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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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Boon J, Rojas-Carabali W, Asad Y, Lim JTY, Rajagopalan R, Agrawal R. Evaluation of a Digital Amsler Grid (PocDoc) for Macular Disease Screening: A Comparative Analysis with the Conventional Method. Ophthalmol Ther 2024; 13:1289-1301. [PMID: 38507191 DOI: 10.1007/s40123-024-00910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Macular diseases are major contributors to visual impairment and blindness worldwide. This study introduces PocDoc, a digital version of the conventional Amsler grid, aimed at enhancing the screening and monitoring of macular diseases. We conducted a comprehensive evaluation to compare the effectiveness of PocDoc against the conventional method. METHODS Our comparative analysis involved two distinct phases. Initially, we assessed the capability of both PocDoc and the conventional method in detecting central visual field abnormalities. This phase included a cohort of 72 healthy and 155 eyes affected by various conditions such as age-related macular degeneration (AMD), uveitis, polypoidal choroidal vasculopathy (PCV), and macular telangiectasia. We primarily focused on the area of compromise and observed the correlation between the results obtained from both methods, measuring their concordance using a correlation coefficient. In the second phase, we evaluated the accuracy of both methods in diagnosing AMD. This involved a group of 127 eyes, including 70 healthy and 57 AMD-affected eyes. We determined the sensitivity, specificity, and overall accuracy of each method in diagnosing AMD. RESULTS In the initial phase, both PocDoc and the conventional Amsler grid demonstrated a high correlation in detecting central visual field defects across various macular diseases (correlation coefficient > 0.9). In the second phase, focused on AMD diagnosis, PocDoc showed a sensitivity of 50%, specificity of 100%, and an overall accuracy of 78%. Comparatively, the conventional method exhibited a sensitivity of 49%, specificity of 100%, and accuracy of 77%. CONCLUSION PocDoc's digital Amsler grid exhibits comparable effectiveness to the conventional method in both detecting visual field abnormalities across a range of macular diseases and specifically in the diagnosis of AMD. The high correlation in results, combined with the digital advantages of PocDoc, such as ease of use and potential for telemedicine applications, suggests its viability as a valuable tool in the screening and monitoring of macular diseases.
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Affiliation(s)
- Joewee Boon
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - William Rojas-Carabali
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yusra Asad
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Jonathan Tzien Yih Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rajesh Rajagopalan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Duke NUS Medical School, Singapore, Singapore.
- Moorfields Eye Hospital, NHUS Foundation Trust, London, UK.
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Kuzucu Üşümüş SA, Koçak Altıntaş AG, Özdemir A, Aypak C. Using the Amsler Grid Test for Age-Related Macular Degeneration Screening. Turk J Ophthalmol 2024; 54:11-16. [PMID: 38385315 PMCID: PMC10895168 DOI: 10.4274/tjo.galenos.2023.04238] [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: 02/23/2024] Open
Abstract
Objectives To evaluate the use of the Amsler grid test (AGT) in screening for age-related macular degeneration (AMD), one of the most common causes of blindness, in primary healthcare settings. Materials and Methods The AGT was applied to 700 eyes of 355 people aged 50 and over who applied to a family health center in Ankara and had no eye complaints. The test was considered positive if the lines on the AGT card were seen as broken or curved, there was a difference in shape or size between the squares, or a color change or blurring was described in any area. An ophthalmologist was consulted if the AGT was positive in one or both eyes. Patients considered suitable by ophthalmologists were evaluated with optical coherence tomography. AGT results were compared with ophthalmologist examination and tomography findings in terms of AMD detection. Results The AGT was positive in 97 (13.9%) and negative in 603 (86.1%) out of 700 eyes included in the study. A total of 184 eyes, 79 with a positive AGT and 105 eyes with a negative test, were evaluated by an ophthalmologist. As a result of examinations and tests performed by ophthalmologists, AMD was detected in a total of 67 eyes: 42 of 79 eyes with positive AGT and 25 of 105 eyes with negative AGT but referred to an ophthalmologist for different reasons. In our study, the AGT had 62.7% sensitivity and 68.4% specificity. Conclusion The AGT is an inexpensive and easily applicable test. Although moderate sensitivity and specificity were found in our study; further studies are needed to evaluate the suitability of its use for AMD screening in primary care with limited facilities.
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Affiliation(s)
- Seyyide Ayşenur Kuzucu Üşümüş
- University of Health Sciences Türkiye, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Family Medicine, Ankara, Türkiye
| | - Ayşe Gül Koçak Altıntaş
- University of Health Sciences Türkiye, Ulucanlar Eye Training and Research Hospital, Clinic of Ophthalmology, Ankara, Türkiye
| | - Ayşe Özdemir
- University of Health Sciences Türkiye, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Family Medicine, Ankara, Türkiye
| | - Cenk Aypak
- University of Health Sciences Türkiye, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Family Medicine, Ankara, Türkiye
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4
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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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5
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Najjar RP, Sia JT, Lamoureux EL, Man REK. Associations between sleep and eye diseases: The concurrent promotion of sleep health and tackling knowledge gaps is key for better public health outcomes. Clin Exp Ophthalmol 2023. [PMID: 37193671 DOI: 10.1111/ceo.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Raymond P Najjar
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Josh Tjunrong Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ecosse L Lamoureux
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Ryan E K Man
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
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6
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Chaudhuri M, Hassan Y, Bakka Vemana PPS, Bellary Pattanashetty MS, Abdin ZU, Siddiqui HF. Age-Related Macular Degeneration: An Exponentially Emerging Imminent Threat of Visual Impairment and Irreversible Blindness. Cureus 2023; 15:e39624. [PMID: 37388610 PMCID: PMC10300666 DOI: 10.7759/cureus.39624] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Age-related macular degeneration (AMD) is a significant cause of blindness globally. With the exponential rise in the aging population, AMD is the third leading cause of visual impairment worldwide. Neovascular AMD (nAMD; Wet AMD) and geographical atrophy (GA, late-stage dry AMD) are the advanced AMD accountable for substantial cases of visual deterioration among the elderly. Our review of the literature depicted that notable risk factors include cigarette smoking, nutritional elements, cardiovascular disorders, and genetic markers, including genes regulating complement, lipid, and angiogenic pathways. Some studies have suggested a relative decline in the proportion of AMD cases in the last two decades attributable to novel diagnostic and therapeutic modalities. Accurate diagnosis is the result of a combination of clinical examination and imaging techniques, including retinal photography, angiography, and optical coherence tomography. The incorporation of dietary antioxidant supplements, explicitly lutein, slows the progression of the disease in advanced stages. The induction of vascular endothelial growth factor (VEGF) inhibitors in the treatment of neovascular AMD, often combined with other modalities, has shown an immensely favorable prognosis. Research to integrate gene therapy and regenerative techniques using stem cells is underway to further mitigate AMD-associated morbidity. It is imperative to establish screening and therapeutic guidelines for AMD to curtail the future social and financial burden and improve the diminishing quality of life among the elderly.
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Affiliation(s)
- Madhurima Chaudhuri
- Department of Ophthalmology, Medical College and Hospital, Kolkata, IND
- Ophthalmology, University of Illinois at Chicago, Chicago, USA
| | - Yusra Hassan
- Department of Ophthalmology, Mayo Hospital Lahore, Lahore, PAK
| | | | | | - Zain U Abdin
- Department of Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Humza F Siddiqui
- Department of Medicine, Jinnah Sindh Medical University, Karachi, PAK
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7
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Abd Rahman MH, Amirtharatnam P, Sharanjeet-Kaur S, Narayanasamy S, Mohd Rasdi HF, Catherine Bastion ML. Development of Knowledge, Attitude and Practice Questionnaire for age-related macular degeneration patients. Int J Ophthalmol 2023; 16:589-600. [PMID: 37077492 PMCID: PMC10089905 DOI: 10.18240/ijo.2023.04.13] [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: 10/01/2022] [Accepted: 02/16/2023] [Indexed: 04/05/2023] Open
Abstract
AIM To develop and validate a questionnaire to evaluate knowledge, attitude and practice of patients diagnosed with age-related macular degeneration (AMD) who have undergone intravitreal injection treatment. METHODS This study was conducted among patients diagnosed with AMD in Kuala Lumpur. The generation of the instrument included four phases which included item and domains development, content, face validity and exploratory factor analysis. Content validity and modified Kappa was used for validation of knowledge domain. Exploratory factor analysis was used for validation of both attitude and practice domains. Face validity was conducted in 12 patients, content validity was ascertained in 120 patients and test-retest reliability was determined in 39 patients with AMD. RESULTS Content validity index (CVI) and modified kappa showed excellent values for most items in the knowledge domain with CVI for item (I-CVI) values between 0.78-1.0 and Kappa values of >0.74. The Kaiser-Meyer-Olkin (KMO) sampling adequacy showed acceptable scores of 0.70 and 0.75 for both attitude and practice domains respectively and Bartlett's Test of sphericity were significant (χ2 =0.00, P<0.001). Factor analysis resulted in five factors with thirty items for attitude domain and four factors with twenty items for practice domain. The Cronbach's alpha showed acceptable values for all items in knowledge, attitude and practice domain with values >0.70 and good test-retest reliability. The final version of the questionnaire consisted of 93 items from four sections consisting of demographic details, knowledge, attitude and practice. CONCLUSION The findings of this validation and reliability study show that the developed questionnaire has a satisfactory psychometric property for measuring KAP of patients diagnosed with AMD undergoing intravitreal injection treatment.
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Affiliation(s)
- Mohd Harimi Abd Rahman
- Optometry and Vision Science Programme, Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 53000, Malaysia
| | - Prashanti Amirtharatnam
- Optometry and Vision Science Programme, Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 53000, Malaysia
| | - Sharanjeet Sharanjeet-Kaur
- Optometry and Vision Science Programme, Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 53000, Malaysia
| | - Sumithira Narayanasamy
- Optometry and Vision Science Programme, Center for Community Health Studies (Reach), Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur 53000, Malaysia
| | - Hanif Farhan Mohd Rasdi
- Occupational Therapy Programme, Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 53000, Malaysia
| | - Mae-Lynn Catherine Bastion
- Ophthalmology Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Pesonen T, Saarela KM, Falck A, Edgren J, Kyngäs H, Siira H. Visual impairment and the need for vision care services amongst older Finnish people receiving home care. Nurs Open 2023; 10:2519-2529. [PMID: 36564916 PMCID: PMC10006660 DOI: 10.1002/nop2.1510] [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: 07/28/2022] [Revised: 10/25/2022] [Accepted: 11/20/2022] [Indexed: 12/25/2022] Open
Abstract
AIM This study aimed to describe visual performance and the need for vision care services among Finnish older people receiving home care. We evaluated the applicability of the Resident Assessment Instrument of Home Care (RAI HC) in identifying visual impairment (VI) and the need for vision care services among older people. DESIGN A descriptive quantitative, cross-sectional design. METHODS Visual impairment and the need for vision care services for older people receiving home care (N = 70) were determined by an optometrist's screening examination and vision assessment by home care workers using the RAI HC instrument. In this study, the definition of visual impairment was visual acuity (VA) <0.63 (logMAR >0.2). RESULTS According to the distance VA measurements, 41% of the participants showed VI (<0.63) of the better eye, while the RAI HC assessment revealed VI among 36% of the participants. The Kappa value for interrater reliability in classifying VI was 0.137. The optometrist's vision screening examination recognized a previously unknown and unmet need for vision care services more than twice as often as the RAI HC assessment.
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Affiliation(s)
- Tiina Pesonen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Kaisa-Mari Saarela
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Aura Falck
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
| | - Johanna Edgren
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Heidi Siira
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
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Faes L, Golla K, Islam M, Lienhard KR, Schmid MK, Sim DA, Bachmann LM. System usability, user satisfaction and long-term adherence to mobile hyperacuity home monitoring-prospective follow-up study. Eye (Lond) 2023; 37:650-654. [PMID: 35292773 PMCID: PMC9998848 DOI: 10.1038/s41433-022-01959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the usability and long-term adherence to the mobile hyperacuity app Alleye in patients with retinal pathology. METHODS We enroled 72 patients (95 eyes) mainly treated for wet AMD (48/95; 50.5%). We calculated changes of clinical characteristics and the System Usability Score (SUS), and personal ratings of usefulness and number of tests performed per month at a follow-up visit of eighteen months. RESULTS At baseline, mean best corrected visual acuity (BCVA) was 74.9 letters (SD 14.8), mean age was 69.9 (SD 11.4) and 39/72 (54.2%) were female. Of included patients, 47/72 (65.2%) reported to use mobile devices daily. The retention rate until last follow-up was 73.6 % (53/72). The median SUS score at baseline was 90 (interquartile range (IQR) 82.5-95) and 92.5 (IQR 82.5-95) in the follow-up. No association between changes of SUS and clinical characteristics was seen. At baseline, 76.4% (55/72) stated that they would recommend the app to a friend, 83.3% (60/72) were very satisfied with the app and 58/72 (80.6%) of respondents said they trusted the app. These assessments remained similar among patients remaining on the program until the follow-up. Patients who dropped out of the study (n = 19) did not differ in age, gender, BCVA, and SUS at baseline, but stated that they did not use the mobile device daily (Odds Ratio 7.40 (95%CI: 2.32-23.65); p = 0.001). CONCLUSIONS The majority of users willing to perform home monitoring with the Alleye app are satisfied with the usability and have a positive attitude towards its trustworthiness and usefulness.
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Affiliation(s)
- Livia Faes
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- Moorfields Eye Hospital, London, UK
| | - Kathrin Golla
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | | | - Kenny R Lienhard
- Oculocare Medical AG, Zurich, Switzerland
- Medignition AG, Research Consultants, Zurich, Switzerland
| | - Martin K Schmid
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- Oculocare Medical AG, Zurich, Switzerland
| | | | - Lucas M Bachmann
- Oculocare Medical AG, Zurich, Switzerland.
- Medignition AG, Research Consultants, Zurich, Switzerland.
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Bjerager J, Schneider M, Potapenko I, van Dijk EHC, Faber C, Grauslund J, Pfau K, Huemer J, Muttuvelu DV, Rasmussen MLR, Sabaner MC, Subhi Y. Diagnostic Accuracy of the Amsler Grid Test for Detecting Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-analysis. JAMA Ophthalmol 2023; 141:315-323. [PMID: 36795396 DOI: 10.1001/jamaophthalmol.2022.6396] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Importance Patients with nonneovascular age-related macular degeneration (AMD) are encouraged to use the Amsler grid test for self-assessment to facilitate early diagnosis. The test is widely recommended, suggesting a belief that it signals worsening AMD, warranting its use in home monitoring. Objective To systematically review studies of the diagnostic test accuracy of the Amsler grid in the diagnosis of neovascular AMD and to perform diagnostic test accuracy meta-analyses. Data Sources A systematic literature search was conducted in 12 databases for relevant titles from database inception until May 7, 2022. Study Selection Studies included those with groups defined as having (1) neovascular AMD and (2) either healthy eyes or eyes with nonneovascular AMD. The index test was the Amsler grid. The reference standard was ophthalmic examination. After removal of obviously irrelevant reports, 2 authors (J.B. and M.S.) independently screened the remaining references in full text for potential eligibility. Disagreements were resolved by a third author (Y.S.). Data Extraction and Synthesis Two authors (J.B. and I.P.) independently extracted all data and evaluated quality and applicability of eligible studies using the Quality Assessment of Diagnostic Accuracy Studies 2. Disagreements were resolved by a third author (Y.S.). Main Outcomes and Measures Sensitivity and specificity of the Amsler grid for detecting neovascular AMD with comparators being either healthy control participants or patients with nonneovascular AMD. Results Of 523 records screened, 10 studies were included with a total of 1890 eyes (mean participant age ranging from 62 to 83 years). Sensitivity and specificity to diagnose neovascular AMD were 67% (95% CI, 51%-79%) and 99% (95% CI, 85%-100%), respectively, when comparators were healthy control participants and 71% (95% CI, 60%-80%) and 63% (95% CI, 49%-51%), respectively, when control participants were patients with nonneovascular AMD. Overall, potential sources of bias were low across studies. Conclusions and Relevance Although the Amsler grid is easy and inexpensive to use for detection of metamorphopsia, its sensitivity may be at levels typically not recommended for monitoring. Coupling this lower sensitivity with only moderate specificity to identify neovascular AMD in a population at risk, these findings suggest that such patients typically should be encouraged to undergo ophthalmic examination regularly, regardless of any results of Amsler grid self-assessment.
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Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Ivan Potapenko
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Ophthalmology, Haga Hospital, The Hague, the Netherlands
| | - Carsten Faber
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Kristina Pfau
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany.,Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Josef Huemer
- National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Danson V Muttuvelu
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,MitØje Aps, Skive, Denmark
| | - Marie L R Rasmussen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Cem Sabaner
- Department of Ophthalmology, Kütahya Health Sciences University, Evliya Celebi Training and Research Hospital, Kütahya, Turkey
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Perspectives on the Home Monitoring of Macular Disease. Ophthalmol Ther 2023; 12:1-6. [PMID: 36538241 PMCID: PMC9834460 DOI: 10.1007/s40123-022-00632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Recent advancements in imaging technology have led to increasing interest in home monitoring of macular disease. The prevalence of macular disease is projected to rise considerably over time, leading to a significant burden on hospital services for age-related macular degeneration and diabetic macular edema. Home monitoring has the potential to augment conventional hospital assessment and so enable improved access to clinical care for low- and moderate-risk patients, while also allowing sensitive detection of early signs of disease that may require prompt intervention. Despite this, there are significant considerations before large-scale implementation could be possible. These are related to both the current availability of home monitoring technology and the logistical barriers to its widespread introduction. Access to home monitoring is also likely to be more challenging in lower-income communities and countries, with subsequent implications for health inequality that will need to be considered and addressed appropriately.
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Kielwasser G, Kodjikian L, Dot C, Burillon C, Denis P, Mathis T. Real-Life Value of the Odysight ® Application in At-Home Screening for Exudative Recurrence of Macular Edema. J Clin Med 2022; 11:jcm11175010. [PMID: 36078941 PMCID: PMC9457015 DOI: 10.3390/jcm11175010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022] Open
Abstract
Background: The aim of this study was to describe the value of the Odysight® application in addition to a classical follow-up regimen in the detection of exudative recurrences in patients with macular edema. Methods: We conducted an observational, multicenter, retrospective study. The Odysight® application includes a visual acuity (VA) test that can lead to alerts in case of a drop of >5 VA letters on two successive tests. The efficacy of the alerts in detecting exudative recurrence was studied. Results: A total of 149 eyes of 123 patients were included. The sensitivity of alerts for the detection of recurrence was 30.8% (95% CI [17.6; 44.0]) and its specificity was 83.7% (95% CI [73.2; 94.3]. A better baseline VA was found to be significantly associated with a better retention of the application (OR = 0.05, 95% CI [0.002; 0.62]; p = 0.045). Of the 12/39 alerts that detected a recurrence, eight (20.5% of all alerts) resulted in the scheduling or advancement of an intravitreal injection. Conclusions: In the present study, the sensitivity and positive predictive value of the Odysight® application seems low but its use in addition to the usual follow-up of the patient can detect, in certain cases, an early recurrence and thus allow an anticipated readjustment of the treatment.
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Affiliation(s)
- Gauthier Kielwasser
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- Service d’Ophtalmologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Laurent Kodjikian
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- Laboratoire UMR-CNRS 5510 Matéis, 69100 Villeurbanne, France
| | - Corinne Dot
- Service d’Ophtalmologie, Hôpital D’instruction des Armées Desgenettes, 69003 Lyon, France
| | - Carole Burillon
- Service d’Ophtalmologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Philippe Denis
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Thibaud Mathis
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- Laboratoire UMR-CNRS 5510 Matéis, 69100 Villeurbanne, France
- Correspondence: ; Tel.: +33-(0)-4-26-10-93-21
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13
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Waisberg E, Ong J, Paladugu P, Zaman N, Kamran SA, Lee AG, Tavakkoli A. Optimizing Screening for Preventable Blindness With Head-Mounted Visual Assessment Technology. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2022. [DOI: 10.1177/0145482x221124186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Joshua Ong
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Phani Paladugu
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Andrew G. Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TE, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
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14
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von der Burchard C, Sudkamp H, Tode J, Ehlken C, Purtskhvanidze K, Moltmann M, Heimes B, Koch P, Münst M, Vom Endt M, Kepp T, Theisen-Kunde D, König I, Hüttmann G, Roider J. Self-Examination Low-Cost Full-Field Optical Coherence Tomography (SELFF-OCT) for neovascular age-related macular degeneration: a cross-sectional diagnostic accuracy study. BMJ Open 2022; 12:e055082. [PMID: 35760534 PMCID: PMC9237881 DOI: 10.1136/bmjopen-2021-055082] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Self-Examination Low-Cost Full-Field Optical Coherence Tomography (SELFF-OCT) is a novel OCT technology that was specifically designed for home monitoring of neovascular age-related macular degeneration (AMD). First clinical findings have been reported before. This trial investigates an improved prototype for patients with AMD and focusses on device operability and diagnostic accuracy compared with established spectral-domain OCT (SD-OCT). DESIGN Prospective single-arm diagnostic accuracy study. SETTING Tertiary care centre (University Eye Clinic). PARTICIPANTS 46 patients with age-related macular degeneration. INTERVENTIONS Patients received short training in device handling and then performed multiple self-scans with the SELFF-OCT according to a predefined protocol. Additionally, all eyes were examined with standard SD-OCT, performed by medical personnel. All images were graded by at least 2 masked investigators in a reading centre. PRIMARY OUTCOME MEASURE Rate of successful self-measurements. SECONDARY OUTCOME MEASURES Sensitivity and specificity of SELFF-OCT versus SD-OCT for different biomarkers and necessity for antivascular endothelial growth factor (anti-VEGF) treatment. RESULTS In 86% of all examined eyes, OCT self-acquisition resulted in interpretable retinal OCT volume scans. In these patients, the sensitivity for detection of anti-VEGF treatment necessity was 0.94 (95% CI 0.79 to 0.99) and specificity 0.95 (95% CI 0.82 to 0.99). CONCLUSIONS SELFF-OCT was used successfully for retinal self-examination in most patients, and it could become a valuable tool for retinal home monitoring in the future. Improvements are in progress to reduce device size and to improve handling, image quality and success rates. TRIAL REGISTRATION NUMBER DRKS00013755, CIV-17-12-022384.
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Affiliation(s)
| | | | - Jan Tode
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Cristoph Ehlken
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | | | - Britta Heimes
- Department of Ophthalmology, St. Franziskus-Hospital, Münster, Germany
| | - Peter Koch
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | | | | | - Timo Kepp
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | | | - Inke König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lubeck, Germany
| | - Gereon Hüttmann
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, Lubeck, Germany
| | - Johann Roider
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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15
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Jeffrey BG, Flynn OJ, Huryn LA, Pfau M, Cukras CA. Scotopic Contour Deformation Detection Reveals Early Rod Dysfunction in Age-Related Macular Degeneration With and Without Reticular Pseudodrusen. Invest Ophthalmol Vis Sci 2022; 63:23. [PMID: 35749129 PMCID: PMC9234356 DOI: 10.1167/iovs.63.6.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to investigate scotopic contour deformation detection (sCDD), and its structural determinants, in participants with intermediate age-related macular degeneration (iAMD) with or without reticular pseudodrusen (RPD). Methods Forty-one participants (aged 58–89 years), including 9 with iAMD and RPD, 16 with iAMD only, and 16 controls, underwent functional testing. The sCDD was evaluated with radial frequency arcs presented at 4 loci: ±4 degrees and 8 degrees vertical eccentricity. Scotopic thresholds and dark adaptation (DA) were measured at the same loci. Retinal layers of spectral domain optical coherence tomography (SD-OCT) volume scans were segmented. To establish the concurrent validity of the functional test, we evaluated the fraction of variability in sCDD thresholds explained by SD-OCT data. Results The iAMD group had significantly worse sCDD thresholds compared with controls (8 degrees inferior retina: P = 0.004 and the 4 degrees loci: P < 0.02 for both). Elevated sCDD thresholds were observed in iAMD and RPD eyes at loci with normal scotopic thresholds; the opposite was rarely encountered. Elevated sCDD thresholds were also observed in iAMD eyes with normal DA. Elevated sCDD thresholds were associated with increased age and presence of late AMD in the fellow eye. The optimal machine learning model predicted 16% of variability (cross-validated R2) in sCDD thresholds at 8 degrees. Discussion A novel scotopic contour deformation task can provide unique information about rod dysfunction in participants with iAMD and RPD not observed with structural and other functional assessments. Rod dysfunction observed with scotopic contour deformation testing was associated with factors linked to risk of AMD progression.
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Affiliation(s)
- Brett G Jeffrey
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Oliver J Flynn
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Laryssa A Huryn
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Maximilian Pfau
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States.,University of Bonn, Bonn, Germany
| | - Catherine A Cukras
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
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16
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Telemedicine for the Diagnosis and Management of Age-Related Macular Degeneration: A Review. J Clin Med 2022; 11:jcm11030835. [PMID: 35160286 PMCID: PMC8836711 DOI: 10.3390/jcm11030835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 01/30/2023] Open
Abstract
Use of ophthalmic telemedicine for patients with age-related macular degeneration (AMD) has shown remarkable advances over recent years. The recent COVID pandemic accelerated this transition since in-person evaluation of elderly patients at high risk for advanced AMD and severe vision loss were also at higher risk for complications from COVID infection. To date, ophthalmic telemedicine has been successfully used in remote retinal consultation by general ophthalmologists for AMD management, hybrid testing visits with both in-office testing and remote evaluation, as well as early successes in home-based remote monitoring of patients with high-risk AMD. We therefore review the current literature and evidence base related to ophthalmic telemedicine for AMD.
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17
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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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18
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Hu ML, Ayton LN, Jolly JK. The Clinical Use of Vernier Acuity: Resolution of the Visual Cortex Is More Than Meets the Eye. Front Neurosci 2021; 15:714843. [PMID: 34675763 PMCID: PMC8523788 DOI: 10.3389/fnins.2021.714843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/15/2021] [Indexed: 01/27/2023] Open
Abstract
Vernier acuity measures the ability to detect a misalignment or positional offset between visual stimuli, for example between two vertical lines when reading a vernier scale. It is considered a form of visual hyperacuity due to its detectable thresholds being considerably smaller than the diameter of a foveal cone receptor, which limits the spatial resolution of classical visual acuity. Vernier acuity relies heavily on cortical processing and is minimally affected by optical media factors, making it a useful indicator of cortical visual function. Vernier acuity can be measured, usually in seconds of arc, by freely available automated online tools as well as via analysis of steady state visual-evoked potentials, which allows measurement in non- or pre-verbal subjects such as infants. Although not routinely measured in clinical practice, vernier acuity is known to be reduced in amblyopia, glaucoma and retinitis pigmentosa, and has been explored as a measure of retinal or neural visual function in the presence of optical media opacities. Current clinical utility includes a home-based vernier acuity tool, preferential hyperacuity perimetry, which is used for screening for choroidal neovascularisation in age-related macular degeneration. This review will discuss the measurement of vernier acuity, provide a current understanding of its neuro-ophthalmic mechanisms, and finally explore its utility through a clinical lens, along with our recommendations for best practice.
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Affiliation(s)
- Monica L Hu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Lauren N Ayton
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Jasleen K Jolly
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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19
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Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group. Eye (Lond) 2021; 34:1-51. [PMID: 32504038 DOI: 10.1038/s41433-020-0961-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.
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20
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Hanumunthadu D, Lescrauwaet B, Jaffe M, Sadda S, Wiecek E, Hubschman JP, Patel PJ. Clinical Update on Metamorphopsia: Epidemiology, Diagnosis and Imaging. Curr Eye Res 2021; 46:1777-1791. [PMID: 33825600 DOI: 10.1080/02713683.2021.1912779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To discuss the pathophysiology of metamorphopsia, its characterisation using retinal imaging and methods of assessment of patient symptoms and visual function.Methods: A literature search of electronic databases was performedResults: Metamorphopsia has commonly been associated with vitreomacular interface disorders (such as epiretinal membrane) and has also regularly been noted in diseases of the retina and choroid, particularly age-related macular degeneration and central serous chorioretinopathy. Developments in optical coherence tomography retinal imaging have enabled improved imaging of the foveal microstructure and have led to the localisation of the pathophysiology of metamorphopsia within the retinal layers of the macula. Alteration of alignment of inner and outer retinal layers at various retinal loci has been identified using multimodal imaging in patients with metamorphopsia in a range of conditions. Although the Amsler Grid assessment of metamorphopsia is a useful clinical indicator, new emerging methods of metamorphopsia assessment with psychophysical tests such as M-CHARTS and preferential hyperacuity perimetry, have been developed.Conclusions: It appears that there is a complex relationship between visual acuity and metamorphopsia symptoms that vary between retinal conditions. Although metamorphopsia has traditionally been challenging to measure in the clinic, advances in technology promise more robust, easy-to-use tests. It is possible that home assessment of metamorphopsia, particularly in conditions such as age-related macular degeneration, may help to guide the need for further clinic evaluation and consideration of treatment.
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Affiliation(s)
- Daren Hanumunthadu
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | | | - Myles Jaffe
- Innova Medical Communications, LLC, Tustin, California, USA
| | - Srinivas Sadda
- Doheny Eye Institute, University of California, Los Angeles, California, USA
| | - Emily Wiecek
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jean Pierre Hubschman
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
| | - Praveen J Patel
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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21
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Wong TY, Lanzetta P, Bandello F, Eldem B, Navarro R, Lövestam-Adrian M, Loewenstein A. CURRENT CONCEPTS AND MODALITIES FOR MONITORING THE FELLOW EYE IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: An Expert Panel Consensus. Retina 2021; 40:599-611. [PMID: 32032258 PMCID: PMC7099845 DOI: 10.1097/iae.0000000000002768] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neovascular age-related macular degeneration in one eye is a major risk factor for developing neovascular age-related macular degeneration in the fellow eye; effective monitoring is therefore critical. This review summarizes existing and developing methods to monitor the fellow eye of patients with unilateral neovascular age-related macular degeneration and provides guidance for patients and clinicians. The presence of neovascular age-related macular degeneration (nAMD) in one eye is a major risk factor for the development of disease in the fellow eye. Several methods exist to help physicians monitor the fellow eye, with new technologies becoming increasingly available.
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Affiliation(s)
- Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute University, Scientific Institute San Raffaele, Milan, Italy
| | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Rafael Navarro
- Retina and Vitreous Department, Institute of Ocular Microsurgery, Barcelona, Spain
| | | | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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USING MICROPERIMETRY AND LOW-LUMINANCE VISUAL ACUITY TO DETECT THE ONSET OF LATE AGE-RELATED MACULAR DEGENERATION: A LEAD Study Report. Retina 2021; 41:1094-1101. [PMID: 33009222 DOI: 10.1097/iae.0000000000002982] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the performance of microperimetry and low-luminance visual acuity for detecting late age-related macular degeneration (AMD) onset. METHODS Two hundred ninety-two individuals with bilateral large drusen in the Laser Intervention in the Early Stages of AMD study underwent best-corrected visual acuity, low-luminance visual acuity, and microperimetry testing as well as multimodal imaging to detect late (neovascular or atrophic) AMD onset. The performance of the change in the measurement from baseline of each of visual function test for detecting late AMD onset was compared. RESULTS The area under the receiver operating characteristic curve for detecting neovascular and atrophic AMD onset was not significantly different for low-luminance visual acuity (area under the receiver operating characteristic curve = 0.71 and 0.56, respectively) and microperimetry (area under the receiver operating characteristic curve = 0.82 and 0.62, respectively) compared with best-corrected visual acuity (area under the receiver operating characteristic curve = 0.57 and 0.56, respectively; P ≥ 0.126 for all). There was also only a fair degree of agreement between the three visual function measures for detecting the onset of neovascular and atrophic AMD (κ ≥ 0.24). CONCLUSION Microperimetry, low-luminance visual acuity, and best-corrected visual acuity demonstrate limited performance for detecting the earliest onset of late AMD. It remains to be established whether they perform better than current methods designed to enable self-detection of neovascular AMD onset, such as Amsler grid testing.
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Patterns and Characteristics of a Clinical Implementation of a Self-Monitoring Program for Retina Diseases during the COVID-19 Pandemic. Ophthalmol Retina 2021; 5:1245-1253. [PMID: 33610833 PMCID: PMC8160297 DOI: 10.1016/j.oret.2021.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/27/2021] [Accepted: 02/12/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE We describe the large-scale self-initiated recruitment of patients to a self-monitoring initiative for macular pathologic features during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN Observational study with retrospective analysis. PARTICIPANTS A total of 2272 patients from the Singapore National Eye Centre (SNEC) whose visits were rescheduled over lockdown (April 13-June 1, 2020) were offered participation in a self-monitoring initiative administered by SNEC with the Alleye application (Switzerland) as the testing instrument. METHODS This was an observational study with retrospective analysis. Demographics and characteristics were compared between those who signed up and those who did not. Similar comparisons were made between patients who complied with the initiative versus those who did not. Outcomes were tracked for 6 months starting from the commencement of lockdown. MAIN OUTCOME MEASURES Participation and compliance rates and characteristics of patients who were more likely to participate and comply with the initiative. RESULTS Seven hundred thirty-two patients (32%) participated in this self-monitoring initiative. Those who participated were younger (62 years of age vs. 68 years of age; P < 0.001), men, and living with family. Patients not receiving treatment and those with poorer vision in the worse-seeing eye were more likely to participate. When grouped according to diagnosis, the proportion who participated was highest for diabetic macular edema (52%), nonneovascular age-related macular degeneration (AMD; 42%), diabetic retinopathy (35%), retinal vein occlusions (18%), and neovascular AMD (15%; P < 0.001). Testing compliance rate was 43% (315/732). Patients who complied with the initiative were older, were receiving treatment, and had poorer vision in the worse-seeing eye. Trigger events occurred in 33 patients, with 5 patients having clinically verified disease progression (1.6%). CONCLUSIONS We provide clinical data on characteristics of patients with stable retinal diseases who were offered, participated in, and complied with a self-monitoring program. The lower participation rate compared with standardized clinical studies reflects the difficulties in implementation for such initiatives in clinical settings. Despite this, self-monitoring continues to show promise in relieving clinic resources, suggesting the feasibility of scaling such programs beyond the COVID-19 pandemic.
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False alarms and the positive predictive value of smartphone-based hyperacuity home monitoring for the progression of macular disease: a prospective cohort study. Eye (Lond) 2021; 35:3035-3040. [PMID: 33414531 PMCID: PMC7790308 DOI: 10.1038/s41433-020-01356-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/27/2022] Open
Abstract
Background Home monitoring of hyperacuity allows early detection of progression in exudative neovascular age-related macular degeneration (nvAMD) and diabetic macular oedema (DMO). However, false alarms may pose a significant burden to both patients and healthcare professionals alike. Purpose To assess the false alarm rate and positive predictive value of smartphone-based home monitoring of nvAMD and DMO. Methods Patients treated with anti-angiogenic therapy in a pro re nata scheme for nvAMD or DMO at the Medical Retina service (Lucerne, Switzerland) between March and June 2016 were included in this prospective cohort study. The home monitoring test Alleye (Oculocare Ltd, Switzerland) provided a session score from 0–100 in addition to a traffic-light system feedback via the smartphone application. Three consecutive “red” scores were considered as a positive test or alarm signal. Specificity, 1-specificity (false alarm rate) and the predictive value for optical coherence tomography-based disease progression were analysed. Results 73 eyes of 56 patients performed 2258 tests in 222 “follow-up periods”. Progression was observed in 141 periods (63.5%). The specificity of the test was 93.8% (95% CI: 86.2–98.0%), the false alarm rate 6.1% (95% CI: 2.0–13.8%), and the positive predictive value 80.0% (95% CI: 59.3–93.2%) for the detection of progression. Conclusion False alarm rates for the detection of progression in macular disease via home monitoring is low. These findings suggest that home monitoring may be a useful adjunct for remote management of nvAMD and DMO.
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25
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Ung C, Lains I, Miller JW, Kim IK. Current Management of Age-Related Macular Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1256:295-314. [PMID: 33848007 DOI: 10.1007/978-3-030-66014-7_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Age-related macular degeneration (AMD) remains a leading cause of blindness worldwide. The assessment and management of patients with this condition has evolved in the last decades. In this chapter, current standards for diagnosis, follow-up, and treatment of patients with AMD are reviewed and summarized. Namely, we highlight how current assessment has moved from conventional ophthalmoscopy and fluorescein angiography testing to a multimodal approach, and its important advantages. Alternatives to visual acuity for functional assessment of patients with AMD are also presented. Regarding strategies for follow-up and treatment, we provide specific information for the different stages (i.e., early, intermediate, and late) and forms (for example, choroidal neovascularization and geographic atrophy) of AMD. Specifically, we discuss the relevance and options for self-monitoring and non-pharmacological interventions. Additionally, a summary of the important trials (both on exudative and non-exudative AMD) that have helped inform clinical practice is provided, including data on antiangiogenic agents currently available, and outcomes of the different regimens that have been studied. The influence of advances in imaging on treatment strategies is also discussed.In summary, this chapter is a resource for all clinicians engaged in providing state of the art care for patients with AMD, and can help improve diagnosis, management, and outcomes of individuals with this blinding condition.
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Affiliation(s)
- Cindy Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ines Lains
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ivana K Kim
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Gocuk SA, Lee J, Keller PR, Ayton LN, Guymer RH, McKendrick AM, Downie LE. Clinical audit as an educative tool for optometrists: an intervention study in age‐related macular degeneration. Ophthalmic Physiol Opt 2020; 41:53-72. [DOI: 10.1111/opo.12754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/13/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sena A Gocuk
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
| | - Ji‐hyun Lee
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
| | - Peter R Keller
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
| | - Lauren N Ayton
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
- Department of Surgery (Ophthalmology) The University of Melbourne Parkville Australia
- Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital Melbourne Australia
| | - Robyn H Guymer
- Department of Surgery (Ophthalmology) The University of Melbourne Parkville Australia
- Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital Melbourne Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Australia
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27
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Faes L, Rosenblatt A, Schwartz R, Touhami S, Ventura CV, Chatziralli IP, Ruiz-Medrano J, Vogt D, Savastano A, Ruiz-Garcia H, Pohlmann D, Loewenstein A. Overcoming barriers of retinal care delivery during a pandemic—attitudes and drivers for the implementation of digital health: a global expert survey. Br J Ophthalmol 2020; 105:1738-1743. [DOI: 10.1136/bjophthalmol-2020-316882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/11/2020] [Accepted: 09/04/2020] [Indexed: 01/02/2023]
Abstract
Background/AimsThe SARS-CoV-2 pandemic has imposed barriers to retinal care delivery worldwide. In this context, retinal services are exploring novel ways to ensure access to healthcare.MethodsWe conducted a worldwide survey among retinal specialists between March 31, 2020 and April 12, 2020. The expert survey was developed on the basis of focus group discussions involving retinal specialists and literature searches. It included 44 questions on alternative ways of care provision including digital health domains such as teleophthalmology, home monitoring or decentralised patient care.Results214 retinal experts participated in the survey, of which 120 (56.1%) had more than 15 years of experience in ophthalmology. Most participants were clinicians (n=158, 73.9%) practising in Western Europe (n=159, 74%). In the majority of institutions, teleophthalmology, home monitoring and decentralised patient care have not been implemented before the pandemic (n=46, 21.8.1%; n=64, 29.9%; n=38, 19.1%). During the pandemic, the use of teleophthalmology and home monitoring increased significantly (n=105, p<0.001; n=90, p<0.001). In the subgroup of institutions reporting no teleophthalmology service before and implementing a service during the pandemic (34/70, 48.6%), reimbursement was the sole significant parameter (OR 9.62 (95% CI 2.42 to 38.16); p<0.001).ConclusionDigital health is taking the centre stage tackling unpreceded challenges of retinal care delivery during the SARS-CoV-2 pandemic and may sustainably change the way we practice ophthalmology.
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Validation of a novel functional test for assessing metamorphopsia using epiretinal membranes as a model. Sci Rep 2020; 10:14938. [PMID: 32913214 PMCID: PMC7484749 DOI: 10.1038/s41598-020-71627-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/03/2020] [Indexed: 11/09/2022] Open
Abstract
Current tests for assessing metamorphopsia do not account for confounders such as perceptual filling-in and spatial redundancy, which affect its sensitivity and repeatability. This proof-of-concept study aimed to assess the performance of a novel laboratory-based psychophysical test (Line Sag Test, LST) which addresses these issues for quantification of metamorphopsia in idiopathic epiretinal membranes. The LST quantifies perpendicular metamorphopsia at three eccentricities (3°, 6°, and 9°) along eight meridians (45° steps). Metamorphopsia was assessed using the LST and Amsler grid and the hit rates of both tests for detecting metamorphopsia were compared. Normal metamorphopsia scores using the LST did not differ significantly from 0 and fell within one step-size (p = 0.500). The LST detected significantly more cases of metamorphopsia than the Amsler grid (14/21 versus 3/21) (p = 0.003). Similarly, significantly more cases of visual distortions in asymptomatic iERMs were detected using the LST than the Amsler grid (11/18 versus 0/18) (p = 0.008). The LST has a higher hit rate compared to the Amsler grid (67% versus 14%). This work demonstrates a psychophysically-robust functional test addressing perceptual confounders is more sensitive for quantifying and localising metamorphopsia in macular disease, particularly in asymptomatic disease.
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29
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Faes L, Bachmann LM, Sim DA. Home monitoring as a useful extension of modern tele-ophthalmology. Eye (Lond) 2020; 34:1950-1953. [PMID: 32405047 PMCID: PMC7784909 DOI: 10.1038/s41433-020-0964-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Livia Faes
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Cantonal Hospital Lucerne, Lucerne, Switzerland
| | | | - Dawn A Sim
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
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30
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Kumar A, Narde H. Commentary: Teleconsultation at a tertiary care set-up during COVID-19 lockdown in India. Indian J Ophthalmol 2020; 68:1384-1385. [PMID: 32587170 PMCID: PMC7574121 DOI: 10.4103/ijo.ijo_1874_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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Determination of scotopic and photopic conventional visual acuity and hyperacuity. Graefes Arch Clin Exp Ophthalmol 2019; 258:129-135. [PMID: 31754827 DOI: 10.1007/s00417-019-04505-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/23/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Visual acuity (VA) is an important determinant of visual function. Here we establish procedures and recommendations for VA testing extending beyond the classical VA and thus make them available for future studies of visual function in health and disease. Specifically, we provide reference values for photopic and scotopic conventional uncrowded visual acuity (cVA) and Vernier-hyperacuity (hVA) and assess their reproducibility and dependence on contrast polarity. METHODS For ten observers with normal vision, we determined photopic ("p"; maximal luminance 220 cd/m2) and scotopic ("s"; maximal luminance 0.004 cd/m2; 40 min of dark adaptation) cVA and hVA, for two contrast polarities i.e. black optotypes on white background and vice versa. To assess intersession effects, two sets of measurements were obtained on different days. RESULTS Compared to pcVA (1.32 decimal VA; - 0.12 ± 0.02 LogMAR), the phVA (14.45 decimal VA; - 1.16 ± 0.04 LogMAR) scaled (in terms of decimal visual acuity) on average with a factor 11.0, the scVA (0.12 decimal VA; 0.91 ± 0.03 LogMAR) with a factor of 0.1, and the shVA (1.47 decimal VA; - 0.17 ± 0.02 LogMAR) with a factor of 1.1. There were neither significant effects of contrast polarity (p > 0.12), nor of session (p > 0.28). CONCLUSIONS Our approach optimises integrated photopic and scotopic cVA and hVA measurements for general use and thus encourages the integration of these important measures of scotopic visual function in future studies. The absence of strong intersession effects demonstrates that no dedicated training session is needed to obtain scotopic and hVA measurements. The combined measures of scotopic and photopic VAs open a field of applications to study interplay and plasticity of the retinal photoreceptor systems and cortical processing in health and visual disease. As a rule of thumb, hyperacuity is 10× higher both in the photopic and scotopic range than conventional acuity. Thus, scotopic hyperacuity is close to photopic conventional acuity.
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Chamard C, Lacombe S, Navarre S, Rohart C, Daures JP, Allieu S. Is current age related macular degeneration self-monitoring a good tool for detecting exudative recurrence? J Fr Ophtalmol 2019; 42:1049-1055. [PMID: 31727329 DOI: 10.1016/j.jfo.2019.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the ability of patients with exudative AMD to detect exudative recurrence. Another objective was to assess if self-monitoring, as currently taught, improves this ability. MATERIALS AND METHODS An observational cross-sectional study was carried out in the ophthalmology center of BeauSoleil clinic in Montpellier between March 1 and April 1 2016. Inclusion criteria were presence of neovascular age related macular degeneration treated with the loading dose of three monthly intravitreal anti-VEGF injections, with at least one injection in the past 12 months and at least one exudative recurrence. All patients underwent a visual acuity measurement with ETDRS charts at 4 meters. A questionnaire assessed familiarity with the Amsler grid and its proper use, performance of and type of self-monitoring at home and the subjective feeling of an exudative recurrence at the visit with a 5-level Likert scale. RESULTS A total of 94 eyes of 70 patients were included in this study with 69.0 % women and a median (interquartile range) age of 83 (77-96) years. Among them, 81 % performed regular self-monitoring, mostly with environmental Amsler tests (70 %). Only 63 % of the patients knew of the Amsler grid, among which 52 % used it correctly. Sensitivity (95 % confidence interval, 95 % CI) and specificity (95 % CI) of the subjective sensation of exudative recurrence were 0.32 (0.14-0.55) and 0.85 (0.74-0.92), respectively, for the entire population. Sensitivity (95 % CI) and specificity (95 % CI) were 0.33 (0.13-0.59) and 0.85 (0.74-0.93); 0.25 (0.0063-0.81) and 0.82 (0.48-0.98), respectively, in patients performing and not performing self-monitoring. CONCLUSION Patients' prediction in wet AMD is insufficient in detecting exudative recurrences, even if regular self-monitoring with Amsler grid or environmental Amsler is performed.
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Affiliation(s)
- C Chamard
- Service d'ophtalmologie CHRU Montpellier, hôpital Gui de-Chauliac, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
| | - S Lacombe
- Centre d'ophtalmologie, clinique BeauSoleil Montpellier, 119, avenue de Lodève, 34070 Montpellier, France
| | - S Navarre
- Centre d'ophtalmologie, clinique BeauSoleil Montpellier, 119, avenue de Lodève, 34070 Montpellier, France
| | - C Rohart
- Centre d'ophtalmologie, clinique BeauSoleil Montpellier, 119, avenue de Lodève, 34070 Montpellier, France
| | - J-P Daures
- Centre d'ophtalmologie, clinique BeauSoleil Montpellier, 119, avenue de Lodève, 34070 Montpellier, France
| | - S Allieu
- Centre d'ophtalmologie, clinique BeauSoleil Montpellier, 119, avenue de Lodève, 34070 Montpellier, France
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Mao X, You Z, Cheng Y. Outcomes of 23G vitrectomy and internal limiting membrane peeling with brilliant blue in patients with myopic foveoschisis from a retrospective cohort study. Exp Ther Med 2019; 18:589-595. [PMID: 31258694 PMCID: PMC6566017 DOI: 10.3892/etm.2019.7610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/21/2019] [Indexed: 11/18/2022] Open
Abstract
The aim of the present study was to investigate whether internal limiting membrane (ILM) peeling in patients with myopic foveoschisis (MF) treated with 23-gauge (23G) vitrectomy improved the anatomical and visual outcomes. In this retrospective cohort study, from March 2014 to August 2017 at the Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University (Nanchang, China), 60 patients (60 eyes) with MF underwent 23G vitrectomy. The patients were grouped according to whether they underwent brilliant blue-assisted ILM peeling (peeling group) or not (non-peeling group). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography were measured. There were 30 eyes in each group and the baseline characteristics were similar (all P>0.05). BCVA improved in 24 eyes (80%) in the peeling group and 25 eyes (83.3%) in the non-peeling group (P=0.922). Preoperative CMT was not significantly different between the peeling and non-peeling group (458±62.2 vs. 460±61.1 µm, respectively, P=0.229). However, postoperative CMT was significantly different between the peeling and non-peeling group (269.3±67.7 vs. 294.4±60.5 µm, respectively; P=0.015). In the peeling group, MF was completely resolved in all 30 eyes, but only in 26 eyes in the non-peeling group (P=0.038). Postoperative Amsler testing was positive in five eyes in the peeling group and 13 eyes in the non-peeling group (P=0.024). Complications were similar in both groups; postoperatively, there were one and two cases of iatrogenic peripheral retinal break, three and two cases of macular hole, and one and one case of retinal detachment in the peeling and non-peeling groups, respectively.23G vitrectomy combined with brilliant blue-assisted ILM peeling resulted in better visual and anatomical effects compared with 23G vitrectomy alone in patients with MF.
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Affiliation(s)
- Xinbang Mao
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zhipeng You
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Yanhua Cheng
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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Mohaghegh N, Ghafar-Zadeh E, Magierowski S. Recent Advances of Computerized Graphical Methods for the Detection and Progress Assessment of Visual Distortion Caused by Macular Disorders. Vision (Basel) 2019; 3:E25. [PMID: 31735826 PMCID: PMC6802783 DOI: 10.3390/vision3020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/27/2019] [Indexed: 12/02/2022] Open
Abstract
Recent advances of computerized graphical methods have received significant attention for detection and home monitoring of various visual distortions caused by macular disorders such as macular edema, central serous chorioretinopathy, and age-related macular degeneration. After a brief review of macular disorders and their conventional diagnostic methods, this paper reviews such graphical interface methods including computerized Amsler Grid, Preferential Hyperacuity Perimeter, and Three-dimensional Computer-automated Threshold Amsler Grid. Thereafter, the challenges of these computerized methods for accurate and rapid detection of macular disorders are discussed. The early detection and progress assessment of macular disorders can significantly enhance the required clinical procedure for the diagnosis and treatment of macular disorders.
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Affiliation(s)
| | - Ebrahim Ghafar-Zadeh
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON M3J 1P3, Canada
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Schmid MK, Thiel MA, Lienhard K, Schlingemann RO, Faes L, Bachmann LM. Reliability and diagnostic performance of a novel mobile app for hyperacuity self-monitoring in patients with age-related macular degeneration. Eye (Lond) 2019; 33:1584-1589. [PMID: 31043690 DOI: 10.1038/s41433-019-0455-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/25/2019] [Accepted: 04/19/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the reliability and the diagnostic performance of a novel CE (European Conformity)-marked and FDA (Food and Drug Administration)-cleared dot patient self-monitoring test (Alleye, Oculocare medical Inc.) for the detection and characterization of metamorphopsia in age-related macular degeneration (AMD). METHODS Three consecutive tests were performed in 63 wet AMD, 26 dry AMD, and 19 age-matched healthy eyes. In addition, the test was performed in 34 young healthy eyes. The mean Alleye score and standard deviations (SDs) were calculated for each eye and group. We compared and tested healthy with dry and wet AMD eyes and assessed the extent to which the test discriminated between healthy subjects and patients with dry and wet AMD using the area under the receiver operating characteristic curve (AUC). RESULTS The mean (SD) Alleye score was 49.5 (16.1) in wet AMD eyes, 62.1 (22.5) in dry AMD eyes, 69.8 (10.2) in age-matched healthy eyes, and 85.3 (10.0) in young healthy subjects. Compared to age-matched healthy subjects, the AUC (95% confidence interval) to detect wet AMD was 0.845 (0.759-0.932), and 0.660 (0.520-0.799) to discriminate between dry and wet AMD. Compared to young healthy subjects, the AUC to detect dry AMD was 0.799 (0.675-0.923), and 0.969 (0.940-0.997) to detect wet AMD. CONCLUSIONS This is the first assessment of Alleye in clinical practice. The test is highly accurate to detect wet AMD and reasonably accurate to classify dry vs. wet AMD. Data from longitudinal monitoring and its role in the therapeutic management of AMD is warranted.
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Affiliation(s)
- Martin K Schmid
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Michael A Thiel
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | | | - Livia Faes
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland.,Medical Retina Department, Moorfield's Eye hospital NHS Foundation Trust, London, UK
| | - Lucas M Bachmann
- Faculty of Medicine, University of Zurich, Zurich, Switzerland. .,Oculocare Medical AG, Zurich, Switzerland.
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Bowen M, Zutshi H, Cordiner M, Crutch S, Shakespeare T. Qualitative, exploratory pilot study to investigate how people living with posterior cortical atrophy, their carers and clinicians experience tests used to assess vision. BMJ Open 2019; 9:e020905. [PMID: 30898793 PMCID: PMC6475252 DOI: 10.1136/bmjopen-2017-020905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate the experiences and views of people living with posterior cortical atrophy (PCA), their family carers and healthcare professionals of vision assessment tests. DESIGN A qualitative investigation using video recordings of vision assessments, semistructured interviews and audio recordings of a focus group. Interviews and focus group used broad, open questions around the topic to prompt and guide discussion. Video and audio recordings were transcribed, manually coded and analysed using framework analysis. SETTING University College, London's Queen Square neurology centre provided the venues for all stages of the research. PARTICIPANTS Participants living with PCA were one male and two females (age range 67-78 years). Health professional participants were a neurologist (male), two ophthalmologists (male) and an optometrist (female). PRIMARY AND SECONDARY OUTCOMES: (1) Experiences and attitudes of people living with PCA and health professionals to vision assessment tests, (2) views of health professionals and people living with PCA of whether some tests are more effective at discriminating between cortical vision problems and vision problems related to optical or ocular causes. RESULTS Patients were able to engage with and complete a number of tests. Their partners played a vital role in the process. Participants reported that simple, short tests were more effective than more subjective tests. Examples of tests that appeared to be more problematic for the patient participants were the Amsler Grid and visual field analysis. CONCLUSIONS Although limited in scope and execution, the project suggests that some vision assessment tests are likely to support health professionals to discriminate between cortical and optical/ocular causes of visual impairment. It supports existing evidence that there are vision assessments that people with dementia can engage with and complete. We identify areas of importance for future research and make tentative suggestions for clinical practice.
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Affiliation(s)
- Michael Bowen
- Department of Research, The College of Optometrists, London, UK
| | - Harry Zutshi
- Department of Research, The College of Optometrists, London, UK
| | - Martin Cordiner
- Department of Research, The College of Optometrists, London, UK
| | - Sebastian Crutch
- Dementia Research Centre, University College London, Institute of Neurology, London, UK
| | - Tim Shakespeare
- Dementia Research Centre, University College London, Institute of Neurology, London, UK
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Gale RP, Mahmood S, Devonport H, Patel PJ, Ross AH, Walters G, Downey L, El-Sherbiny S, Freeman M, Berry S, Jain N. Action on neovascular age-related macular degeneration (nAMD): recommendations for management and service provision in the UK hospital eye service. Eye (Lond) 2019; 33:1-21. [PMID: 30926932 PMCID: PMC6474281 DOI: 10.1038/s41433-018-0300-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This report by a group of UK retina specialists and health professionals considers best practice recommendations for the management of sight-threatening neovascular age-related macular degeneration (nAMD), based on collective experience and expertise in routine clinical practice. The authors provide an update for ophthalmologists, allied healthcare professionals and commissioners on practice principles for optimal patient care and service provision standards. Refinement of care pathways for nAMD has improved access to intravitreal anti-vascular endothelial growth factor therapy but there are still variations in care and reported outcomes between clinic centres. Innovative organisational models of service provision allow providers to better match capacity with increasing demand. The authors review the recent NICE guideline for diagnosis and management of AMD, considerations for switching therapies and stopping treatment and need for regular monitoring of non-affected fellow eyes in patients with unilateral nAMD. Actions for delivery of high-quality care and to improve long-term patient outcomes are discussed. Local pathways need to detail nAMD target time to treat, maintenance of review intervals to ensure proactive treatment regimens are delivered on time and appropriate discharge for patients deemed low risk or no longer benefiting from treatment. Actual visual acuity outcomes achieved and maintenance of the level of vision when disease stability is achieved are considered good measures for judging the quality of care in the treatment of patients with nAMD. Robust community referral pathways must be in place for suspected reactivation of choroidal neovascularisation and rapid referral for second eye involvement. Practical considerations for intravitreal injection therapy are outlined.
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Affiliation(s)
- Richard P Gale
- The Action on nAMD Group, Birmingham, UK.
- The York Hospital, York, UK.
| | - Sajjad Mahmood
- The Action on nAMD Group, Birmingham, UK
- Manchester Royal Eye Hospital, Manchester, UK
| | - Helen Devonport
- The Action on nAMD Group, Birmingham, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Praveen J Patel
- The Action on nAMD Group, Birmingham, UK
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Adam H Ross
- The Action on nAMD Group, Birmingham, UK
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Gavin Walters
- The Action on nAMD Group, Birmingham, UK
- Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Louise Downey
- The Action on nAMD Group, Birmingham, UK
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Samer El-Sherbiny
- The Action on nAMD Group, Birmingham, UK
- South Warwickshire NHS Foundation Trust, Warwickshire, UK
| | - Mary Freeman
- The Action on nAMD Group, Birmingham, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Simon Berry
- The Action on nAMD Group, Birmingham, UK
- Simon Berry Optometrist, Durham, UK
| | - Nitin Jain
- The Action on nAMD Group, Birmingham, UK
- Bayer, Reading, UK
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38
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Pitrelli Vazquez N, Harding SP, Heimann H, Czanner G, Knox PC. Radial shape discrimination testing for new-onset neovascular age-related macular degeneration in at-risk eyes. PLoS One 2018; 13:e0207342. [PMID: 30408127 PMCID: PMC6224174 DOI: 10.1371/journal.pone.0207342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/30/2018] [Indexed: 11/19/2022] Open
Abstract
We investigated the performance of the handheld radial shape discrimination (hRSD) test in detecting the development of neovascular AMD (nAMD) in a prospective, longitudinal, observational study. Patients diagnosed with unilateral nAMD, with no nAMD in the other eye (the study eye, SE), completed the hRSD test on consecutive, routine clinic visits up to a maximum of 12, or until they were diagnosed with nAMD in the SE based on slit-lamp biomicroscopy and spectral-domain OCT assessment, with fluorescein angiography confirmation. Masked grading was carried out to confirm the diagnosis of nAMD, and to ensure no cases of nAMD were missed. Receiver operating characteristics (ROC) analysis was used to explore the diagnostic performance of the hRSD test relative to clinical diagnosis. Data were available from 179 patients of whom 19 (10.6%; “converters”) developed nAMD in the SE. The mean hRSD threshold at conversion was -0.47 (95% CI -0.38 to -0.55) logMAR compared to -0.53 (-0.50 to -0.57) logMAR in 160 non-converters. hRSD threshold in the converters began to decline 190 days before diagnosis of nAMD. The ROC curve demonstrated that at an hRSD cut-off of -0.60 logMAR, sensitivity was 0.79 (0.54–0.94) with a specificity of 0.54 (0.46–0.62); positive and negative predictive values were 0.16 and 0.96 respectively. We conclude that the hRSD test has moderate sensitivity for detecting the earliest stages of nAMD in the at-risk fellow eyes of patients with unilateral nAMD, compared to clinical diagnosis. Given its relative inexpensiveness, ease of use and the inherent connectivity of the platforms it can be presented on, it may have a role in early detection of nAMD in the population at large.
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Affiliation(s)
- Noelia Pitrelli Vazquez
- Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
- St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Simon P. Harding
- Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
- St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Heinrich Heimann
- St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Gabriela Czanner
- Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
- Department of Applied Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
| | - Paul C. Knox
- Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
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Thurman SM, Maniglia M, Davey PG, Biles MK, Visscher KM, Seitz AR. Multi-line Adaptive Perimetry (MAP): A New Procedure for Quantifying Visual Field Integrity for Rapid Assessment of Macular Diseases. Transl Vis Sci Technol 2018; 7:28. [PMID: 30356944 PMCID: PMC6192464 DOI: 10.1167/tvst.7.5.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 08/23/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose In order to monitor visual defects associated with macular degeneration (MD), we present a new psychophysical assessment called multiline adaptive perimetry (MAP) that measures visual field integrity by simultaneously estimating regions associated with perceptual distortions (metamorphopsia) and visual sensitivity loss (scotoma). Methods We first ran simulations of MAP with a computerized model of a human observer to determine optimal test design characteristics. In experiment 1, predictions of the model were assessed by simulating metamorphopsia with an eye-tracking device with 20 healthy vision participants. In experiment 2, eight patients (16 eyes) with macular disease completed two MAP assessments separated by about 12 weeks, while a subset (10 eyes) also completed repeated Macular Integrity Assessment (MAIA) microperimetry and Amsler grid exams. Results Results revealed strong repeatability of MAP and high accuracy, sensitivity, and specificity (0.89, 0.81, and 0.90, respectively) in classifying patient eyes with severe visual impairment. We also found a significant relationship in terms of the spatial patterns of performance across visual field loci derived from MAP and MAIA microperimetry. However, there was a lack of correspondence between MAP and subjective Amsler grid reports in isolating perceptually distorted regions. Conclusions These results highlight the validity and efficacy of MAP in producing quantitative maps of visual field disturbances, including simultaneous mapping of metamorphopsia and sensitivity impairment. Translational Relevance Future work will be needed to assess applicability of this examination for potential early detection of MD symptoms and/or portable assessment on a home device or computer.
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Affiliation(s)
- Steven M Thurman
- U.S. Army Research Laboratory, Human Research and Engineering Directorate, Aberdeen Proving Ground, MD, USA
| | - Marcello Maniglia
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | | | - Mandy K Biles
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristina M Visscher
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aaron R Seitz
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
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Osaka R, Manabe K, Manabe S, Nakano Y, Takasago Y, Shiragami C, Hirooka K, Muraoka Y, Tsujikawa A. Persistent metamorphopsia associated with branch retinal vein occlusion. PLoS One 2018; 13:e0204015. [PMID: 30235264 PMCID: PMC6147450 DOI: 10.1371/journal.pone.0204015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 08/31/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose To investigate longitudinal changes in metamorphopsia associated with branch retinal vein occlusion. Methods In this prospective observational case series, we included 32 eyes (32 patients) with branch retinal vein occlusion and acute macular edema. Eyes were treated as needed with intravitreal ranibizumab injections for 12 months. At baseline and 1, 6, and 12 months after initiating treatment, metamorphopsia was quantified using M-CHARTS. Retinal morphology was examined through optical coherence tomography. Results Logarithm of the minimum angle of resolution visual acuity progressively improved from 0.342 ± 0.304 (Snellen equivalent: 20/44) at baseline to 0.199 ± 0.259 (20/32) and 0.118 ± 0.195 (20/26) at 1 and 12 months, respectively (both P < 0.001). The M-CHARTS score significantly decreased from 0.63 ± 0.61 at baseline to 0.45 ± 0.50 at 1 month (P = 0.044), but no further improvement was achieved with 1 year of additional treatment (6 months: 0.47 ± 0.53 [P = 0.094] and 12 months: 0.50 ± 0.44 [P = 0.173]). Three (13.6%) of 22 eyes with baseline metamorphopsia had complete metamorphopsia resolution. At 12 months, the M-CHARTS score was correlated with baseline foveal thickness (r = 0.373, P = 0.035) and the baseline M-CHARTS score (r = 0.503, P = 0.003). A multiple regression analysis revealed that only the baseline M-CHARTS score was correlated with the 12-month M-CHARTS score (β = 0.460, P = 0.027). Conclusions Eyes with branch retinal vein occlusion often have persistent metamorphopsia, even when visual acuity and retinal morphology improve. Metamorphopsia at 12 months was correlated with metamorphopsia and foveal thickness at baseline.
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Affiliation(s)
- Rie Osaka
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Miki, Japan
- * E-mail:
| | - Koichiro Manabe
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Miki, Japan
| | - Saki Manabe
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Miki, Japan
| | - Yuki Nakano
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Miki, Japan
| | - Yukari Takasago
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Miki, Japan
| | - Chieko Shiragami
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Miki, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Miki, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Bruender MC, Benjamin N, Agostini HT, Stahl A, Ehlken C. Subjective evaluation of visual acuity is not reliable to detect disease activity in different exudative maculopathies. Graefes Arch Clin Exp Ophthalmol 2018; 256:1565-1571. [PMID: 29858676 DOI: 10.1007/s00417-018-4021-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/03/2018] [Accepted: 05/23/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients with exudative maculopathies (neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO)) are faced with a high burden of examinations and treatments. This study was conceived to analyze the accuracy of a subjective evaluation of visual acuity (VA) and metamorphopsia to detect disease reactivation, compared to morphological signs of reactivation assessed by means of SD-OCT. METHODS Retrospective study of 888 patients treated for nAMD (n = 638), DME (84), BRVO (110), and CRVO (56) was conducted. Subjective evaluation of the patient at an examination (i.e., change of VA and/or metamorphopsia) was compared to clinical evaluation of disease activity as assessed by SD-OCT. Sensitivity and specificity, negative and positive predictive values (PPV/NPV) for detection of active disease were calculated. Factors associated with false-negative subjective evaluation were analyzed by regression analysis. RESULTS The sensitivity of the subjective evaluation to detect disease reactivation was < 0.50 in all exudative maculopathies. Sensitivity was increased to ≥ 0.60 by combining subjective worsening with loss of 1 line in the VA test in RVO, but not in DME and nAMD. The specificity was > 0.85 in all patients. PPV was > 0.85 in patients with RVO. Regression analysis did not reveal any factors that could reliably identify patient subgroups in which OCT could be omitted, though CRVO patients with a visual acuity of < 0.3 logMAR had an odds ratio of 0.20 for false-negative subjective evaluation (p = 0.009). CONCLUSION The accuracy of subjective evaluation to discriminate disease activity in patients with different exudative maculopathies was low and cannot substitute for frequent SD-OCT exams. Routinely assessed clinical parameters such as age, visual acuity, or treatment experience were of no use to predict the validity of subjective evaluation of disease activity. TRIAL REGISTRATION This trial was registered at the DRKS (Deutsches Register Klinischer Studien, drks.de; No 00006851) prior to the inclusion of the first patient.
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Affiliation(s)
- Marie-Christine Bruender
- Eye Center, Medical Center, Faculty of Medicine, Albert-Ludwigs-University, Killianstraße 5, 79106, Freiburg im Breisgau, Germany
| | - Nicola Benjamin
- Center for Pulmonary Hypertension, Thoraxclinic at the University Hospital Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Hansjuergen Thomas Agostini
- Eye Center, Medical Center, Faculty of Medicine, Albert-Ludwigs-University, Killianstraße 5, 79106, Freiburg im Breisgau, Germany
| | - Andreas Stahl
- Eye Center, Medical Center, Faculty of Medicine, Albert-Ludwigs-University, Killianstraße 5, 79106, Freiburg im Breisgau, Germany
| | - Christoph Ehlken
- Eye Center, Medical Center, Faculty of Medicine, Albert-Ludwigs-University, Killianstraße 5, 79106, Freiburg im Breisgau, Germany.
- Department of Ophthalmology, Faculty of Medicine, Christian-Albrechts-University, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
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Schmid MK, Faes L, Bachmann LM, Thiel MA. Accuracy of a Self-monitoring Test for Identification and Monitoring of Age-related Macular Degeneration: A Diagnostic Case-control Study. Open Ophthalmol J 2018; 12:19-28. [PMID: 29619125 PMCID: PMC5861526 DOI: 10.2174/1874364101812010019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/23/2018] [Accepted: 02/21/2018] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate diagnostic accuracy of a new self-monitoring device using a Vernier hyperacuity alignment task. Method: A total of 11 wet Age-Related Macular Degeneration (AMD) patients and 9 controls contributing 37 eyes were consecutively enrolled into this prospective diagnostic case-control study at the retina centre of the Cantonal Hospital Lucerne, Switzerland. Vernier acuity testing (index test) and Optical Coherence Tomography (OCT, reference test) were performed in all participants. OCT scans were evaluated and graded by a retinal specialist masked to diagnosis and index test results. Candidate parameters of the index test to be used as the diagnostic statistic were identified using a bootstrap procedure. Ten parameters remaining were further assessed in univariate analyses. The overall Standard Deviation (SD) of absolute distances across all four axes of the Vernier acuity test provided the highest area under the Receiver Operating Characteristics (ROC) curve and was therefore selected. Results: Mean age of patients with wet AMD was 81.2 years (SD 4.99), mean numbers of letters were 67.4 (SD 14.1). The proportion of women was similar in both groups (controls: 88%, wet AMD: 72%). The area under the ROC curve was 0.87 (95% confidence interval CI: 0.75- 0.99) indicating excellent discrimination. Best accuracy was reached at a cut-off value of 0.64 with a sensitivity of 75% and a specificity of 94%. Conclusion: This diagnostic case-control study of a new screening device for AMD shows acceptable diagnostic accuracy. The promising preliminary data of this study call for further upstream evaluations in reasonably sized clinical studies.
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Affiliation(s)
| | - Livia Faes
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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Sim PY, Gajree S, Dhillon B, Borooah S. Investigation of time to first presentation and extrahospital factors in the treatment of neovascular age-related macular degeneration: a retrospective cross-sectional study. BMJ Open 2017; 7:e017771. [PMID: 29229653 PMCID: PMC5778287 DOI: 10.1136/bmjopen-2017-017771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To assess the time from symptom onset to treatment for neovascular age-related macular degeneration (nvAMD) and to measure the awareness of AMD in Southeast Scotland. DESIGN Retrospective cross-sectional study. SETTING Secondary care, Southeast of Scotland. METHODS Patients treated with intravitreal therapy (IVT) for nvAMD in Southeast Scotland between 2013 and 2015 were identified using a treatment register. Notes were retrospectively reviewed. We measured time from: (A) symptom onset to first presentation at primary care, (B) referral to ophthalmic clinic appointment and (C) ophthalmic clinic appointment to first IVT treatment. To investigate AMD awareness, we performed a cluster random sample survey of patients visiting non-AMD ophthalmic clinics using a previously validated 12-item questionnaire. RESULTS 195 patients (mean age 78 years) were included in the study. The mean delays between the different stages-A, B and C-were 54.2 (95% CI ±13), 28.2 (95% CI ±4.0) and 31.5 (95% CI ±3.6) days, respectively. There was an additional mean delay of 7.5 (95% CI ±1.6) days when patients were indirectly referred by optometrists via general practitioners (P<0.05). 140 patients (mean age 78) participated in the awareness survey; 62.1% reported being 'aware' of AMD but only 37.3% described AMD symptoms correctly. CONCLUSIONS There was a significant delay at every step of the nvAMD care pathway. The causes for this were multifactorial and included delays in first presentation to a healthcare provider, referral from primary care and initiation of secondary care treatment. Our data are likely to underestimate prehospital delays as a large number of cases are likely to have undefined symptoms and onset. We also identified suboptimal awareness of AMD which could account for a substantial delay in presentation from symptom onset. These findings highlight the need to address AMD awareness and the need for urgent treatment to prevent avoidable vision loss resulting from nvAMD.
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Affiliation(s)
- Peng Yong Sim
- College of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Sonul Gajree
- Ophthalmology Department, Gartnavel General Hospital, Glasgow, UK
| | - Baljean Dhillon
- College of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
- The Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Shyamanga Borooah
- Moorfields Eye Hospital, London, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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Singh N, Srinivasan S, Muralidharan V, Roy R, V J, Raman R. Prevention of Age-Related Macular Degeneration. Asia Pac J Ophthalmol (Phila) 2017; 6:520-526. [PMID: 29204995 DOI: 10.22608/apo.2017416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/06/2017] [Indexed: 11/08/2022] Open
Abstract
Age-related macular degeneration (AMD) compromises quality of life. However, the available therapeutic options are limited. This has led to the identification of modifiable risk factors to prevent the development or alter the natural course and prognosis of AMD. The identification and modification of risk factors has the potential for greater public health impact on reducing morbidity from AMD. Likewise, identifying the imaging clues and genetic clues could serve as a guide to recognizing the propensity for progression to severe and end stages of the disease. Several attempts, both successful and unsuccessful, have been made for interventions that could delay the progression of AMD. Of these, pharmacological interventions have shown promising results. The Age-Related Eye Disease Study 1 and 2 have shown the beneficial role of antioxidants in a selected group of patients.
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Affiliation(s)
- Niharika Singh
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sangeetha Srinivasan
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vinata Muralidharan
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Jayprakash V
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Metamorphopsia associated with central retinal vein occlusion. PLoS One 2017; 12:e0186737. [PMID: 29049410 PMCID: PMC5648234 DOI: 10.1371/journal.pone.0186737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/08/2017] [Indexed: 11/24/2022] Open
Abstract
This prospective study aimed to investigate metamorphopsia in eyes with central retinal vein occlusion (CRVO) and included 28 eyes (28 patients) with unilateral CRVO that had macular edema (ME) in the acute phase. The ME was treated with anti-vascular endothelial growth factor agents. At baseline and at 1 and 6 months after initiation of treatment, quantitative measurements of metamorphopsia were performed using M-CHARTS and the retinal morphologic changes were examined by optical coherence tomography. At baseline, metamorphopsia was detected on M-CHARTS in 14 (50.0%) eyes. The mean M-CHARTS score was 0.37 ± 0.53. At 1 month and 6 months after initiation of treatment, there was substantial resolution of ME and significant recovery of visual acuity. In contrast, metamorphopsia was still detected in 16 eyes at 6 months; the mean M-CHARTS scores were 0.29 ± 0.37 at 1 month and 0.32 ± 0.38 at 6 months, and had not significantly improved from baseline (p = 0.580, and p = 0.604, respectively). Although the M-CHARTS score at 6 months was associated with the baseline M-CHARTS score (p = 0.004), it did not have any associations with morphologic parameters at baseline. However, the M-CHARTS score at 6 months was significantly associated with foveal photoreceptor status, height of serous detachment, and parafoveal thickening at 1 month. Metamorphopsia associated with CRVO could be quantified using M-CHARTS, and often persisted in contrast with the recovery of visual acuity and resolution of ME after treatment with anti-vascular endothelial growth factor agents.
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García-Layana A, Cabrera-López F, García-Arumí J, Arias-Barquet L, Ruiz-Moreno JM. Early and intermediate age-related macular degeneration: update and clinical review. Clin Interv Aging 2017; 12:1579-1587. [PMID: 29042759 PMCID: PMC5633280 DOI: 10.2147/cia.s142685] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in developed countries. With the aging of population, AMD will become globally an increasingly important and prevalent disease worldwide. It is a complex disease whose etiology is associated with both genetic and environmental risk factors. An extensive decline in the quality of life and progressive need of daily living assistance resulting from AMD among those most severely affected highlights the essential role of preventive strategies, particularly advising patients to quit smoking. In addition, maintaining a healthy diet, controlling other risk factors (such as hypertension, obesity, and atherosclerosis), and the use of nutritional supplements (antioxidants) are recommendable. Genetic testing may be especially important in patients with a family history of AMD. Recently, unifying criteria for the clinical classification of AMD, defining no apparent aging changes; normal aging changes; and early, intermediate, and late AMD stages, are of value in predicting AMD risk of progression and in establishing recommendations for the diagnosis, therapeutic approach, and follow-up of patients. The present review is focused on early and intermediate AMD and presents a description of the clinical characteristics and ophthalmological findings for these stages, together with algorithms for the diagnosis and management of patients, which are easily applicable in daily clinical practice.
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Affiliation(s)
- Alfredo García-Layana
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain.,Sociedad Española de Retina y Vítreo (SERV), Madrid, Spain.,Red Telemática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Cabrera-López
- Service of Ophthalmology, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Las Palmas Gran Canaria University, Las Palmas de Gran Canaria, Spain
| | - José García-Arumí
- Department of Retina and Vitreous, Instituto de Microcirugía Ocular (IMO), Barcelona, Spain.,Department of Ophthalmology, Universidad Autónoma de Barcelona, Barcelona, Spain.,Hospital Universitario Valle Hebrón, Barcelona, Spain
| | - Lluís Arias-Barquet
- Section of Medical-Surgical Retina, Service of Ophthalmology, Hospital Universitari de Bellvitge, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - José M Ruiz-Moreno
- Red Telemática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain.,Universidad Castilla-La Mancha, Albacete, Spain.,Vissum Corporación Oftalmológica, Madrid, Spain
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47
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48
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Patient knowledge concerning age-related macular degeneration: an AMD questionnaire. Wien Klin Wochenschr 2017; 129:345-350. [DOI: 10.1007/s00508-016-1044-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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49
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Ly A, Nivison-Smith L, Zangerl B, Assaad N, Kalloniatis M. Self-reported optometric practise patterns in age-related macular degeneration. Clin Exp Optom 2017; 100:718-728. [PMID: 28266060 DOI: 10.1111/cxo.12528] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/18/2016] [Accepted: 12/13/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The use of advanced imaging in clinical practice is emerging and the use of this technology by optometrists in assessing patients with age-related macular degeneration is of interest. Therefore, this study explored contemporary, self-reported patterns of practice regarding age-related macular degeneration diagnosis and management using a cross-sectional survey of optometrists in Australia and New Zealand. METHODS Practising optometrists were surveyed on four key areas, namely, demographics, clinical skills and experience, assessment and management of age-related macular degeneration. Questions pertaining to self-rated competency, knowledge and attitudes used a five-point Likert scale. RESULTS Completed responses were received from 127 and 87 practising optometrists in Australia and New Zealand, respectively. Advanced imaging showed greater variation in service delivery than traditional techniques (such as slitlamp funduscopy) and trended toward optical coherence tomography, which was routinely performed in age-related macular degeneration by 49 per cent of respondents. Optical coherence tomography was also associated with higher self-rated competency, knowledge and perceived relevance to practice than other modalities. Most respondents (93 per cent) indicated that they regularly applied patient symptoms, case history, visual function results and signs from traditional testing, when queried about their management of patients with age-related macular degeneration. Over half (63 per cent) also considered advanced imaging, while 31 per cent additionally considered all of these as well as the disease stage and clinical guidelines. Contrary to the evidence base, 68 and 34 per cent rated nutritional supplements as highly relevant or relevant in early age-related macular degeneration and normal aging changes, respectively. CONCLUSIONS These results highlight the emergence of multimodal and advanced imaging (especially optical coherence tomography) in the assessment of age-related macular degeneration by optometrists. Clinically significant variations in self-rated test competency and the understanding regarding nutritional supplements for different stages of age-related macular degeneration suggest that further work to up-skill optometrists may be required.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Nagi Assaad
- Centre for Eye Health, Sydney, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
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50
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Sanfilippo PG, Hewitt AW, Mackey DA. The Importance of Conditional Probability in Diagnostic Reasoning and Clinical Decision Making: A Primer for the Eye Care Practitioner. Ophthalmic Epidemiol 2017; 24:81-89. [PMID: 28102752 DOI: 10.1080/09286586.2016.1255975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To outline and detail the importance of conditional probability in clinical decision making and discuss the various diagnostic measures eye care practitioners should be aware of in order to improve the scope of their clinical practice. METHODS We conducted a review of the importance of conditional probability in diagnostic testing for the eye care practitioner. RESULTS Eye care practitioners use diagnostic tests on a daily basis to assist in clinical decision making and optimizing patient care and management. These tests provide probabilistic information that can enable the clinician to increase (or decrease) their level of certainty about the presence of a particular condition. While an understanding of the characteristics of diagnostic tests are essential to facilitate proper interpretation of test results and disease risk, many practitioners either confuse or misinterpret these measures. CONCLUSIONS In the interests of their patients, practitioners should be aware of the basic concepts associated with diagnostic testing and the simple mathematical rule that underpins them. Importantly, the practitioner needs to recognize that the prevalence of a disease in the population greatly determines the clinical value of a diagnostic test.
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Affiliation(s)
- Paul G Sanfilippo
- a Centre for Ophthalmology and Visual Science , University of Western Australia, Lions Eye Institute , Perth , Australia.,b Centre for Eye Research Australia , University of Melbourne, Royal Victorian Eye and Ear Hospital , Melbourne , Victoria , Australia
| | - Alex W Hewitt
- a Centre for Ophthalmology and Visual Science , University of Western Australia, Lions Eye Institute , Perth , Australia.,b Centre for Eye Research Australia , University of Melbourne, Royal Victorian Eye and Ear Hospital , Melbourne , Victoria , Australia.,c School of Medicine, Menzies Research Institute Tasmania , University of Tasmania , Hobart , Tasmania , Australia
| | - David A Mackey
- a Centre for Ophthalmology and Visual Science , University of Western Australia, Lions Eye Institute , Perth , Australia.,b Centre for Eye Research Australia , University of Melbourne, Royal Victorian Eye and Ear Hospital , Melbourne , Victoria , Australia.,c School of Medicine, Menzies Research Institute Tasmania , University of Tasmania , Hobart , Tasmania , Australia
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