyes with a thicker GC-IPL at baseline showed a greater reduction in GC-IPL thickness over time.
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Lee J, Choi S, Lee CS, Kim M, Kim SS, Koh HJ, Lee SC, Byeon SH. Neovascularization in Fellow Eye of Unilateral Neovascular Age-related Macular Degeneration According to Different Drusen Types. Am J Ophthalmol 2019; 208:103-110. [PMID: 31377285 DOI: 10.1016/j.ajo.2019.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/18/2019] [Accepted: 07/24/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the incidence of fellow eye (FE) neovascular age-related macular degeneration (nAMD) in patients with unilateral nAMD according to FE drusen type. DESIGN Retrospective cohort study. METHODS Between January 2013 and June 2016, 434 consecutive patients with naïve nAMD were enrolled. We selected 280 eligible patients with treatment-naïve, unilateral nAMD for analysis (280/280 = 100% patients were followed up at 2 years; 50/280 = 17.9% patients were followed up at 5 years). The incidence and hazard ratios (HR) of FE nAMD according to age, sex, choroidal thickness, nAMD subtype, and drusen type were analyzed. RESULTS The 5-year incidence of FE nAMD was 20.9%. The incidences of the soft plus subretinal drusenoid deposits (SDD), soft drusen only, and SDD only groups were 76.4%, 46.2%, and 25.7%, respectively; they were significantly higher than the no drusen group (vs 3.6%; P < .001, P < .001, P < .001). There was no significant difference between the pachydrusen and no drusen groups (7.1% vs 3.6%; P = .101). The multivariate Cox regression hazard model revealed older age (HR, 1.053; P = .031) and drusen type were significant (P = .001). Compared with the no drusen group, the soft drusen plus SDD, soft drusen only, and SDD groups showed an HR of 18.460 (P = .001), 8.302 (P = .015), and 5.465 (P = .082), respectively. Pachydrusen was not shown to be a significant risk factor compared to the no drusen group (HR, 2.417; P = .281). CONCLUSION The incidence of FE nAMD was significantly different with respect to drusen type. Soft drusen plus SDD had the highest risk of neovascular AMD, followed by soft drusen only and SDD only.
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Affiliation(s)
- Junwon Lee
- Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Seonghee Choi
- Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Human Barrier Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Human Barrier Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea.
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