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Vinge E, Bro T. Treatment burden on patients receiving intravitreal anti-VEGF for wet age-related macular degeneration. Acta Ophthalmol 2024; 102:478-482. [PMID: 37800611 DOI: 10.1111/aos.15783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE The aim of this study was to map the treatment burden for patients with wet age-related macular degeneration (wAMD). METHOD Patients with ongoing treatment with anti-VEGF for wAMD at a Swedish eye unit underwent a survey about the time spent receiving treatment, caregiver assistance, way of transportation, self-rated vision and negative experiences associated with the treatment such as discomfort, anxiety or transportation problems. Information about current visual acuity, number of treatments and current treatment intervals were obtained from medical records. RESULTS The study included 93 patients with an average age of 79.9 years, 68% were women. The average interval between treatments was 7.3 weeks, and 26% had active treatment in both eyes. On average, patients had to spend 2.7 h (2.4-2.9: 95% CI) per treatment and a caregiver assisted the patient in 58% of cases. Caregivers spent on average 2.6 h (2.5-2.8: 95% CI) per visit, and 19% needed to take time off work. The majority (91%) of patients did not experience any transportation problems associated with treatment. A multivariate logistic regression analysis showed a significantly lower odds ratio for discomfort with higher self-rated vision and a significantly higher odds ratio for discomfort with longer treatment intervals. DISCUSSION Anti-VEGF treatment is an effective treatment for wAMD. However, the relatively short treatment intervals place a considerable burden on patients and their relatives regarding time. Although the patients in this study had to spend a lot of time to receive treatment, the majority did not experience any problems associated with treatment.
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Affiliation(s)
- Erik Vinge
- Department of Ophthalmology Höglandssjukhuset Eksjö, Region Jönköping County, Eksjö, Sweden
| | - Tomas Bro
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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2
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van Munster EPJ, van Nispen RMA, Hoogland J, van der Aa HPA. Feasibility and potential effectiveness of the IdentifEYE training programmes to address mental health problems in adults with vision impairment. Ophthalmic Physiol Opt 2024; 44:399-412. [PMID: 38063259 DOI: 10.1111/opo.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE Two training programmes about depression and anxiety in adults with vision impairment were developed to support eye care practitioners (ECPs) and low vision service (LVS) workers in identifying and discussing mental health problems. The purpose of this study was to evaluate the training programmes' potential effectiveness and feasibility. METHODS The training programmes were offered to ECPs (n = 9) and LVS workers (n = 17). All participants completed surveys pre-, mid- and post-training, and at a 4 week follow-up about the training programmes' content, effectiveness, feasibility and implementation. The Kirkpatrick model was used as a theoretical framework; linear mixed models were used to determine the potential effectiveness, and outcomes were explored during three focus group meetings. RESULTS Expectations were met in the majority of the participants (84.6%). Post-training, both ECPs and LVS workers reported increased confidence (β = 3.67, confidence interval (CI): 0.53-6.80; β = 4.35, CI: 1.57 to 7.14, respectively) and less barriers (β = -3.67, CI: -6.45 to -0.89; β = -1.82, CI: -4.56 to 0.91). Mental health problems were more likely addressed in both the groups (ECP β = 2.22, CI: -0.17 to 4.62; LVS β = 4.18, CI: 2.67 to 5.68), but these effects did not last in ECPs (β = -3.22, CI: -7.37 to 0.92). Variations of these learning effects between individual participants were found within both the groups, and LVS workers indicated a need to focus on their own profession. Participants provided information on how to improve the training programmes' feasibility, effectiveness and implementation. CONCLUSION The training programmes seemed feasible and potentially effective. Transfer of the lessons learned into daily practice could be enhanced by, for example, specifying the training programmes for healthcare providers with the same profession, introducing microlearning and incorporating mental health management into organisation policies.
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Affiliation(s)
- Edine P J van Munster
- Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands
- Robert Coppes Foundation, Expertise Innovation and Knowledge, Vught, the Netherlands
| | - Ruth M A van Nispen
- Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands
| | - Jeroen Hoogland
- Epidemiology & Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hilde P A van der Aa
- Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands
- Robert Coppes Foundation, Expertise Innovation and Knowledge, Vught, the Netherlands
- The Lighthouse Guild NYC, New York, New York, USA
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Dinah C, Enoch J, Ghulakhszian A, Sekhon M, Crabb DP, Taylor DJ. Patient acceptability of intravitreal complement inhibitors in geographic atrophy (GA): protocol for a UK-based cross-sectional study. BMJ Open 2024; 14:e075713. [PMID: 38238063 PMCID: PMC10806947 DOI: 10.1136/bmjopen-2023-075713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Geographic atrophy (GA) is the advanced form of the non-neovascular ('dry') type of age-related macular degeneration (AMD). Previously untreatable, complement inhibitors delivered by regular intravitreal injections have recently been demonstrated to slow down the progression of GA lesions in phase 3 trials. One such treatment, Syfovre (pegcetacoplan), was approved by the US Food and Drug Administration in February 2023. These therapies slow down, but do not stop or reverse, the progression of GA; they may also increase the risk of developing the neovascular ('wet') type of AMD. In light of these developments, this study aims to quantify the acceptability of these new intravitreal injection treatments to patients with GA in the UK and explore factors that may influence the acceptability of these treatments. METHODS AND ANALYSIS In this cross-sectional, non-interventional study, the primary objective is to determine the proportion of patients with GA that find regular intravitreal therapy acceptable for slowing the progression of GA. We will use a validated acceptability questionnaire in order to quantify the acceptability of new treatments among patients with GA. The correlation between acceptability and functional and structural biomarkers of GA will be established. We will also explore demographic, general health and ocular factors that may influence acceptability. 180 individuals with a diagnosis of GA will be recruited from 7 to 8 participating National Health Service trusts across the UK. Multiple regression analysis will be conducted to determine the simultaneous effects of multiple factors on patient acceptability. ETHICS AND DISSEMINATION The study received ethical approval from the Health Research Authority on 14 March 2023 (IRAS Project ID: 324854). Findings will be disseminated through peer-reviewed publications and conference presentations to the medical retina community, as well as through dialogue with patients and macular disease charities.
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Affiliation(s)
- Christiana Dinah
- Ophthalmology, London North West Healthcare NHS Trust, Harrow, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | | | | | - Mandeep Sekhon
- Population Health Research Institute, St George's University of London, London, UK
| | - David P Crabb
- Department of Optometry and Visual Science, City University, London, UK
| | - Deanna J Taylor
- Department of Optometry and Visual Science, City University, London, UK
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Khachigian LM, Liew G, Teo KYC, Wong TY, Mitchell P. Emerging therapeutic strategies for unmet need in neovascular age-related macular degeneration. J Transl Med 2023; 21:133. [PMID: 36810060 PMCID: PMC9942398 DOI: 10.1186/s12967-023-03937-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/27/2023] [Indexed: 02/23/2023] Open
Abstract
Neovascular age-related macular degeneration (nAMD) is a major cause of visual impairment and blindness. Anti-vascular endothelial growth factor (VEGF) agents, such as ranibizumab, bevacizumab, aflibercept, brolucizumab and faricimab have revolutionized the clinical management of nAMD. However, there remains an unmet clinical need for new and improved therapies for nAMD, since many patients do not respond optimally, may lose response over time or exhibit sub-optimal durability, impacting on real world effectiveness. Evidence is emerging that targeting VEGF-A alone, as most agents have done until recently, may be insufficient and agents that target multiple pathways (e.g., aflibercept, faricimab and others in development) may be more efficacious. This article reviews issues and limitations that have arisen from the use of existing anti-VEGF agents, and argues that the future may lie in multi-targeted therapies including alternative agents and modalities that target both the VEGF ligand/receptor system as well as other pathways.
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Affiliation(s)
- Levon M. Khachigian
- grid.1005.40000 0004 4902 0432Vascular Biology and Translational Research, Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052 Australia
| | - Gerald Liew
- grid.476921.fCentre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| | - Kelvin Y. C. Teo
- grid.419272.b0000 0000 9960 1711Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Y. Wong
- grid.419272.b0000 0000 9960 1711Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore ,grid.12527.330000 0001 0662 3178Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Paul Mitchell
- grid.476921.fCentre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
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Longer treatment intervals are associated with reduced treatment persistence in neovascular age related macular degeneration. Eye (Lond) 2023; 37:467-473. [PMID: 35140329 PMCID: PMC9905488 DOI: 10.1038/s41433-022-01957-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/22/2021] [Accepted: 01/20/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS To test the hypothesis that patients treated for neovascular age related macular degeneration (nAMD) with longer treatment intervals are more likely to persist with treatment. METHODS Data were obtained from the prospectively-defined Fight Retinal Blindness! registry. Treatment interval at 2 years was stratified based on the mean treatment interval over the three visits prior to and including the 2-year visit. Rates of non-persistence to follow-up were assessed from 2 to 5 years. RESULTS Data from 1538 eyes were included. The overall rate of non-persistence was 51% at 5 years. Patients on longer treatment intervals (12-weeks) at 2 years were found to be less persistent to long-term follow-up. These eyes were found to have fewer active disease visits in the first 2 years (40%) than eyes treated at 4-weekly intervals (66%, p < 0.001). In the multivariable analysis, better vision at 2 years was associated with a lower risk of non-persistence (hazards ratio [HR] [95% CI]: 0.95 [0.93, 0.97], P < 0.001), while longer treatment intervals (HR [95% CI]: 1.31 [0.95, 1.8] and 1.54 [1.15, 2.06] for 12-week and > 12-week intervals vs. 4-week intervals, respectively, P = 0.002) and older patients (HR [95% CI]: 1.03 [1.02, 1.04], p < 0.001) were at higher risk of non-persistence. CONCLUSIONS We found that patients on longer treatment intervals at 2 years were more likely to be non-persistent with treatment in later years. Reinforcing the need for ongoing treatment is important for patients on longer intervals who may feel complacent or that treatment is no longer effective, particularly if newer, longer lasting agents become widely available.
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Laser-Induced Porcine Model of Experimental Retinal Vein Occlusion: An Optimized Reproducible Approach. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020243. [PMID: 36837445 PMCID: PMC9962108 DOI: 10.3390/medicina59020243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
Retinal vein occlusion (RVO) is a frequent visually disabling condition. The management of RVO continues to challenge clinicians. Macular edema secondary to RVO is often recurrent, and patients typically require intravitreal injections for several years. Understanding molecular mechanisms in RVO is a key element in improving the treatment of the condition. Studying the molecular mechanisms in RVO at the retinal level is possible using animal models of experimental RVO. Most studies of experimental RVO have been sporadic, using only a few animals per experiment. Here, we report on 10 years of experience of the use of argon laser-induced experimental RVO in 108 porcine eyes from 65 animals, including 65 eyes with experimental branch retinal vein occlusion (BRVO) and 43 eyes with experimental central retinal vein occlusion (CRVO). Reproducibility and methods for evaluating and controlling ischemia in experimental RVO are reviewed. Methods for studying protein changes in RVO are discussed in detail, including proteomic analysis, Western blotting, and immunohistochemistry. Experimental RVO has brought significant insights into molecular changes in RVO. Testing intravitreal interventions in experimental RVO may be a significant step in developing personalized therapeutic approaches for patients with RVO.
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7
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Karimaghaei C, Ali A, Safdar N, Tanwani A, Schmitz-Brown M, Banaee T, El-Annan J, Gupta PK. The Injection Practice Patterns of Retina Specialists in Managing Exudative Age-Related Macular Degeneration: A Retrospective Study. Clin Ophthalmol 2023; 17:375-383. [PMID: 36721668 PMCID: PMC9884458 DOI: 10.2147/opth.s391282] [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: 09/26/2022] [Accepted: 12/28/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose To compare the PRN anti-VEGF injection patterns of four retina specialists with respect to the visual and anatomic outcomes in the management of wet age-related macular degeneration (AMD). Methods Medical records of patients who received bevacizumab, ranibizumab, and aflibercept anti-VEGF injections (years 2010-2020) by four retina specialists were reviewed for frequency, injection intervals, best corrected visual acuity (BCVA), and central macular thickness, center involved (CMT) for statistical analysis. Outcomes measured were change in logMAR BCVA and CMT from the first to last injection visit. Results Out of 137 AMD patients, 172 eyes were injected by four retina specialists in PRN fashion. Although all four specialists started the injection at similar baseline BCVA and CMT (p > 0.1), significant differences in mean injection number (9.0, p = 0.0001), injection intervals (5.06 weeks, p = 0.001), and total length of treatments (53.3 weeks, p = 0.0001) were observed. The mean change in logMAR BCVA between the first and last injection was -0.05, -0.22, 0.07, and 0.06 for the four specialists, respectively (p = 0.031), and the mean change in CMT was -53.3, -41.4, -72.7, and -21.9 µm (p = 0.41), respectively. Conclusion Despite similar baseline criteria for injections by the retina specialists, different anti-VEGF injection regimens were practiced resulting in variations in BCVA and CMT outcomes. This suggests a need in establishing a universally adoptable injection regimen with possible integration of the confounding factors to reduce burden on both patients and retina specialists.
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Affiliation(s)
- Cina Karimaghaei
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA,Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Amir Ali
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Nida Safdar
- Department of Ophthalmology, Nazareth Hospital, Trinity Health Mid-Atlantic, Philadelphia, PA, USA,IC Laser Eye Care, Bensalem, PA, USA
| | - Anika Tanwani
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Mary Schmitz-Brown
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Touka Banaee
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Jaafar El-Annan
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Praveena K Gupta
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA,Correspondence: Praveena K Gupta Professor, Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA, Tel +1 409-747-5823, Fax +1 409 747-5824, Email
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8
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Wang R, McClard CK, Laswell S, Mahmoudzadeh R, Salabati M, Ammar M, Vannavong J, Aziz AA, Ewald A, Calvanese AV, Lehman EB, Fried S, Windham V, Strutt A, Saroj N, Khanani AM, Eichenbaum DA, Regillo C, Wykoff CC. Quantifying burden of intravitreal injections: questionnaire assessment of life impact of treatment by intravitreal injections (QUALITII). BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001188. [PMID: 36794741 PMCID: PMC9764643 DOI: 10.1136/bmjophth-2022-001188] [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: 10/20/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
AIM To quantify the areas of burden experienced by patients requiring repeated intravitreal injections (IVI) in the management of exudative retinal diseases. METHODS The validated Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections survey was administered to patients at four retina clinical practices across four US states. The primary outcome measure was Treatment Burden Score (TBS), a single score assessing overall burden. RESULTS Of 1416 (n=657 age-related macular degeneration; n=360 diabetic macular oedema/diabetic retinopathy; n=221 retinal vein occlusion; n=178 other/uncertain) patients, 55% were women with an average age of 70 years. Patients most frequently reported receiving IVI every 4-5 weeks (40%). The mean TBS was 16.1±9.2 (range 1-48; scale of 1-54), and the TBS was higher in patients with diabetic macular oedema and/or diabetic retinopathy (DMO/DR) (17.1) compared with those with age-related macular degeneration (15.5) or retinal venous occlusive (15.3) (p=0.028). Though the mean level of discomfort was quite low (1.86) (scale 0-6), 50% of patients reported experiencing side effects more than half of the visits. Patients having received fewer than 5 IVI reported higher mean anxiety levels before (p=0.026), during (p=0.050) and after (p=0.016) treatment compared with patients having received more than 50 IVI. After the procedure, 42% of patients reported restrictions from usual activities due to discomfort. Patients reported a high mean satisfaction rating of 5.46 (scale 0-6) with the care of their diseases. CONCLUSIONS The mean TBS was moderate and highest among patients with DMO/DR. Patients with more total injections reported lower levels of discomfort and anxiety but higher disruption to daily life. Despite the challenges related to IVI, the overall satisfaction with treatment remained high.
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Affiliation(s)
- Rui Wang
- Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Cynthia K McClard
- Ophthalmology, Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA,The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | | | - Raziyeh Mahmoudzadeh
- Mid Atlantic Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Mirataollah Salabati
- Mid Atlantic Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Michael Ammar
- Mid Atlantic Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - Aamir A Aziz
- University of Nevada Reno School of Medicine, Reno, Nevada, USA
| | - Amy Ewald
- Retina Vitreous Associates of Florida, St. Petersburg, Florida, USA
| | | | - Erik B Lehman
- Department of Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Sagit Fried
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Adriana Strutt
- Neurology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Arshad Mohammad Khanani
- Sierra Eye Associates, Reno, Nevada, USA,University of Nevada Reno School of Medicine, Reno, Nevada, USA
| | - David A Eichenbaum
- Retina Vitreous Associates of Florida, St. Petersburg, Florida, USA,Ophthalmology, Morsani College of Medicine at the University of South Florida, Tampa, Florida, USA
| | - Carl Regillo
- Mid Atlantic Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Charles Clifton Wykoff
- Retina Consultants of Texas, Houston, Texas, USA .,Blanton Eye Institute, Houston, Texas, USA
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9
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Talks SJ, Daien V, Mitchell P, Aslam T, Barratt J, Biberger A, Lamoureux EL, Hirst C, Sylvanowicz M, Finger RP. The Patient Voice in Neovascular Age-Related Macular Degeneration: Findings from a Qualitative Study. Ophthalmol Ther 2022; 12:561-575. [PMID: 36525220 PMCID: PMC9756919 DOI: 10.1007/s40123-022-00631-7] [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: 10/27/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Visual impairment resulting from diseases such as neovascular age-related macular degeneration (nAMD) may cause behavioural, environmental, psychological, and logistical challenges that could act as barriers to effective uptake and sustainability of treatment with anti-vascular endothelial growth factor agents (anti-VEGFs). Understanding emotions and experiences of patients with nAMD may help inform the determinants of adherence, and could contribute to improvements in ophthalmic outcomes and quality of life. METHODS Seventeen patients with nAMD receiving anti-VEGF injections were enrolled from three clinics: one each in France (n = 5), Germany (n = 6), and the UK (n = 6). Patients' health information and treatment characteristics were collected. Individual phone interviews were conducted by experienced health care interviewers. Transcripts were analysed thematically. RESULTS Patients (53% female) had a mean age of 77 years. Bilateral anti-VEGF injections were received by 24% (n = 4); and most (76%, n = 13) were adherent to their treatment. Patient emotions at diagnosis ranged from happiness at learning about the treatment for nAMD to being terrified of receiving an injection in the eye. Most patients mentioned feeling anxious and fearful before their first injection despite receiving reassurance. After the first injection, these feelings and apprehension abated for many, but not all. With the goal of maintaining the best possible vision, few (24%, n = 4) patients reported more than one missed appointment, and most had never considered stopping treatment. No patient reported additional assistance beyond family support; however, many had difficulties with recreational and domestic activities and had developed coping strategies. CONCLUSION This study provides insights on patients' emotions related to their experience of nAMD and its management, highlighting the varying experiences between individuals. It shows the importance of the patient's voice when considering patient care and management, and how the nature and timing of interventions can improve the experience of living with and managing nAMD.
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Affiliation(s)
- S. James Talks
- grid.420004.20000 0004 0444 2244Newcastle Eye Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vincent Daien
- grid.157868.50000 0000 9961 060XDepartment of Ophthalmology, University Hospital of Montpellier, Montpellier, France
| | - Paul Mitchell
- grid.1013.30000 0004 1936 834XUniversity of Sydney (Westmead Institute for Medical Research), Sydney, NSW Australia
| | - Tariq Aslam
- grid.416375.20000 0004 0641 2866Manchester Royal Eye Hospital, Manchester, UK ,grid.5379.80000000121662407University of Manchester, Manchester, UK
| | - Jane Barratt
- grid.511577.00000 0001 0942 4326International Federation on Ageing, Toronto, ON Canada
| | | | - Ecosse L. Lamoureux
- grid.272555.20000 0001 0706 4670Singapore Eye Research Institute, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Singapore, Singapore
| | - Ceri Hirst
- grid.483721.b0000 0004 0519 4932Bayer Consumer Care AG, Basel, Switzerland
| | | | - Robert P. Finger
- grid.10388.320000 0001 2240 3300Department of Ophthalmology, University of Bonn, Bonn, Germany
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10
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Antiangiogenic potential of small polypeptide sequences: In vivo assays, cytotoxicity, synthetic approaches and influence of C-terminal carboxyamidation. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2022.133493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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11
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Hogg HDJ, Chung N, Reed J, Berrett G, Pearce M, Di Simplicio S. An observational clinical study of the influence of phacoemulsification on choroidal neovascular membrane activity in age related macular degeneration. Eye (Lond) 2022; 36:1379-1383. [PMID: 34172945 PMCID: PMC9232623 DOI: 10.1038/s41433-021-01653-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Thousands of phacoemulsification surgeries are performed on eyes with age-related macular degeneration (AMD) complicated by choroidal neovascular membrane (CNV) in the United Kingdom each year. As populations age this number is expected to rise. Controversy over phacoemulsification's influence on CNV activity limits the information which clinicians and these patients use to decide on surgery. This observational study aims to resolve this controversy by reporting on intravitreal injection (IVI) frequency as a pragmatic marker of CNV activity in a large cohort. METHODS A cohort of eyes with AMD complicated by CNV (n = 327) that underwent cataract surgery at a single tertiary centre from 2014 to 2019 were identified. These cases were matched by interval since CNV diagnosis at a specified 'time zero' within the follow-up of pseudophakic eyes with AMD (n = 327). Data concerning demographics, visual acuity (VA) and intravitreal injection frequency before and after 'time zero'/phacoemulsification were collected. RESULTS Following 'time zero'/phacoemulsification' the mean reduction in annual IVI frequency was 0.6 injections/year (95% CI 0.4,0.9) and 0.4 injections/year (95% CI 0.1,0.7) in the comparison and phacoemulsification cohorts respectively. The mean VA gain 12 months after phacoemulsification in the intervention cohort was 11.3 (95% CI 9.2,13.4) early treatment of diabetic retinopathy study (ETDRS) letters, with 214 eyes (65.4%) having gained ≥5 ETDRS letters after surgery. CONCLUSIONS Phacoemulsification has no clinically significant impact on the activity of pre-existent CNV secondary to AMD. Phacoemulsification should be offered to patients with AMD and cataract that limits vision, regardless of CNV activity.
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Affiliation(s)
- H D Jeffry Hogg
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE1 4LP, UK.
| | - N Chung
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - J Reed
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - G Berrett
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE1 4LP, UK
| | - M Pearce
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - Sandro Di Simplicio
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE1 4LP, UK
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Schmid A, Bucher F, Liczenczias E, Maslanka Figueroa S, Müller B, Agostini H. nAMD: optimization of patient care and patient-oriented information with the help of an internet-based survey. Graefes Arch Clin Exp Ophthalmol 2022; 260:3241-3253. [PMID: 35552499 PMCID: PMC9477947 DOI: 10.1007/s00417-022-05678-7] [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: 12/13/2021] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This survey was conducted to identify factors that influence how patients with neovascular age-related macular degeneration (nAMD) deal with their disease and information that are considered useful from a patient's point of view. METHODS A total of 5035 patients with nAMD living in Germany were interviewed via internet-based cross-sectional survey, where the following information was collected: personal data, disease awareness, and patients' needs. In addition, a Quality of Life questionnaire (SF-12v2) could be completed. RESULTS Out of the 5035 participants, more males than females participated (55% vs 45%), and most participants were in the age groups 76 to 85 years (37%) and 66 to 75 years (35%). Seventy-three percent of patients rated their understanding of the disease as at least sufficient, and more than two-thirds of the patients (68%) were aware that their disease needs to be controlled on a regular basis and treated on an "as needed" basis. Regarding potential risk factors for AMD, most participants were aware of age (89%), but only 39% of hereditary load and 33% of smoking as evidence-based risk factors, indicating a need for further information. The doctor remains the major source of information (93%), with internet (29%), brochures (14%), opticians (13%), or patient support groups (4%) with only limited contribution. Distance to the treatment center was identified as one of the factors, which had the greatest influence on patients' compliance. A "treat as needed" regime turned out to be the preferred control and treatment schedule in contrast to a "fixed appointment" every 4 weeks. CONCLUSION This internet-based survey appears to be representative for nAMD patients. To increase patients' compliance, proximity to the treatment center and a "treat as needed" regime turned out to be important factors as well as patients' awareness of their disease. In this regard, the reported desire for more information indicates that patients' knowledge still needs to be improved. Our results will help to further optimize patient care and patient-oriented information.
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Affiliation(s)
- Anke Schmid
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Felicitas Bucher
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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13
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Dinah C, Enoch J, Ghulakhszian A, Taylor DJ, Crabb DP. Intravitreal treatment for geographic atrophy: coming soon to a patient near you? Eye (Lond) 2022; 36:1121-1123. [PMID: 34007061 PMCID: PMC9046256 DOI: 10.1038/s41433-021-01591-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Christiana Dinah
- grid.439325.a0000 0000 9897 4348Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK
| | - Jamie Enoch
- grid.28577.3f0000 0004 1936 8497Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Arevik Ghulakhszian
- grid.439325.a0000 0000 9897 4348Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK
| | - Deanna J. Taylor
- grid.28577.3f0000 0004 1936 8497Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - David P. Crabb
- grid.28577.3f0000 0004 1936 8497Department of Optometry and Visual Sciences, City, University of London, London, UK
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14
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Calles-Monar PS, Sanabria MR, Alonso-Tarancon AM, Coco-Martin RM, Mayo-Iscar A. Modifiable Determinants of Satisfaction with Intravitreal Treatment in Patients with Neovascular Age-Related Macular Degeneration. Drugs Aging 2022; 39:355-366. [PMID: 35486357 DOI: 10.1007/s40266-022-00937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The success of intravitreal treatment for neovascular age-related macular degeneration (nAMD) depends on maximal adherence to treatment, which in turn requires patient satisfaction. OBJECTIVE The aim of this study was to assess the factors associated with nAMD patient satisfaction to implement actions to improve treatment experiences and increase adherence. DESIGN This was a prospective, observational, analytical, cross-sectional study. SUBJECTS Our study included 100 consecutive nAMD patients under intravitreal treatment for at least 1 year. METHODS Patients completed the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) and the EuroQol Visual Analog Scale (EQ VAS). A logistic regression was estimated to model the low values of the satisfaction score (MacTSQ < 50). RESULTS The mean age of patients was 82.1 ± 7.8 years and 62% were female. Males (p = 0.002) and patients who improved their visual acuity (p = 0.004) were more satisfied, while patients who received a higher number of injections (p = 0.036) and treatment in both eyes (p = 0.001) were less satisfied. Higher health-related quality of life was related to higher satisfaction. The sensitivity and specificity of the predictive model were 75.8% and 76.1%, respectively. Factors independently associated with low satisfaction were female sex (odds ratio [OR] 6.84), going to the clinic alone (OR 8.51), longer duration of treatment (OR 0.62), receiving treatment in both eyes (OR 3.54), and suffering a decline in visual acuity (OR 3.30). The questionnaire revealed patients' needs for more information and injection points closer to their homes. CONCLUSIONS Well-defined areas for improvement were identified, i.e. to improve the information offered to each patient, to incorporate new long-acting drugs, and to establish locations for injection services in peripheral areas.
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Affiliation(s)
- Paola S Calles-Monar
- Ophthalmology Department, San Telmo Hospital, Palencia University Hospital Complex, 34004, Palencia, Spain.
| | - María R Sanabria
- Ophthalmology Department, San Telmo Hospital, Palencia University Hospital Complex, 34004, Palencia, Spain
| | - Ana M Alonso-Tarancon
- Ophthalmology Department, San Telmo Hospital, Palencia University Hospital Complex, 34004, Palencia, Spain
| | - Rosa M Coco-Martin
- Institute of Applied Ophthalmobiology, University of Valladolid, Valladolid, Spain.,OFTARED Health Research Thematic Network, Carlos III Health Institute, Madrid, Spain
| | - Agustín Mayo-Iscar
- Department of Statistics and O.R. & IMUVA, University of Valladolid, Valladolid, Spain
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15
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Fernández-Vigo JI, Burgos-Blasco B, Calvo-González C, Escobar MJ, Shi H, Jiménez-Santos M, Valverde-Megías A, Reche-Frutos J, López-Guajardo L, Donate-López J. Assessment of the perception of healthcare barriers and the impact of intravitreal injections on neovascular age-related macular degeneration. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:198-204. [PMID: 35523466 DOI: 10.1016/j.oftale.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/09/2021] [Indexed: 06/14/2023]
Abstract
AIM To evaluate the perception of barriers in healthcare and the impact of intravitreal injections in patients with neovascular age-related macular degeneration (nAMD). METHODS Cross-sectional study including 108 patients with nAMD in treatment with intravitreal injections. The patients answered a questionnaire with 26 questions (score from 1 to 5) divided in three sections: 1) the disease and its treatment with injections, 2) healthcare barriers and 3) new technologies. RESULTS The mean age was 80.4 ± 7.0 years and visual acuity (VA) was 75.2 ± 12.4 letters. The main barriers in healthcare were long waiting times (72%), followed by other comorbidities (10%). Some 63% of patients have to wait between 3 and 5 h to attend their clinical visit. Significant anxiety due to the injections (2.8 ± 1.3) was observed, being present in 71% of the cases the day before. A great fear of blindness and losing independence was observed (4.4 ± 0.9 and 4.3 ± 1.1), with no differences in relation to VA, age or sex (p ≥ 0.135). Moreover, 28% of the patients reported that it was quite or very difficult for them to attend the clinical visit, with 69% of the total showing great interest in having a diagnostic device at home. CONCLUSION The nAMD and its treatment represent a significant burden on patients, among whom there is a great fear of blindness and of losing their independence, the main barrier being the long waiting time for the clinical visit.
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Affiliation(s)
- J I Fernández-Vigo
- Departamento de Retina, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain.
| | - B Burgos-Blasco
- Departamento de Retina, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - C Calvo-González
- Departamento de Retina, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - M J Escobar
- Departamento de Retina, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - H Shi
- Departamento de Retina, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - M Jiménez-Santos
- Departamento de Retina, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - A Valverde-Megías
- Departamento de Retina, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - J Reche-Frutos
- Departamento de Retina, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - L López-Guajardo
- Departamento de Retina, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - J Donate-López
- Departamento de Retina, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
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16
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Perrone V, Dovizio M, Veronesi C, Citraro R, De Francesco A, Dell’Orco S, Di Manno G, Paciello A, Resta AM, Quarta F, Ferrante N, Ritrovato D, Degli Esposti L. Retrospective Analysis of the Pharmaco-Utilization of VEGF Inhibitors and Health Care Costs among Patients with Wet Age-Related Macular Degeneration and Other Ocular Diseases in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052548. [PMID: 35270241 PMCID: PMC8909764 DOI: 10.3390/ijerph19052548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/28/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
This Italian retrospective study aimed to analyze the pharmaco-utilization of anti-VEGF drugs and health care costs among patients with wet age-related macular degeneration (wAMD) or other ocular diseases. A retrospective analysis was performed on administrative databases of Italian entities covering approximately six million individuals. Across January 2010–December 2017, patients aged ≥50 years with a prescription of intravitreal anti-VEGFs were included as “wAMD” patients [by wAMD hospitalization or intravitreal injections] or as “other ocular diseases” patients [by hospitalization for other ocular disorders or intravitreal injections, with concomitant diabetes diagnosis or dexamethasone treatment]. The date of first matching of inclusion criteria was index-date. wAMD-cohort. Overall, 3879 patients were included; at index-date, 82.2% were treated with Ranibizumab, 15.8% with Aflibercept, and 2% with Pegaptanib. During the follow-up, the mean/annual anti-VEGF prescription [3.6 (first-year)–0.8 (third-year)] and the total expenditure [5799.84 € (first-year)–3212.84 € (third-year)] decreased. Other ocular diseases-cohort. Overall, 2646 patients were enclosed; 85.9% were treated with Ranibizumab, 13.5% with Aflibercept, and 0.6% with Pegaptanib. During the follow-up, the mean/annual anti-VEGF prescription [3.3 (first-year)–0.5 (third-year)] and the total cost [7196.83 € (first-year)–5162.68 € (third-year)] decreased. This observational study highlighted a decline in anti-VEGF prescriptions over time in both cohorts, suggesting a trend of under-treatment that could worsen the patients’ clinical outcomes and increase health care resource consumption.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, 40121 Bologna, Italy; (M.D.); (C.V.); (L.D.E.)
- Correspondence:
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, 40121 Bologna, Italy; (M.D.); (C.V.); (L.D.E.)
| | - Chiara Veronesi
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, 40121 Bologna, Italy; (M.D.); (C.V.); (L.D.E.)
| | - Rita Citraro
- Unita’ Operativa di Farmacologia Clinica e Farmacovigilanza, Azienda Ospedaliero-Universitaria “Mater Domini”, Università Magna Grecia di Catanzaro, 88100 Catanzaro, Italy; (R.C.); (A.D.F.)
| | - Adele De Francesco
- Unita’ Operativa di Farmacologia Clinica e Farmacovigilanza, Azienda Ospedaliero-Universitaria “Mater Domini”, Università Magna Grecia di Catanzaro, 88100 Catanzaro, Italy; (R.C.); (A.D.F.)
| | - Stefania Dell’Orco
- Azienda Sanitaria Locale (ASL) Roma 6, Albano Laziale, 00100 Rome, Italy; (S.D.); (G.D.M.)
| | - Gianluca Di Manno
- Azienda Sanitaria Locale (ASL) Roma 6, Albano Laziale, 00100 Rome, Italy; (S.D.); (G.D.M.)
| | - Arrigo Paciello
- Agenzia di Tutela della Salute (ATS) Bergamo, 24100 Bergamo, Italy;
| | - Anna Maria Resta
- Struttura Complessa di Farmacia Territoriale Area Vasta 1, 61032 Fano, Italy;
| | - Fabrizio Quarta
- U.O. Epidemiologia e Statistica, Azienda Sanitaria Locale (ASL) Lecce, 73100 Lecce, Italy;
| | - Nicola Ferrante
- Novartis Farma S.p.A., Origgio, 21100 Varese, Italy; (N.F.); (D.R.)
| | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, 40121 Bologna, Italy; (M.D.); (C.V.); (L.D.E.)
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17
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Real-life patient journey in neovascular age-related macular degeneration: a narrative medicine analysis in the Italian setting. Eye (Lond) 2022; 36:182-192. [PMID: 33674730 PMCID: PMC8727581 DOI: 10.1038/s41433-021-01470-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/20/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate the real-life experience of patients affected by neovascular age-related macular degeneration (nAMD), in the healthcare pathway for the management of the disease, using a "patient journey" and narrative method approach. METHODS The patient journey of subjects affected by nAMD was designed using a process-mapping methodology involving a team from 11 Italian centres. Subsequently, narratives were collected from nAMD patients and family members. The interviews were analyzed using the narrative medicine methodology. RESULTS Eleven specialized retina centres across Italy were involved and 205 narratives collected. In 29% of cases, patients underestimated their symptoms or attributed them to non-pathological causes, thus delaying the specialist consultation. The delay in accessing to care was due to a lack of awareness of this disease (50% of the participants didn't know what nAMD is) and to critical issues faced at first visit (long waiting lists, failed diagnosis, underestimation of the problem). Despite anti-VEGF therapies were perceived as effective in improving or stabilizing vision in 91% of narratives collected, 77% of patients still reduced or ceased daily activities such as reading and driving. Within the pathway of care there was not a multidisciplinary approach, and the patients were treated just by the ophthalmologist. CONCLUSIONS nAMD may significantly affect the quality of life of affected patients, both from a functional and psychological point of view. The narrative medicine approach highlights some critical points in the healthcare journey of nAMD patients and represents a useful background in implementing patient management algorithms and pathways of care.
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18
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Zhou P, Zheng S, Wang E, Men P, Zhai S. Conbercept for Treatment of Neovascular Age-Related Macular Degeneration and Visual Impairment due to Diabetic Macular Edema or Pathologic Myopia Choroidal Neovascularization: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:696201. [PMID: 34712132 PMCID: PMC8546330 DOI: 10.3389/fphar.2021.696201] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/10/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Conbercept is a new anti-vascular endothelial growth factor (VEGF) drug. Here, we systematically conducted the efficacy, safety, compliance, and pharmacoeconomic evaluation of intravitreal conbercept (IVC) compared with other treatments in patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or pathologic myopia choroidal neovascularization (pmCNV). Methods: Databases of PubMed, Embase, Cochrane Library, ClinicalTrials.gov, SinoMed, China National Knowledge Infrastructure, and WanFang Data were systematically searched from the inception to July 27, 2021. Randomized clinical trials and pharmacoeconomic studies comparing IVC with control groups in adults with nAMD, DME, or pmCNV were reviewed and selected. Meta-analyses were performed using the fixed-effects model when pooled data were homogeneous. Heterogeneous data were analyzed using the random-effects model. Primary outcomes included visual improvement rate, mean change in visual acuity or best corrected visual acuity, and pharmacoeconomic outcomes. Additional outcomes were the mean change in fundus examination values, adverse events (AEs), quality-of-life measures, and number of injections. Results: Among 3,591 screened articles, 22 original studies with 1,910 eyes of patients were finally included. For nAMD and DME, IVC was significantly associated with better visual acuity or best corrected visual acuity improvement and fundus quantitative measures than placebo, laser photocoagulation (LP), or intravitreal triamcinolone acetonide (IVT). However, IVC showed non-inferior efficacy to intravitreal ranibizumab (IVR) according to low quality of evidence, and there was lack of trials comparing the priority of IVC to other anti-VEGF regimens. No definitive increased risk of ocular or non-ocular AEs were observed in the study groups. All patients with AEs recovered after symptomatic treatments, and no severe AEs occurred. Patients treated with IVC might have higher quality-of-life scores than those in IVR in nAMD or LP in DME. Additionally, IVC showed cost-utility advantages in nAMD and cost-effectiveness advantages than IVR in pmCNV in China. Conclusion: IVC is well-tolerated and effective for improving vision acuity and quantitative measures in fundus condition in patients with nAMD and DME compared with LP, IVT, and placebo, but gains comparable efficacy to IVR. However, well-designed, large-sample, and long-term evaluation of IVC shall be conducted in additional studies worldwide.
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Affiliation(s)
- Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Siqian Zheng
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Ente Wang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Peng Men
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
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19
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Quist SW, de Jong LA, van Asten F, Knoester P, Postma MJ, Freriks RD. Cost-minimisation analysis of a treat-and-extend regimen with anti-VEGFs in patients with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2021; 260:1083-1095. [PMID: 34643793 PMCID: PMC8511619 DOI: 10.1007/s00417-021-05359-x] [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: 05/06/2021] [Revised: 07/16/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Although intraocular anti-vascular endothelial growth factors (anti-VEGFs) are effective as treatment of neovascular age-related macular degeneration (nAMD), the (economic) burden on the healthcare system is considerable. A treat-and-extend (T&E) regimen is associated with a lower number of injections without compromising the effectiveness and can therefore help optimise nAMD treatment. This study investigates the per-patient costs associated with nAMD treatment, when using aflibercept, bevacizumab, or ranibizumab with a T&E regimen. Methods In this cost-minimisation model, the per-patient costs in the Netherlands were modelled using a healthcare payers’ perspective over a 3-year time horizon with the assumption that efficacy of treatments is similar. Additionally, the break-even price of the different anti-VEGFs was calculated relative to the cheapest option and injection frequency. Results The injection frequency varied from 14.2 for aflibercept to 27.4 for bevacizumab in 3 years. Nonetheless, bevacizumab remains the cheapest treatment option (€14,215), followed by aflibercept (€18,202) and ranibizumab (€31,048). The medication covers the majority of the per-patient costs for aflibercept and ranibizumab, while administration covers the majority of the per-patient costs for bevacizumab. The break-even prices of aflibercept and ranibizumab are respectively €507 and €60.58 per injection. Brolucizumab was included in the scenario analysis and was more expensive than aflibercept (€20,446). Brolucizumab should reduce to 13.8 injections over 3 years to be as costly as aflibercept. Conclusion Bevacizumab is the cheapest anti-VEGF treatment. The list prices of all anti-VEGFs should reduce to be as costly as bevacizumab. Aflibercept is the second-choice treatment and so far brolucizumab is not.
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Affiliation(s)
- S W Quist
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands. .,Asc Academics, Professor Enno Dirk Wiersmastraat 5, Groningen, The Netherlands.
| | - L A de Jong
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands.,Asc Academics, Professor Enno Dirk Wiersmastraat 5, Groningen, The Netherlands
| | - F van Asten
- Department of Ophthalmology, Radboud University Medical Center, Philips Van Leydenlaan 15, Nijmegen, The Netherlands
| | - P Knoester
- Department of Pharmacy, Alrijne Hospital, Simon Smitweg 1, Leiderdorp, The Netherlands
| | - M J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Nettelbosje 2, Groningen, The Netherlands
| | - R D Freriks
- Asc Academics, Professor Enno Dirk Wiersmastraat 5, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Nettelbosje 2, Groningen, The Netherlands
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20
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Fenwick EK, Lee EPX, Man REK, Ho KC, Najjar RP, Milea D, Teo KYC, Tan ACS, Lee SY, Yeo IYS, Tan GSW, Mathur R, Wong TY, Cheung CMG, Lamoureux EL. Identifying the content for an item bank and computerized adaptive testing system to measure the impact of age-related macular degeneration on health-related quality of life. Qual Life Res 2021; 31:1237-1246. [PMID: 34562188 DOI: 10.1007/s11136-021-02989-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE We are developing an age-related macular degeneration (AMD) health-related quality of life (HRQoL) item bank, applicable to Western and Asian populations. We report primarily on content generation and refinement, but also compare the HRQoL issues reported in our study with Western studies and current AMD-HRQoL questionnaires. METHODS In this cross-sectional, qualitative study of AMD patients attending the Singapore National Eye Centre (May-December 2019), items/domains were generated from: (1) AMD-specific questionnaires; (2) published articles; (3) focus groups/semi-structured interviews with AMD patients (n = 27); and (4) written feedback from retinal experts. Following thematic analysis, items were systematically refined to a minimally representative set and pre-tested using cognitive interviews with 16 AMD patients. RESULTS Of the 27 patients (mean ± standard deviation age 67.9 ± 7.0; 59.2% male), 18 (66.7%), two (7.4%), and seven (25.9%) had no, early-intermediate, and late/advanced AMD (better eye), respectively. Whilst some HRQoL issues, e.g. activity limitation, mobility, lighting, and concerns were similarly reported by Western patients and covered by other questionnaires, others like anxiety about intravitreal injections, work tasks, and financial dependency were novel. Overall, 462 items within seven independent HRQoL domains were identified: Activity limitation, Lighting, Mobility, Emotional, Concerns, AMD management, and Work. Following item refinement, items were reduced to 219, with 31 items undergoing amendment. CONCLUSION Our 7-domain, 219-item AMD-specific HRQoL instrument will undergo psychometric testing and calibration for computerized adaptive testing. The future instrument will enable users to precisely, rapidly, and comprehensively quantify the HRQoL impact of AMD and associated treatments, with item coverage relevant across several populations.
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Affiliation(s)
- Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ester P X Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Kam Chun Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,UNSW Sydney, Sydney, Australia
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Kelvin Y C Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Anna C S Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ian Yew San Yeo
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Gavin S W Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ranjana Mathur
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore. .,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore. .,The University of Melbourne, Parkville, Australia.
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21
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Factors of Anti-Vascular Endothelial Growth Factor Therapy Withdrawal in Patients with Neovascular Age-Related Macular Degeneration: Implications for Improving Patient Adherence. J Clin Med 2021; 10:jcm10143106. [PMID: 34300272 PMCID: PMC8306388 DOI: 10.3390/jcm10143106] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/25/2021] [Accepted: 07/10/2021] [Indexed: 11/17/2022] Open
Abstract
We investigated the factors associated with the discontinuation of anti-vascular endothelial growth factor (VEGF) therapies in patients with neovascular age-related macular degeneration (AMD). Japanese patients with AMD aged ≥50 years, reporting at least one prior injection of an anti-VEGF drug, completed an online survey covering reasons for discontinuation or dissatisfaction with therapy, quality of life (EQ-5D-5L) and patient activation (PAM-13). The respondents were divided into two cohorts: Cohort 1-patients who discontinued anti-VEGF therapy (n = 207); Cohort 2-patients continuing anti-VEGF therapy (n = 65). The most common reason for discontinuing therapy was the "doctor's decision" in 89.4% (Cohort 1-1). In the other 22 (10.6%) patients in Cohort 1 (Cohort 1-2), reasons included "no deterioration in vision", "financial burden" and "ineffective treatment". Patients in Cohort 2 were dissatisfied with "long waiting times" (77%), "financial burden" and "ineffective treatment". Pain/discomfort posed the greatest impact on quality of life. Only 5% of patients in Cohorts 1-1 and 2 and none in Cohort 1-2 were considered advocates for their own health. In conclusion, most patients who discontinued anti-VEGF therapy did so at their doctor's decision. Addressing the reasons associated with discontinuation or dissatisfaction with anti-VEGF therapies might help improve their continuation.
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22
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van der Aa HP, van Rens GH, Verbraak FD, Bosscha M, Comijs HC, van Nispen RM. Anxiety and depression in patients who receive anti-VEGF treatment and the usability and feasibility of e-mental health support: the E-PsEYE pilot study. Ophthalmic Physiol Opt 2021; 41:808-819. [PMID: 34050550 PMCID: PMC8252528 DOI: 10.1111/opo.12837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/07/2021] [Indexed: 01/09/2023]
Abstract
Purpose E‐PsEYE is an internet‐based, guided self‐help course, following the principles of cognitive behavioural therapy, to reduce anxiety and depression in patients with retinal exudative diseases who receive anti‐vascular endothelial growth factor (anti‐VEGF) treatment. The purpose of this study was to determine the prevalence and related factors of anxiety and depression in this population and evaluate the usability and feasibility of E‐PsEYE. Methods Symptoms of anxiety and depression and related factors were determined in 90 patients (mean age 77 years, 58% female), based on multiple logistic regression analysis. Five patients with mild to moderate depression/anxiety tested the usability of E‐PsEYE. They were asked to think aloud while completing two modules of the intervention and freely explore system features. The feasibility of the total E‐PsEYE intervention was tested in 14 patients with mild to moderate depression/anxiety, based on a single arm pre‐post study with a follow‐up of three months: fidelity, acceptability, feasibility of study methods and potential effectiveness were explored. Results Fifty‐three percent of the total study population experienced at least mild anxiety and/or depression symptoms. Especially female patients (odds ratio (OR) 3.89, 95% confidence interval (CI) 1.33–11.40), those who experienced limitations in daily life activities due to vision loss (OR 9.67; 95% CI 3.18–29.45) and those who experienced loneliness (OR 3.53, 95% CI 1.14–10.95) were more likely to have anxiety/depression. The usability study raised several possibilities for improvement, based on which E‐PsEYE was improved. The feasibility study showed adequate fidelity and acceptability. Most participants were satisfied with the results (79%). There was a high response rate, no loss to follow‐up and mental health problems decreased in more than half of the patients. The Wilcoxon signed rank test indicated lower post‐test ranks compared to pre‐test ranks (depression Z −1.34, p = 0.18; anxiety Z −1.45, p = 0.15). Conclusions Mental health problems are prevalent in patients who receive anti‐VEGF treatment. Healthcare providers should recognise these problems and related factors in order to refer patients to appropriate care in a timely manner. Outcomes on the usability and feasibility of E‐PsEYE are promising as a prelude to performing a randomised controlled trial, which will shed more light on its (cost‐)effectiveness.
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Affiliation(s)
- Hilde Pa van der Aa
- Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ger Hmb van Rens
- Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | - Frank D Verbraak
- Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Machteld Bosscha
- Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hannie C Comijs
- Psychiatry, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruth Ma van Nispen
- Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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23
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Assi L, Chamseddine F, Ibrahim P, Sabbagh H, Rosman L, Congdon N, Evans J, Ramke J, Kuper H, Burton MJ, Ehrlich JR, Swenor BK. A Global Assessment of Eye Health and Quality of Life: A Systematic Review of Systematic Reviews. JAMA Ophthalmol 2021; 139:526-541. [PMID: 33576772 PMCID: PMC7881366 DOI: 10.1001/jamaophthalmol.2021.0146] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Question What is the association between vision impairment, eye diseases, or ophthalmic interventions and quality of life? Findings In this cross-sectional study, vision impairment and eye diseases were associated with lower quality of life. More than half of the ophthalmic interventions included had a positive association with quality of life. Meaning The associations of quality of life with vision impairment and the improvements in quality of life with ophthalmic interventions support efforts to improve access to ophthalmic treatments globally to reach the millions of people affected by eye disease each year. Importance More than 1 billion people worldwide have vision impairment or blindness from potentially preventable or correctable causes. Quality of life, an important measure of physical, emotional, and social well-being, appears to be negatively associated with vision impairment, and increasingly, ophthalmic interventions are being assessed for their association with quality of life. Objective To examine the association between vision impairment or eye disease and quality of life, and the outcome of ophthalmic interventions on quality of life globally and across the life span, through an umbrella review or systematic review of systematic reviews. Evidence Review The electronic databases MEDLINE, Ovid, Embase, Cochrane Database of Systematic Reviews, Proquest Dissertations, and Theses Global were searched from inception through June 29, 2020, using a comprehensive search strategy. Systematic reviews addressing vision impairment, eye disease, or ophthalmic interventions and quantitatively or qualitatively assessing health-related, vision-related, or disease-specific quality of life were included. Article screening, quality appraisal, and data extraction were performed by 4 reviewers working independently and in duplicate. The Joanna Briggs Institute critical appraisal and data extraction forms for umbrella reviews were used. Findings Nine systematic reviews evaluated the association between quality of life and vision impairment, age-related macular degeneration, glaucoma, diabetic retinopathy, or mendelian eye conditions (including retinitis pigmentosa). Of these, 5 were reviews of quantitative observational studies, 3 were reviews of qualitative studies, and 1 was a review of qualitative and quantitative studies. All found an association between vision impairment and lower quality of life. Sixty systematic reviews addressed at least 1 ophthalmic intervention in association with quality of life. Overall, 33 unique interventions were investigated, of which 25 were found to improve quality of life compared with baseline measurements or a group receiving no intervention. These interventions included timely cataract surgery, anti–vascular endothelial growth factor therapy for age-related macular degeneration, and macular edema. Conclusions and Relevance There is a consistent association between vision impairment, eye diseases, and reduced quality of life. These findings support pursuing ophthalmic interventions, such as timely cataract surgery and anti–vascular endothelial growth factor therapy, for common retinal diseases, where indicated, to improve quality of life for millions of people globally each year.
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Affiliation(s)
- Lama Assi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fatimah Chamseddine
- Clinical Research Institute, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Perla Ibrahim
- Department of Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Hadi Sabbagh
- Department of Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Lori Rosman
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, United Kingdom.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jennifer Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Moorfields Eye Hospital, London, United Kingdom
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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24
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Enoch J, Ghulakhszian A, Crabb DP, Dinah C, Taylor DJ. Acceptability of intravitreal injections in geographic atrophy: protocol for a mixed-methods pilot study. BMJ Open 2021; 11:e049495. [PMID: 33895721 PMCID: PMC8074551 DOI: 10.1136/bmjopen-2021-049495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Age-related macular degeneration (AMD) is a common cause of visual impairment, affecting central vision. Geographic atrophy (GA) is an advanced form of the non-neovascular (dry) type of AMD. Late-stage clinical trials suggest that intravitreal injections of novel therapeutics may slow down the rate of GA progression by up to 30% in 1 year, thus allowing people with GA to preserve central vision for a longer period. While intravitreal injections have become an established treatment modality for neovascular (wet) AMD, it is unknown whether patients with (more gradually progressing) GA would accept regular injections that slow down, but do not stop or reverse, vision loss. Therefore, this mixed-methods pilot study will aim to explore whether regular intravitreal injections will be acceptable as treatment for patients with GA, and the factors that may affect treatment acceptability. METHODS AND ANALYSIS A mixed-methods survey has been designed in collaboration with a GA patient advisory group. The survey comprises of structured questionnaires, semi-structured interview questions regarding patients' perceptions of intravitreal injections and the burden of treatment, and a task eliciting preferences between different potential treatments. Due to COVID-19 restrictions, this study will be conducted remotely by telephone. Thirty individuals will be recruited from NHS Medical Retina clinics at Central Middlesex Hospital, London. Half of the participants will be naïve to intravitreal injections, while half will have previous experience of intravitreal injections for neovascular (wet) AMD. Qualitative data analysis will be conducted using the Framework Method of analysis to identify key themes from participants' accounts. ETHICS AND DISSEMINATION The study received Health Research Authority approval on 23 March 2021 (IRAS Project ID: 287824). Findings will be disseminated through peer-reviewed publications and conference presentations to the medical retina community, as well as through dialogue with patients and macular disease charities.
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Affiliation(s)
- Jamie Enoch
- Optometry and Visual Sciences, City University of London, London, UK
| | - Arevik Ghulakhszian
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK
| | - David P Crabb
- Optometry and Visual Sciences, City University of London, London, UK
| | - Christiana Dinah
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK
| | - Deanna J Taylor
- Optometry and Visual Sciences, City University of London, London, UK
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25
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McClard CK, Wang R, Windham V, Munoz J, Gomez S, Fried S, Saroj N, Regillo C, Wykoff CC, Strutt AM. Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections (QUALITII): Development of a patient-reported measure to assess treatment burden of repeat intravitreal injections. BMJ Open Ophthalmol 2021; 6:e000669. [PMID: 33912685 PMCID: PMC8031709 DOI: 10.1136/bmjophth-2020-000669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 01/22/2023] Open
Abstract
Objective To understand patient burden of treatment of repeated intravitreal injections (IVI) in the management of exudative retinal diseases. Methods and analysis Participants were sampled from a large urban retina specialty practice in Houston, Texas, USA, based on history of ongoing receipt of IVI. The 50-item Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections questionnaire was developed to evaluate the patient experience including discomfort, anxiety, inconvenience and satisfaction. Categorial principal components analysis (CATPCA) was performed to assess construct validity and internal consistency. A subset of these items was used to establish a measure of total treatment burden, referred to as the IVI Treatment Burden Score (TBS). Results 142 patients participated in this study. CATPCA analysis revealed five dimensions of patient burden: disruption of normal routine or capacity, anxiety, frequency of visits, chronicity of disease and perceived treatment value or satisfaction. Together, these dimensions accounted for 67% of variance explained. Cronbach's alpha was 0.97. The most frequently cited cause of discomfort was the feeling after anaesthetic wore off. The most common source of anxiety was fear of injection and associated discomfort or pain. Regarding inconvenience, patients reported temporary postinjection debilitation, requiring an average of 8 hours for recovery per treatment. The most frequently identified sources of satisfaction were confidence in the provider or treatment and interactions with staff. Conclusions Understanding and quantifying the patient burden associated with repeated IVI for exudative retinal diseases can reveal opportunities to improve delivery methods. The TBS could serve to inform strategies to maximise treatment adherence and optimise patient experiences.
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Affiliation(s)
- Cynthia K McClard
- Ophthalmology, Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA.,The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Rui Wang
- Ophthalmology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Jose Munoz
- Retina Consultants of Texas, Houston, Texas, USA
| | - Samuel Gomez
- Retina Consultants of Texas, Houston, Texas, USA
| | - Sagit Fried
- Ben Gurion University of the Negev, Beersheba, Israel
| | | | - Carl Regillo
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Charles Clifton Wykoff
- Retina Consultants of Texas, Retina Consultants of America; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
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26
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Sternfeld A, Schaap-Fogler M, Dotan A, Alaa B, Megiddo E, Ehrlich R, Livny E. Effect of Penetration Angle and Velocity During Intravitreal Injection on Pain. Semin Ophthalmol 2021; 36:437-443. [PMID: 33780315 DOI: 10.1080/08820538.2021.1906914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To evaluate the effect of velocity and angle of the intravitreal injection of anti-vascular endothelial growth factors on pain sensation.Methods: Patients were randomly assigned to one of four injection methods: straight and fast, straight and slow, tunneled and fast, and tunneled and slow. Later, they graded their pain sensation on a Visual Analog Scale (range 0-10).Results: The cohort included 180 patients. Mean pain score was 2.81 ± 2.34. There was no statistically significant difference in mean pain score among the four groups (p = .858); between the slow-injection (straight and tunneled) and fast-injection groups (p = .514); and between the straight-injection (fast and slow) and tunneled-injection groups (p = .992), nor other background variables.Conclusion: Velocity and angle of intravitreal injections are unrelated to the pain sensation. Therefore, the method may be left to the clinician's discretion. This implies that the sensation is mostly subjective.
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Affiliation(s)
- Amir Sternfeld
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Schaap-Fogler
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Dotan
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bashir Alaa
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elinor Megiddo
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rita Ehrlich
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Livny
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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27
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Evaluation of Port Delivery System with ranibizumab for the treatment of neovascular age-related macular degeneration. Ther Deliv 2021; 12:191-200. [PMID: 33641347 DOI: 10.4155/tde-2020-0132] [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: 12/21/2022] Open
Abstract
Current treatment of neovascular age-related macular degeneration involves periodic intravitreal injections of anti-VEGF medication, creating a burden to patients and physicians, resulting in nonadherence to recommended dosing schedules. The Port Delivery System with ranibizumab offers a long-term solution that involves implantation of a device into the pars plana and provides continuous release of anti-VEGF medication into the vitreous, thus requiring fewer office visits. The Port Delivery System has demonstrated comparable visual and anatomic outcomes to monthly injections and shows promise in alleviating the patient burden in the treatment of neovascular age-related macular degeneration, making possible better long-term real-world visual outcomes.
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28
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Castelli V, Paladini A, d'Angelo M, Allegretti M, Mantelli F, Brandolini L, Cocchiaro P, Cimini A, Varrassi G. Taurine and oxidative stress in retinal health and disease. CNS Neurosci Ther 2021; 27:403-412. [PMID: 33621439 PMCID: PMC7941169 DOI: 10.1111/cns.13610] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 12/16/2022] Open
Abstract
Retinal disorders are leading causes of blindness and are due to an imbalance between reactive oxygen species and antioxidant scavenger (in favor of pro‐oxidant species) or a disruption of redox signaling and control. Indeed, it is well known that oxidative stress is one of the leading causes of retinal degenerative diseases. Different approaches using nutraceuticals resulted in protective effects in these disorders. This review will discuss the impact of oxidative stress in retinal neurodegenerative diseases and the potential strategies for avoiding or counteracting oxidative damage in retinal tissues, with a specific focus on taurine. Increasing data indicate that taurine may be effective in slowing down the progression of degenerative retinal diseases, thus suggesting that taurine can be a promising candidate for the prevention or as adjuvant treatment of these diseases. The mechanism by which taurine supplementation acts is mainly related to the reduction of oxidative stress. In particular, it has been demonstrated to improve retinal reduced glutathione, malondialdehyde, superoxide dismutase, and catalase activities. Antiapoptotic effects are also involved; however, the protective mechanisms exerted by taurine against retinal damage remain to be further investigated.
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Affiliation(s)
- Vanessa Castelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonella Paladini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele d'Angelo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | | | | | - Annamaria Cimini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Sbarro Institute for Cancer Research and Molecular Medicine and Center for Biotechnology, Temple University, Philadelphia, PA, USA
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29
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Okada M, Mitchell P, Finger RP, Eldem B, Talks SJ, Hirst C, Paladini L, Barratt J, Wong TY, Loewenstein A. Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age-Related Macular Degeneration: A Mixed-Methods Systematic Review. Ophthalmology 2021; 128:234-247. [PMID: 32763265 PMCID: PMC7403101 DOI: 10.1016/j.ophtha.2020.07.060] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
TOPIC Systematic review of risk factors for nonadherence and nonpersistence to intravitreal anti-vascular endothelial growth factor (VEGF) injection therapy for neovascular age-related macular degeneration (nAMD). CLINICAL RELEVANCE Lack of adherence (nonadherence) or undertreatment (nonpersistence) with respect to evidence from clinical trials remains a significant barrier to optimizing real-world outcomes for patients with nAMD. Contributing factors and strategies to address this are poorly understood. METHODS Studies that reported factors for nonadherence and nonpersistence to anti-VEGF therapy as well as studies examining strategies to improve this were included. Trial eligibility and data extraction were conducted according to Cochrane review methods. Risk of bias was assessed using the Mixed Method Assessment Tool and certainty of evidence evaluated according to the GRADE Confidence in the Evidence from Reviews of Qualitative Research tool. Data were collated descriptively. RESULTS Of the 1284 abstract results screened, 124 articles were assessed in full and 37 studies met the inclusion criteria. Definitions of nonadherence and nonpersistence varied or were not reported. Nonpersistence occurred early, with up to 50% of patients stopping treatment by 24 months. High rates of nonadherence were similarly reported, occurring in 32% to 95% of patients. Certainty of this finding was downgraded to a moderate level because of the heterogeneity in definitions used across studies. Multiple factors determine nonadherence and nonpersistence, including at the condition, therapy, patient, social/economic, and health systems/healthcare team levels. Moderate quality evidence points to lower baseline vision and poorer response to treatment as condition-related variables. The effects of other factors were of lower certainty, predominantly due to small numbers and potential biases in retrospective assessment. Although many factors are not modifiable (e.g., patient comorbidity), other factors are potentially correctable (e.g., lack of transport or mismatched patient expectations). Evidence on strategies to improve adherence and persistence is limited, but where available, these have proven effective. CONCLUSIONS Awareness of factors related to poor patient adherence and persistence in nAMD could help identify at-risk populations and improve real-world outcomes. Further work is required to develop uniform definitions and establish high-quality evidence on interventions that can be easily implemented.
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Affiliation(s)
- Mali Okada
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | - Paul Mitchell
- Department of Ophthalmology, University of Sydney, Sydney, Australia
| | | | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - S. James Talks
- The Newcastle upon Tyne Hospitals NHS Foundation, Newcastle upon Tyne, United Kingdom
| | | | | | - Jane Barratt
- International Federation on Ageing, Toronto, Canada
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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Gualino V, Fourmaux E, Grenet T, Zerbib J, Wolff B. Patient experience of anti-vegf intravitreal injection. J Fr Ophtalmol 2020; 43:1047-1053. [DOI: 10.1016/j.jfo.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/26/2020] [Accepted: 02/04/2020] [Indexed: 10/23/2022]
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31
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Assi L, Rosman L, Chamseddine F, Ibrahim P, Sabbagh H, Congdon N, Evans J, Ramke J, Kuper H, Burton MJ, Ehrlich JR, Swenor BK. Eye health and quality of life: an umbrella review protocol. BMJ Open 2020; 10:e037648. [PMID: 32868362 PMCID: PMC7462163 DOI: 10.1136/bmjopen-2020-037648] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Vision impairment and eye disease are major global health concerns and have been associated with increased morbidity and mortality, and lower quality of life. Quality of life, whether generic, vision-specific or disease-specific, is an important measure of the impact of eye health on people's daily activities, well-being and visual function, and is increasingly used to evaluate the impact of ophthalmic interventions and new devices. While many studies and reviews have examined the relationship between vision or eye health and quality of life across different contexts, there has yet to be a synthesis of the impact of vision impairment, eye disease and ophthalmic interventions on quality of life globally and across the lifespan. METHODS AND ANALYSIS An umbrella review of systematic reviews will be conducted to address these two questions: (1) What is the association of vision impairment and eye disease with quality of life? (2) What is the impact of ophthalmic interventions on quality of life? A search of related literature will be performed on the 11 February 2020 in Medline Ovid, Embase.com, Cochrane Database of Systematic Reviews, Proquest Dissertations and Theses Global, and the grey literature, and repeated at the synthesis stage. Title/abstract and full-text screening, methodological quality assessment and data extraction will be conducted by reviewers working independently and in duplicate. Assessment of methodological quality and data extraction will be performed using Joanna Briggs Institute standard forms. Findings from the systematic reviews and their methodological quality will be summarised qualitatively in the text and using tables. ETHICS AND DISSEMINATION No ethical approval is required. Results of this umbrella review will be published in a peer-reviewed journal and summarised in the Lancet Global Health Commission on Global Eye Health. TRIAL REGISTRATION NUMBER This protocol was registered in the Open Science Framework Registries (https://osf.io/qhv9g/).
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Affiliation(s)
- Lama Assi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lori Rosman
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fatimah Chamseddine
- Clinical Research Institute, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Perla Ibrahim
- Department of Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Hadi Sabbagh
- Department of Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Jennifer Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Cornea & External Eye Disease, Moorfields Eye Hospital, London, UK
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Feelings, preoperative anxiety, and need for information in patients undergoing intravitreal injections. Graefes Arch Clin Exp Ophthalmol 2020; 258:1395-1403. [PMID: 32346786 DOI: 10.1007/s00417-020-04699-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/04/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess feelings, preoperative anxiety, and need for information in patients undergoing intravitreal injections (IVI). METHODS An observational cross-sectional study was conducted in our tertiary university care center between December 2017 and December 2018. Consecutive patients undergoing IVI were included. A paper survey was completed before and after IVI to assess patient experience. Preoperative anxiety and need for information were assessed using the Amsterdam Preoperative Anxiety Information Scale (APAIS) score. RESULTS Hundred patients with a median age of 76.5 years (42-95, SD = 10.1) were included. Median best-corrected visual acuity (BCVA) in both eyes was 0.4 logMAR. Main IVI indications were wet age-related macular degeneration (n = 58), diabetic macular edema (n = 19), and venous occlusion (n = 16). The IVI most unpleasant steps were as follows: using an eyelid retractor, needle entry, changing of physician from one IVI to another, the pre-IVI waiting time, and the high number of IVI required for disease control. Preoperative anxiety (APAIS score ≥ 11) was correlated in the multivariate analysis with the need for information (p = 0.004), changing of ophthalmologist between different IVI sessions (p = 0.006), and pain expected before the IVI (p = 0.010). The need for information (APAIS score ≥ 5) was only associated with the preoperative anxiety in the multivariate analysis (p = 0.001). CONCLUSION Preoperative anxiety and need for information are common in patients undergoing IVI even after many IVI. Being injected by different practitioners was strongly correlated with preoperative anxiety and should be avoided as much as possible. Better educational and information programs are needed.
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Taylor DJ, Jones L, Binns AM, Crabb DP. 'You've got dry macular degeneration, end of story': a qualitative study into the experience of living with non-neovascular age-related macular degeneration. Eye (Lond) 2020; 34:461-473. [PMID: 31118490 PMCID: PMC7042256 DOI: 10.1038/s41433-019-0445-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/25/2019] [Accepted: 04/04/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/OBJECTIVES To investigate the impact of non-neovascular (dry) age-related macular degeneration (AMD) on the person with respect to diagnosis, vision loss and coping strategies. SUBJECTS/METHODS Volunteers with dry AMD with a range of disease severity were given an eye examination and asked to describe aspects of their experience with dry AMD in a semi-structured interview. Interviews were audio-recorded, transcribed, and subjected to Framework analysis. Overarching themes were pre-defined, whilst subthemes were derived from the data. RESULTS Twenty-seven participants (81% female), with early (n = 3), intermediate (n = 16) and advanced dry AMD (GA; n = 8) were interviewed. Median (interquartile range) age (years), logMAR binocular visual acuity and Pelli-Robson contrast sensitivity were 76 (71, 80), 0.2 (0.18, 0.40) and 1.65 (1.35, 1.93), respectively. Overarching themes (and subthemes) were: diagnosis (relationship with healthcare professional, psychological impact of diagnosis, and knowledge of AMD, both pre- and post-diagnosis), impact of visual loss (functional and psychological) and coping strategies (help from others and personal strategies). Many participants reported feelings of distress at the time of diagnosis and, particularly noteworthy, several reported a constant fear of their condition worsening. CONCLUSIONS Dry AMD, for which there is currently no treatment, can have a significant impact on individuals, even in its early stages, before significant functional vision loss is manifest, as well as in its intermediate and advanced stages. Results from this study offer important insight into the experience of living with dry AMD not previously explored. Moreover, the results have the potential to serve as an educational resource for eyecare professionals.
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Affiliation(s)
- Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Lee Jones
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Alison M Binns
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK.
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Monés J, Singh RP, Bandello F, Souied E, Liu X, Gale R. Undertreatment of Neovascular Age-Related Macular Degeneration after 10 Years of Anti-Vascular Endothelial Growth Factor Therapy in the Real World: The Need for A Change of Mindset. Ophthalmologica 2019; 243:1-8. [PMID: 31743912 DOI: 10.1159/000502747] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/15/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the gap between visual acuity (VA) outcomes with anti-vascular endothelial growth factor (anti-VEGF) therapies in clinical trials and real-world practice, and explore the reasons for this gap. METHODS The literature was searched from January 1, 2013, to June 30, 2018, for studies reporting VA gains and injection frequencies in clinical trials and real-world practice. RESULTS Clinical trials of anti-VEGF agents and their extension studies demonstrated initial VA gains maintained at 4 years and beyond (up to 7 years) with continuous proactive treatment. Visual outcomes correlated with injection frequency. In real-world practice, patients are usually undertreated, accounting for the VA decline over time. Reasons for undertreatment include the burden of injections and monitoring visits imposed on patients/caregivers. However, another primary reason is the general mindset in the ophthalmological community that sustained benefits with treatment are not possible, leading to poor compliance and creating a vicious circle. CONCLUSIONS Initial VA gains can be maintained with more intensive/proactive approaches. Promising new treatments requiring less frequent injections/monitoring will help in the near future; meanwhile, better results could be achieved by changing the community mindset that contributes to undertreatment.
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Affiliation(s)
- Jordi Monés
- Institut de la Màcula and Barcelona Macula Foundation, Barcelona, Spain,
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Eric Souied
- Department of Ophthalmology, Hopital Intercommunal de Creteil, Creteil, France
| | - Xin Liu
- Novartis Pharma AG, Basel, Switzerland
| | - Richard Gale
- Department of Ophthalmology, York Teaching Hospital's NHS Foundation Trust and Department of Health Sciences, University of York, York, United Kingdom.,York Teaching Hospitals, York, United Kingdom
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[ANDROMEDA-an investigation of factors influencing the adherence of patients with neovascular age-related macular degeneration using the newly developed patient questionnaire LAF-IVT]. Ophthalmologe 2019; 117:765-774. [PMID: 31720846 DOI: 10.1007/s00347-019-01005-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lack of adherence to treatment is a widespread problem in the anti-VEGF (Vascular Endothelial Growth Factor) treatment of patients with neovascular age-related macular degeneration (nAMD). In contrast to the extent of the lack of treatment adherence, there is so far insufficient evidence for elucidating the causes of nonadherence. The ANDROMEDA study was initiated to investigate the influencing factors on the adherence of nAMD patients to treatment. The focus of the study was on patient reported endpoints, as the perceptions and experiences of the patients are of enormous importance for the investigation of the various aspects of adherence to treatment. OBJECTIVE This publication presents the design of the ANDROMEDA study as well as the development of a new patient questionnaire for the assessment of barriers to treatment within the design of the study. MATERIAL AND METHODS This prospective noninterventional observational study to assess the compliance of patients with nAMD and anti-VEGF treatment was started at the end of January 2019. It is planned to include 1000 patients in 120 study centers throughout Germany with an observational period of 24 months. Patient interviews on general and vision-related quality of life, treatment satisfaction and possible barriers to treatment will be conducted at the beginning and after 4, 12 and 24 months. All patient visits will be documented by the study centers as part of the clinical routine. To date, there has been no suitable instrument for recording patient-related circumstances and potential barriers to anti-VEGF treatment. Therefore, a specific patient questionnaire for longitudinal assessment of adherence factors to intravitreal (anti-VEGF) therapy (LAF-IVT) was developed as part of the study concept. The questionnaire, developed by an expert panel, was tested via qualitative interviews for its cognitive characteristics ahead of its use. RESULTS The results of the study are expected in early 2023. The cognitive examination of the LAF-IVT confirmed the feasibility of the new questionnaire. The practicability and significance of the new instrument can be assessed after completion of the quantitative data collection. CONCLUSION The symptoms, barriers, burdens and quality of life effects experienced by patients influence the adherence to treatment and thus the outcome. A better understanding of the patient's views and experiences is the basis for long-term optimization of care.
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Bian W, Wan J, Tan M, Wu X, Su J, Wang L. Patient experience of treatment decision making for wet age-related macular degeneration disease: a qualitative study in China. BMJ Open 2019; 9:e031020. [PMID: 31481567 PMCID: PMC6731856 DOI: 10.1136/bmjopen-2019-031020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the experience of patients with wet age-related macular degeneration (wAMD) in treatment decision-making process. DESIGN A descriptive qualitative study was designed by using semistructured interviews, and the data analysis was conducted with the thematic analysis approach. PARTICIPANTS AND SETTING A convenient and purposive sample of 21 participants diagnosed with wAMD was recruited from May 2018 to September 2018. The study was conducted in the Eye Clinic of Southwest Hospital of Army Medical University in Chongqing located in the southwest of China. RESULTS The mean age of the participants was 64.48 years (ranging 50-81 years), and the duration of the disease ranged from 6 months to 48 months. Four major themes were identified from the original data analysis. These themes included facing the darkness (choosing from light and darkness and living in pain), constraints on decision making (doctor-oriented decision making, inadequacy of options and time), weighing alternatives (family influence, financial burden and maintaining social function) and decision-making support (professional decision-making assistance and peer support). CONCLUSION This is a qualitative study attempting to explore the patient experience of treatment decision making for wAMD disease in China. Previous literature has focused on treatment effect and symptoms, rather than the individual experience and the wide contexts from a sociocultural perspective. Further studies, such as cross-sectional studies, can be used to describe the status and determine the influencing factors of decision0making process, so as to develop an impact factor model of decision making and to formulate an intervention for patients with wAMD.
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Affiliation(s)
- Wei Bian
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Amy Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Junli Wan
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Amy Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Mingqiong Tan
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Amy Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Xiaoqing Wu
- Outpatient Department of Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Jun Su
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Amy Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Lihua Wang
- Admin Office of Southwest Hospital, Army Medical University, Chongqing, China
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Jelin E, Wisløff T, Moe MC, Heiberg T. Development and testing of a patient-derived questionnaire for treatment of neovascular age-related macular degeneration: dimensions of importance in treatment of neovascular age-related macular degeneration. Acta Ophthalmol 2018; 96:804-811. [PMID: 30198182 DOI: 10.1111/aos.13847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Studies reporting on patient perspectives during treatment of neovascular age-related macular degeneration (nAMD) are limited. Thus, the aim of this study was to develop and test psychometric performance of a patient-derived questionnaire to capture important experiences during intravitreal treatment. METHODS Patients (n = 44) with at least 3-month experience of intravitreal injection treatment for nAMD identified the dimensions of priority and also performed a weighting procedure to develop a score for comparison. The questionnaire comprised two versions: one focusing on the relative importance' of the dimensions and one on the experience of the 'management' during treatment. The questionnaire was then tested for psychometric performance in a longitudinal design in newly diagnosed patients at baseline (n = 197), after three (n = 184) and six (n = 150) months of treatment. RESULTS Of the 15 included dimensions, the following were most frequently reported: 'receive treatment to preserve vision', 'information', 'waiting time', 'trust' and 'accommodating staff. The psychometric testing showed moderate reliability (intraclass correlation coefficient: 0.65-0.67) for the two versions and high level of face validity (8.3). The dimensions, 'preserving vision', 'early access to treatment', 'pain relief', 'information about the treatment/diagnosis' and 'visual aids' were consistently reported higher in 'importance' than in 'management', at both 3 and 6 months, indicating a potential for improvement in clinical practice for these dimensions. CONCLUSION This study provides a brief patient-derived questionnaire, expressed with a score with good psychometric performance that can be used for monitoring during intravitreal injection treatment of nAMD patients.
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Affiliation(s)
- Elma Jelin
- Department of Ophthalmology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Torbjørn Wisløff
- Norwegian Institute of Public Health; Oslo Norway
- Institute of Health and Society; University of Oslo; Oslo Norway
| | - Morten C. Moe
- Department of Ophthalmology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Turid Heiberg
- Regional Research Support; Oslo University Hospital; Oslo Norway
- Østfold University College; Halden Norway
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Habib AE, Abdel-Kader AA, Eissa IM, Awadein A. Adherence to Intravitreal Anti-Vascular Endothelial Growth Factor (Anti-VEGF) Drugs in Diabetic Macular Edema in an Egyptian Population: A Health Belief Model. Curr Eye Res 2018; 44:303-310. [DOI: 10.1080/02713683.2018.1543708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Ahmed E. Habib
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Iman M. Eissa
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Awadein
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Linz MO, Bressler NM, Chaikitmongkol V, Sivaprasad S, Patikulsila D, Choovuthayakorn J, Watanachai N, Kunavisarut P, Menon D, Tadarati M, Delalíbera Pacheco K, Sanyal A, Scott AW. Vision Preference Value Scale and Patient Preferences in Choosing Therapy for Symptomatic Vitreomacular Interface Abnormality. JAMA Ophthalmol 2018; 136:658-664. [PMID: 29800983 DOI: 10.1001/jamaophthalmol.2018.1272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance While symptomatic vitreomacular interface abnormalities (VIAs) are common, assessment of vision preference values and treatment preferences of these may guide treatment recommendations by physicians and influence third-party payers. Objective To determine preference values that individuals with VIA assign to their visual state and preferences of potential treatments. Design, Setting, and Participants In this cross-sectional one-time questionnaire study conducted between December 2015 and January 2017, 213 patients from tertiary care referral centers in Thailand, the United Kingdom, and the United States were studied. Patients with symptomatic VIA diagnosed within 1 year of data collection, visual acuity less than 20/20 OU, and symptoms ascribed to VIAs were included. Data were analyzed from January 2017 to November 2017. Main Outcomes and Measures The primary end points were overall mean preference value that individuals with VIA assigned to their visual state and patients' preferences for potential treatments. Preference values were graded on a scale from 0 to 1, with 0 indicating death and 1 indicating perfect health with perfect vision. Results Of the 213 included patients, 139 (65.3%) were women, and the mean (SD) age was 65.6 (7.7) years. Diagnoses included epiretinal membrane (n = 100 [46.9%]), macular hole (n = 99 [46.5%]), and vitreomacular traction (n = 14 [6.6%]). The mean (SD) vision preference value was 0.76 (0.15), without differences identified among the 3 VIA types. More participants were enthusiastic about vitrectomy (150 [71.1%]) compared with intravitreal injection (120 [56.9%]) (difference, 14.2%; 95% CI, 5.16-23.3; P = .002). Adjusted analyses showed enthusiasm for vitrectomy was associated with fellow eye visual acuity (odds ratio, 10.99; 95% CI, 2.01-59.97; P = .006) and better-seeing eye visual acuity (odds ratio, 0.03; 95% CI, 0.001-0.66; P = .03). Overall enthusiasm for treatment was associated with fellow eye visual acuity (odds ratio, 7.22; 95% CI, 1.29-40.40; P = .02). Overall, most participants (171 [81.0%]) were enthusiastic about surgery, injection, or both. Conclusions and Relevance Study participants reported similar preference values among 3 types of VIAs. The data suggest that most patients with these conditions would be enthusiastic about undergoing vitrectomy or an injection to treat it, likely because of the condition's effect on visual functioning, although there may be a slight preference for vitrectomy at this time.
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Affiliation(s)
- Marguerite O Linz
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Neil M Bressler
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Editor
| | - Voraporn Chaikitmongkol
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sobha Sivaprasad
- Medical Retina Department, National Institute for Health Research Moorfields Biomedical Research Centre, London, United Kingdom
| | - Direk Patikulsila
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Janejit Choovuthayakorn
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Deepthy Menon
- Medical Retina Department, National Institute for Health Research Moorfields Biomedical Research Centre, London, United Kingdom
| | - Mongkol Tadarati
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Retina Division, Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Kátia Delalíbera Pacheco
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Retina, Centro Brasileiro da Visao, Brasília, DF, Brazil
| | - Abanti Sanyal
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Frampton GK, Kalita N, Payne L, Colquitt J, Loveman E. Accuracy of fundus autofluorescence imaging for the diagnosis and monitoring of retinal conditions: a systematic review. Health Technol Assess 2018; 20:1-108. [PMID: 27115052 DOI: 10.3310/hta20310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Natural fluorescence in the eye may be increased or decreased by diseases that affect the retina. Imaging methods based on confocal scanning laser ophthalmoscopy (cSLO) can detect this 'fundus autofluorescence' (FAF) by illuminating the retina using a specific light 'excitation wavelength'. FAF imaging could assist the diagnosis or monitoring of retinal conditions. However, the accuracy of the method for diagnosis or monitoring is unclear. OBJECTIVE To conduct a systematic review to determine the accuracy of FAF imaging using cSLO for the diagnosis or monitoring of retinal conditions, including monitoring of response to therapy. DATA SOURCES Electronic bibliographic databases; scrutiny of reference lists of included studies and relevant systematic reviews; and searches of internet pages of relevant organisations, meetings and trial registries. Databases included MEDLINE, EMBASE, The Cochrane Library, Web of Science and the Medion database of diagnostic accuracy studies. Searches covered 1990 to November 2014 and were limited to the English language. REVIEW METHODS References were screened for relevance using prespecified inclusion criteria to capture a broad range of retinal conditions. Two reviewers assessed titles and abstracts independently. Full-text versions of relevant records were retrieved and screened by one reviewer and checked by a second. Data were extracted and critically appraised using the Quality Assessment of Diagnostic Accuracy Studies criteria (QUADAS) for assessing risk of bias in test accuracy studies by one reviewer and checked by a second. At all stages any reviewer disagreement was resolved through discussion or arbitration by a third reviewer. RESULTS Eight primary research studies have investigated the diagnostic accuracy of FAF imaging in retinal conditions: choroidal neovascularisation (one study), reticular pseudodrusen (three studies), cystoid macular oedema (two studies) and diabetic macular oedema (two studies). Sensitivity of FAF imaging using an excitation wavelength of 488 nm was generally high (range 81-100%), but was lower (55% and 32%) in two studies using longer excitation wavelengths (514 nm and 790 nm, respectively). Specificity ranged from 34% to 100%. However, owing to limitations of the data, none of the studies provide conclusive evidence of the diagnostic accuracy of FAF imaging. LIMITATIONS No studies on the accuracy of FAF imaging for monitoring the progression of retinal conditions or response to therapy were identified. Owing to study heterogeneity, pooling of diagnostic outcomes in meta-analysis was not conducted. All included studies had high risk of bias. In most studies the patient spectrum was not reflective of those who would present in clinical practice and no studies adequately reported how FAF images were interpreted. CONCLUSIONS Although already in use in clinical practice, it is unclear whether or not FAF imaging is accurate, and whether or not it is applied and interpreted consistently for the diagnosis and/or monitoring of retinal conditions. Well-designed prospective primary research studies, which conform to the paradigm of diagnostic test accuracy assessment, are required to investigate the accuracy of FAF imaging in diagnosis and monitoring of inherited retinal dystrophies, early age-related macular degeneration, geographic atrophy and central serous chorioretinopathy. STUDY REGISTRATION This study is registered as PROSPERO CRD42014014997. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Geoff K Frampton
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Neelam Kalita
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Liz Payne
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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Exploring factors predicting changes in patients' expectations and psychosocial issues during the course of treatment with intravitreal injections for wet age-related macular degeneration. Eye (Lond) 2017; 32:673-678. [PMID: 29219960 DOI: 10.1038/eye.2017.271] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/22/2017] [Indexed: 11/08/2022] Open
Abstract
PurposePatients with wet age-related macular degeneration (AMD) often require long courses of treatment. We investigate the psychosocial issues that could hinder compliance, including patient expectations of treatment. The aims of this study were to explore the factors related to changes in patient expectations, pain, and anxiety during treatment.Patients and methodsA structured interview was carried out among 50 patients selected from the list attending the AMD unit at the Princess Alexandra Eye Pavilion (PAEP). The interview was based on a questionnaire. Additionally, a visual analogue scale was created as a tool for measuring patient expectations, pain, and anxiety. Data were analysed using multinomial regression analysis.ResultsThere were significantly more patients who had a fall in expectations (P<0.05) during the course of treatment. A fall in expectations was found to be predicted by higher starting expectations (P=0.00001), greater decline in visual acuity (P=0.008), and perceived deterioration of vision after starting treatment (P=0.013). Of the patients, 32% planned to stop attending for further injections. Planning to stop attending was correlated with worse final visual acuity (P=0.026, 95% CI). Pain and anxiety with intravitreal therapy (IVT) was significantly reduced when patients were accompanied to the clinic by a friend or relative (P<0.01) using Pearson's correlation (r=0.597).ConclusionPatients require appropriate counselling at the start of a course of treatment to align expectations with perceived treatment outcomes in order to improve adherence. Additionally, a large minority of patients would consider stopping treatment. Patients' expectations should be assessed at relevant time points along a course of treatment.
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Péntek M, Brodszky V, Biró Z, Kölkedi Z, Dunai Á, Németh J, Baji P, Rencz F, Gulácsi L, Resch MD. Subjective health expectations of patients with age-related macular degeneration treated with antiVEGF drugs. BMC Geriatr 2017; 17:233. [PMID: 29017463 PMCID: PMC5635533 DOI: 10.1186/s12877-017-0619-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/02/2017] [Indexed: 12/04/2022] Open
Abstract
Background Subjective expectations regarding future health may influence patients’ judgement of current health and treatment effects, as well as adherence to therapies in chronic diseases. We aimed to explore subjective expectations on longevity and future health-related quality of life (HRQOL) of patients with age-related macular degeneration (AMD) treated with antiVEGF injections and analyse the influencing factors. Methods Consecutive AMD patients in two ophthalmology centres were included. Demographics, clinical characteristics and informal care utilisation were recorded. Current health was evaluated by the EQ-5D generic health status questionnaire and time trade-off (TTO) methods. Happiness was measured on a visual analogue scale (VAS). Subjective life-expectancy and expected EQ-5D status at ages 70, 80 and 90 were surveyed. T-test was applied to compare subgroups and Pearson correlations were performed to analyse relationships between variables. Results One hundred twenty two patients were involved (females 62%) with a mean (SD) age of 75.2 (7.9) years and disease duration of 2.9 (2.5) years. The majority were in AREDS-4 state, the better eye’s ETDRS was 64.7 (15.4). EQ-5D and TTO revealed moderate deterioration of health (0.66 vs. 0.72, p = 0.131), happiness VAS was 6.3 (2.2). Correlation between EQ-5D and ETDRS was moderate (R = 0.242, p < 0.05) and having both versus one eye in AREDS-4 resulted lower TTO (0.68 vs. 0.83; p = 0.013). Subjective life-expectancy did not differ significantly from statistical life-expectancy and had no significant impact on TTO. The self-estimated mean EQ-5D score was 0.60, 0.40 and 0.24 for ages 70, 80 and 90 which is lower than the population norm of age-groups 65–74, 75–84 and 85+ (0.77, 0.63 and 0.63, respectively). Age, gender, current EQ-5D, need for informal care and happiness were deterministic factors of subjective health expectations. Conclusion AMD patients with antiVEGF treatment have comparable HRQOL as the age-matched general public but expect a more severe deterioration of health with age. Older patients with worse HRQOL have worse subjective expectations. Exploring patients’ health expectations provides an opportunity for ophthalmologists to correct misperceptions and improve the quality of AMD care. Further studies should provide evidences on the relationship between subjective expectations and actual health outcomes, and on its impact on patients’ AMD-specific health behaviour. Electronic supplementary material The online version of this article (10.1186/s12877-017-0619-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Zsolt Biró
- Department of Ophthalmology, Pécs University of Sciences, Nyár u. 8, Pécs, 7624, Hungary
| | - Zsófia Kölkedi
- Department of Ophthalmology, Pécs University of Sciences, Nyár u. 8, Pécs, 7624, Hungary
| | - Árpád Dunai
- Department of Ophthalmology, Semmelweis University Budapest, Mária u. 39, Budapest, 1085, Hungary
| | - János Németh
- Department of Ophthalmology, Semmelweis University Budapest, Mária u. 39, Budapest, 1085, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.,Clinical Medicine Doctoral School, Semmelweis University Budapest, Ulloi u. 26, Budapest, 1085, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Miklós D Resch
- Department of Ophthalmology, Semmelweis University Budapest, Mária u. 39, Budapest, 1085, Hungary
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Senra H, Balaskas K, Mahmoodi N, Aslam T. Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration. Am J Ophthalmol 2017; 177:213-224. [PMID: 28302534 DOI: 10.1016/j.ajo.2017.03.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate detailed patient experiences specific to receiving vascular endothelial growth factor inhibitors (anti-VEGF) for wet age-related macular degeneration (wAMD), and to acquire a snapshot of the frequency of clinically significant levels of depression, anxiety, and posttraumatic stress among patients and levels of burden in patients' carers. DESIGN Observational cross-sectional mixed-methods study. METHODS Three hundred patients with wAMD receiving anti-VEGF treatment and 100 patient carers were recruited. Qualitative data on patients' experience of treatment were collected using a structured survey. Standardized validated questionnaires were used to quantify clinically significant levels of anxiety, depression, and posttraumatic stress, as well as cognitive function and carers' burden. RESULTS Qualitative data showed that 56% of patients (n = 132) reported anxiety related to anti-VEGF treatment. The main sources of anxiety were fear of going blind owing to intravitreal injections and concerns about treatment effectiveness, rather than around pain. From validated questionnaires, 17% of patients (n = 52) showed clinical levels of anxiety and 12% (n = 36) showed clinical levels of depression. Depression levels, but not anxiety, were significantly higher in patients who received up to 3 injections compared with patients who received from 4 to 12 injections (analysis of variance [ANOVA] P = .027) and compared with patients who received more than 12 injections (ANOVA P = .001). CONCLUSIONS Anti-VEGF treatment is often experienced with some anxiety related to treatment, regardless of the number of injections received. Clinical levels of depression seem to be more frequent in patients at early stages of anti-VEGF treatment. Strategies to improve patient experience of treatment and minimize morbidity are suggested.
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Marakis TP, Koutsandrea C, Chatzistefanou KI, Tountas Y. Treatment satisfaction of patients with neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents. Int Ophthalmol 2017; 38:565-576. [PMID: 28285389 DOI: 10.1007/s10792-017-0492-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the psychometric properties of the Greek Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) and evaluate the factors that influence treatment satisfaction of patients with neovascular age-related macular degeneration (nAMD). METHODS The MacTSQ was translated into Greek and administered to 176 patients. All patients completed the SF-12 Health Survey and the Macular disease Dependent Quality of Life Questionnaire (MacDQoL) and underwent vision measurements. For test-retest reliability, a subset of 19 participants completed the MacTSQ twice, two weeks apart. Stepwise multiple linear regression analyses were performed to identify predictors of treatment satisfaction. Change in MacTSQ scores over time was assessed on 83 patients who completed the MacTSQ at a follow-up visit, one year later. RESULTS The intraclass correlation coefficients between the first and second test-retest administration ranged from 0.88 to 0.98 for the items and total score. Internal reliability of the total score was adequate (Cronbach's a = 0.837). Principal component analysis revealed three subscales (effectiveness, information provision and convenience, impact). The MacTSQ score showed significant correlations with SF-12 summary scales and MacDQoL scores (ρ = 0.16-0.27). The most important factor that determined the satisfaction was mental health. Distance visual acuity (VA) in better eye was the best predictor of the effectiveness subscale, and the total number of injections was a negative predictor for the convenience subscale. Treatment satisfaction increased at one-year follow-up, despite the deterioration in distance VA. CONCLUSIONS The Greek MacTSQ is a reliable and valid instrument for assessing nAMD patients' perceptions of treatment satisfaction, especially using its three new subscales. Treatment satisfaction is multifactorial and was primarily determined by patients' mental health status.
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Affiliation(s)
- Theodoros P Marakis
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece.
| | - Chrysanthi Koutsandrea
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Klio I Chatzistefanou
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Yannis Tountas
- Department of Hygiene and Epidemiology, Center for Health Services Research, University of Athens Medical School, Athens, Greece
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45
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Retinal Diseases Associated with Oxidative Stress and the Effects of a Free Radical Scavenger (Edaravone). OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:9208489. [PMID: 28194256 PMCID: PMC5286467 DOI: 10.1155/2017/9208489] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/20/2016] [Indexed: 02/07/2023]
Abstract
Oxidative stress plays a pivotal role in developing and accelerating retinal diseases including age-related macular degeneration (AMD), glaucoma, diabetic retinopathy (DR), and retinal vein occlusion (RVO). An excess amount of reactive oxygen species (ROS) can lead to functional and morphological impairments in retinal pigment epithelium (RPE), endothelial cells, and retinal ganglion cells (RGCs). Here we demonstrate that edaravone, a free radical scavenger, decreased apoptotic cell death, oxidative damage to DNA and lipids, and angiogenesis through inhibiting JNK and p38 MAPK pathways in AMD, glaucoma, DR, and RVO animal models. These data suggest that the therapeutic strategy for targeting oxidative stress may be important for the treatment of these ocular diseases, and edaravone may be useful for treating retinal diseases associated with oxidative stress.
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46
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Boyle J, Vukicevic M, Koklanis K, Itsiopoulos C, Rees G. Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration. PSYCHOL HEALTH MED 2017; 23:127-140. [DOI: 10.1080/13548506.2016.1274040] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jessica Boyle
- Department of Community & Clinical Allied Health, La Trobe University, Melbourne, Australia
- Eye Surgery Associates, Cabrini Medical Hospital, Malvern, Australia
| | - Meri Vukicevic
- Department of Community & Clinical Allied Health, La Trobe University, Melbourne, Australia
- Eye Surgery Associates, Cabrini Medical Hospital, Malvern, Australia
| | - Konstandina Koklanis
- Department of Community & Clinical Allied Health, La Trobe University, Melbourne, Australia
- Department of Ophthalmology, Royal Children’s Hospital, Melbourne, Australia
| | - Catherine Itsiopoulos
- Department of Rehabilitation, Nutrition & Sport, La Trobe University, Melbourne, Australia
| | - Gwyneth Rees
- Centre for Eye Research, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery, University of Melbourne, Melbourne, Australia
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47
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Patient Perceptions and Experiences of Stereotactic Radiotherapy for Wet Age-Related Macular Degeneration. Eur J Ophthalmol 2016; 26:e80-2. [DOI: 10.5301/ejo.5000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/20/2022]
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48
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Senra H, Ali Z, Balaskas K, Aslam T. Psychological impact of anti-VEGF treatments for wet macular degeneration-a review. Graefes Arch Clin Exp Ophthalmol 2016; 254:1873-1880. [PMID: 27262729 PMCID: PMC5045477 DOI: 10.1007/s00417-016-3384-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 04/05/2016] [Accepted: 05/10/2016] [Indexed: 01/14/2023] Open
Abstract
Purpose To review the current literature on the psychological impact of anti-VEGF treatments for wet age-related macular degeneration (wAMD), in terms of patients’ experiences of receiving these treatments, and the impact of these treatments for patients’ mental health and quality of life. Methods We critically analyzed current literature evaluating psychological impact of anti-VEGF treatments for wAMD. Primary searches of PubMed, Science Direct, and Web of Science were conducted in July and August of 2015. We reviewed all papers on the topic published until August 5, 2015. Results Our literature search found 14 papers addressing the psychological impact of anti-VEGF treatments for wAMD. Results highlighted potential anxieties and experiences of pain caused by receiving regular intravitreal injections. A positive visual outcome of anti-VEGF therapy is associated with positive vision-related QOL outcomes, although such association seems to be dependent on improvements on visual acuity. In the literature reviewed, patients receiving anti-VEGF treatments showed a prevalence rate of depression between 20 and 26 %. Conclusions Although anti-VEGF treatments can cause some anxiety and being experienced as a stressful event, especially in the beginning of the treatment, preliminary findings suggest a potential benefit for long-term vision-related quality of life. Further longitudinal and qualitative research should bring more evidence on the positive and negative effects of these treatments on patients’ long-term mental health.
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Affiliation(s)
- Hugo Senra
- Institute of Human Development, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Zaria Ali
- Manchester Royal Eye Hospital, Manchester, UK
| | | | - Tariq Aslam
- Institute of Human Development, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.,Manchester Royal Eye Hospital, Manchester, UK.,Heriot Watt University, Edinburgh, UK
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49
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Vukicevic M, Heraghty J, Cummins R, Gopinath B, Mitchell P. Caregiver perceptions about the impact of caring for patients with wet age-related macular degeneration. Eye (Lond) 2015; 30:413-21. [PMID: 26611848 DOI: 10.1038/eye.2015.235] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/29/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Caregivers of older persons with eye disease, namely age-related macular degeneration (AMD), have been reported to have a higher than expected distress. Very few studies have explored caregiver perceptions as to what is important when providing care. The aim of this study was to explore the perceptions of caregivers of persons with neovascular AMD in relation to the most important aspects of caring, as described in extended answers to self-administered survey questions. METHODS A cross-sectional, self-administered survey of 643 caregivers of people with neovascular AMD, comprising 27 closed-response questions and 2 open ended questions. The latter were analysed as part of this study utilising and 'inductive' Grounded Theory approach. RESULTS Six-hundred and forty-three caregiver responses to 2 open ended questions were analysed using an inductive approach and sorted into thematic networks. Three discrete categories arose: The Impact of Caring; Injections and Information and Activities of Daily Living. CONCLUSIONS Most caregivers were family caregivers and were found to be compassionate and self-sacrificing. They accepted additional responsibility whilst providing an encouraging environment for their care recipient. As a result, they experience distress and consider their own needs as secondary. Very few seek or receive respite and this added burden can have a negative impact upon the relationship between caregiver and care recipient.
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Affiliation(s)
- M Vukicevic
- Discipline of Orthoptics, School of Allied Health, Department of Clinical and Community Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - J Heraghty
- Macular Disease Foundation Australia, Sydney, NSW, Australia
| | - R Cummins
- Macular Disease Foundation Australia, Sydney, NSW, Australia
| | - B Gopinath
- Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia
| | - P Mitchell
- Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia
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50
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McCloud C, Lake S. Understanding the patient's lived experience of neovascular age-related macular degeneration: a qualitative study. Eye (Lond) 2015; 29:1561-9. [PMID: 26381099 DOI: 10.1038/eye.2015.167] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/07/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In industrialised populations age-related macular degeneration (ARMD) is the leading cause of visual disability of the elderly. Successful new treatment with anti-endothelial growth factors for neovascular-classified ARMD has led to a divergence in treatment and experiences of people ARMD. This study aimed to understand the participant's experience of neovascular ARMD, including ongoing treatment with anti-vascular endothelial growth factor. METHODS Twenty-five participants from one clinical site were qualitatively interviewed to elicit their experiences of treatment for neovascular ARMD. RESULTS Two major themes were identified. A life negotiated by neovascular ARMD captures the participants' experience of living with the condition and treatment regime for neovascular ARMD. The second major theme: Uncertainty displayed their appraisal of life, treatment and their perceived future. CONCLUSIONS Anxieties concerning the injections, new limitations to lifestyles, and an uncertain future all emerged from the data analysis. However, thankfulness for the treatment, the importance of familiar patterns in treatments and recovery and a guarded optimism also emerged. Knowledge of the experiences, anxieties and concerns of this patient population can be used to inform clinical practice and lead to patient-centred care.
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Affiliation(s)
- C McCloud
- Faculty of Medicine, Nursing and Health Science, Flinders University, Bedford Park, South Australia, Australia
| | - S Lake
- Flinders Medical Centre, Adelaide, South Australia, Australia
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