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Myers V, Luxenburg O, Wilf-Miron R, Verbin HL. Timely care for age-related macular degeneration: a qualitative study among retina specialists in Israel. Isr J Health Policy Res 2024; 13:28. [PMID: 38835087 DOI: 10.1186/s13584-024-00616-w] [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: 07/30/2023] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Age-related macular degeneration (AMD) affects quality of life and independence, and its incidence and prevalence are increasing due to ageing of the population. Access to effective timely treatment can improve vision and reduce incidence of blindness. This study aimed to explore the perspectives of ophthalmologists in the Israeli public healthcare system regarding timely treatment of AMD patients. METHODS Qualitative semi-structured interviews were conducted in 2020-2021 with 22 senior ophthalmologists, from 10 general hospitals and from two HMOs, representing different geographic regions. All interviewees specialize in retinal diseases and work with AMD patients. Interviews discussed patient pathways involved in the diagnosis and treatment of AMD, access to care, and obstacles to timely care. Thematic analysis was conducted. RESULTS Based on the interviews, we describe the usual referral and treatment pathways. Themes included regional disparities, long wait times in some areas, a lack of retina specialists, differences in referral pathways, inappropriate use of emergency department to obtain timely treatment, and second-line treatment not fully covered by insurance, most affecting the weakest segments of the population. CONCLUSIONS Loss of vision incurs high health and societal costs. In the context of insufficient medical manpower in Israel, the healthcare system will need to assess future resources to cope with accumulating burden of AMD cases over time in an ageing population. Precise referral information, and simultaneous referral to imaging and retinal clinics, may minimize delays in treatment. Awareness of AMD symptoms and the importance of early intervention could be highlighted by campaigns, particularly among high-risk groups. HIGHLIGHTS • Interviews with hospital-based and community ophthalmologists showed regional disparities in AMD treatment, with long wait times and a lack of retina specialists in some areas. • Differences in referral pathways, inappropriate use of emergency department to obtain timely treatment, and second line treatment not fully covered by insurance were highlighted. • The healthcare system will need to assess future resources to cope with accumulating burden of AMD cases over time in an ageing population • Precise referral information, and simultaneous referral to imaging and retinal clinics, may minimize delays in treatment. • Awareness of AMD symptoms and the importance of early intervention should be emphasized in high-risk groups.
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Affiliation(s)
- Vicki Myers
- Center for Healthcare Technology and Innovation Policy Research, Gertner Institute of Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
- School of Public Health, Faculty of Medical & Health Sciences, Tel Aviv University, Ramat Aviv, Israel.
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Rachel Wilf-Miron
- Center for Healthcare Technology and Innovation Policy Research, Gertner Institute of Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Faculty of Medical & Health Sciences, Tel Aviv University, Ramat Aviv, Israel
| | - Hani Levkovitch Verbin
- Ophthalmology Department, Faculty of Medical & Health Sciences, Tel Aviv University, Ramat Aviv, Israel
- Glaucoma Service, Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
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2
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Tan ACS, Peterson CL, Htoon HM, Tan LLY, Tan Y, Sim KT, Ong L, Tan ZK, Heng SH, Yeo IYS, Wong TY, Cheung G, Man R, Fenwick EK, Lamoureux E. Development and Validation of Performance-Based Assessment of Daily Living Tasks in Age-Related Macular Degeneration. Transl Vis Sci Technol 2024; 13:9. [PMID: 38884546 PMCID: PMC11185266 DOI: 10.1167/tvst.13.6.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/09/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose To establish the reliability and validity of five performance-based activities of daily living task tests (ADLTT), to correlate structure to function, to evaluate the impact of visual impairment (VI) on age-related macular degeneration (AMD), and to develop new outcome measures. Methods A multidisciplinary team developed five ADLTTs: (1) reading test (RT); (2) facial expression (FE) recognition; (3) item search (IS) task; (4) money counting (MC) task; and (5) making a drink (MD), tested with binocular and monocular vision. ADLTTs were tested for known-group (i.e., difference between AMD group and controls) and convergent (i.e., correlation to other measures of visual function), validity metrics, and test-retest reliability in 36 patients with VI (visual acuity (logMAR VA > 0.4) in at least one eye caused by AMD versus 36 healthy controls without VI. Results Compared to controls, AMD patients had a slower reading speed (-77.41 words/min; P < 0.001); took longer to complete MC using monocular worse eye and binocular vision (15.13 seconds and 4.06 seconds longer compared to controls, respectively; P < 0.001); and MD using monocular worse eye vision (9.37 sec; P = 0.033), demonstrating known-group validity. Only RT and MC demonstrated convergent validity, showing correlations with VA, contrast sensitivity, and microperimetry testing. Moderate to good test-retest reliability was observed for MC and MD (interclass correlation coefficient = 0.55 and 0.77; P < 0.001) using monocular worse eye vision. Conclusions Real-world ADL functioning associated with VI-related AMD can be assessed with our validated ADLTTs, particularly MC and MD. Translational Relevance This study validates visual function outcome measures that are developed for use in future clinical practice and clinical trials.
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Affiliation(s)
- Anna C S Tan
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Claire L Peterson
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Hla M Htoon
- Singapore Eye Research Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Lynn L Y Tan
- Singapore National Eye Centre, Singapore, Singapore
| | - Yanwen Tan
- Singapore General Hospital, Singapore, Singapore
| | - Kai Ting Sim
- Singapore National Eye Centre, Singapore, Singapore
| | - Lisa Ong
- Singapore National Eye Centre, Singapore, Singapore
| | - Zhen K Tan
- Singapore National Eye Centre, Singapore, Singapore
| | - Shih H Heng
- Singapore General Hospital, Singapore, Singapore
| | - Ian Y S Yeo
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Tien Y Wong
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Gemmy Cheung
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ryan Man
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- University of Melbourne, Melbourne, Australia
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Van Vu K, Mitchell P, Detaram HD, Burlutsky G, Liew G, Gopinath B. Prevalence and risk factors for impaired activities of daily living in patients with neo-vascular age-related macular degeneration who present for anti-VEGF treatment. Eye (Lond) 2024; 38:1647-1653. [PMID: 38374365 PMCID: PMC11156866 DOI: 10.1038/s41433-024-02983-9] [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: 05/25/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND/OBJECTIVES To assess the prevalence and correlates of impaired activities of daily living (ADLs) in patients with neovascular age-related macular degeneration (nAMD) who present for anti-vascular endothelial growth factor (VEGF) therapy. METHODS In a clinic-based cohort of 437 patients with nAMD who presented for anti-VEGF therapy, the Older American Resources and Services Scale (OARS) was administered to assess for impairments in basic, instrumental and total ADL. Logistic regression analyses were conducted to determine odds ratios (OR) and 95% confidence intervals (CI) for factors associated with ADL impairment. RESULTS The prevalence of impaired basic, instrumental and total ADL was 37.76%, 67.82% and 39.59%, respectively. In multivariate-adjusted models, moderate visual impairment [OR 5.65, 95% CI (2.31-13.83) and blindness [OR 5.43, 95% CI (2.09-14.12)] were associated with greater odds of impaired total ADL. Depressive symptoms [OR 2.08, 95% CI (1.08-4.00)], the presence of any disability [OR 3.16, 95% CI (1.64-0.07)] and never driving [OR 4.00, 95% CI (1.60-10.00)] were also positively associated with total ADL impairment. Better vision-related quality of life (QoL) was inversely associated with impaired instrumental ADL whilst higher health-related QoL scores were associated with decreased odds of total ADL impairment. CONCLUSIONS There is a high prevalence rate of ADL impairment among nAMD patients presenting for therapy. Visual impairment, never driving, poor physical and mental health increased the odds of experiencing ADL impairment whilst better VRQoL and HRQoL reduced the odds of impairment.
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Affiliation(s)
- Kim Van Vu
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Harshil Dharamdasani Detaram
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - George Burlutsky
- Macquarie University Hearing, Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Gerald Liew
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Bamini Gopinath
- Macquarie University Hearing, Department of Health Sciences, Macquarie University, Sydney, NSW, Australia.
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Rowen D, Carlton J, Terheyden JH, Finger RP, Wickramasekera N, Brazier J. Development and Valuation of a Preference-Weighted Measure in Age-Related Macular Degeneration From the Vision Impairment in Low Luminance Questionnaire: A MACUSTAR Report. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:642-654. [PMID: 38369283 DOI: 10.1016/j.jval.2024.02.001] [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: 09/12/2023] [Revised: 01/29/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES This study generates VILL-UI (Vision Impairment in Low Luminance - Utility Index), a preference-weighted measure (PWM) derived from the VILL-33 measure for use in patients with age-related macular degeneration (AMD) and valued to generate United Kingdom and German preference weights. METHODS A PWM consists of a classification system to describe health and utility values for every state described by the classification. The classification was derived using existing data collected as part of the MACUSTAR study, a low-interventional study on AMD, conducted at 20 clinical sites across Europe. Items were selected using psychometric and Rasch analyses, published criteria around PWM suitability, alongside instrument developer views and concept elicitation work that informed VILL-33 development. An online discrete choice experiment (DCE) with duration of the health state was conducted with the United Kingdom and German public. Responses were modeled to generate utility values for all possible health states. RESULTS The classification system has 5 items across the 3 domains of VILL-33: reading and accessing information, mobility and safety, and emotional well-being. The DCE samples (United Kingdom: n = 1004, Germany: n = 1008) are broadly representative and demonstrate good understanding of the tasks. The final DCE analyses produce logically consistent and significant coefficients. CONCLUSIONS This study enables responses to VILL-33 to be directly used to inform economic evaluation in AMD. The elicitation of preferences from both United Kingdom and Germany enables greater application of VILL-UI for economic evaluation throughout Europe. VILL-UI fills a gap in AMD in which generic preference-weighted measures typically lack sensitivity.
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Affiliation(s)
- Donna Rowen
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Jill Carlton
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, England, UK
| | | | | | - Nyantara Wickramasekera
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - John Brazier
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, England, UK
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5
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Gökce SE, Çelik A, Başkan C. The role of blood neutrophil lymphocyte ratio in predicting the initial response to anti-VEGF treatment in neovascular AMD patients. Ir J Med Sci 2024; 193:517-521. [PMID: 37247185 DOI: 10.1007/s11845-023-03379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/18/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Vascular endothelial growth factor (VEGF) has a critical role in age-related macular degeneration (AMD), and intravitreal injection of anti-VEGF drugs is the mainstay of neovascular AMD treatment. Blood neutrophil-to-lymphocyte ratio (NLR) is shown to be a biomarker of inflammation in AMD. We aimed to investigate the role of NLR in predicting favorable short-term anti-VEGF treatment results in neovascular AMD patients. METHODS A total of 112 patients diagnosed with exudative AMD and had taken 3 monthly intravitreal bevacizumab injections were analyzed retrospectively. Medical records were reached to obtain neutrophil and lymphocyte values to calculate NLR. Best-corrected visual acuity and central macular thickness (CMT) measurements were recorded at each visit. T test or Mann-Whitney U test was used to compare continuous variables, and chi-square test was used to compare categorical variables. Receiver operating characteristics curve (ROC) analysis was performed to determine cut-off, sensitivity, and specificity values. P value of ≤ 0.05 was considered statistically significant. RESULTS The mean age was 68.1 ± 7.2 years, and the mean NLR was 2.11 ± 0.81. The ROC analysis revealed a cut off value of 2.0 for NLR to predict at least 100 μm CMT change (sensitivity 87.1%; specificity 87.8%) and a cut off value of 2.4 for NLR to predict at least 0.1 logMAR visual improvement (sensitivity 77.2%; specificity 64.8%) after 3 monthly IVT bevacizumab injections. CONCLUSION NLR can provide additional prognostic information for the identification of patients with a good initial response to anti-VEGF therapy.
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Affiliation(s)
- Sabite Emine Gökce
- Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Research and Training Hospital, 06550, Yenimahalle, Ankara, Turkey.
| | - Ayşenur Çelik
- Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Research and Training Hospital, 06550, Yenimahalle, Ankara, Turkey
| | - Ceyda Başkan
- Department of Ophthalmology, Ankara City Hospital, Ankara, Turkey
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Zaman N, Ong J, Waisberg E, Masalkhi M, Lee AG, Tavakkoli A, Zuckerbrod S. Advanced Visualization Engineering for Vision Disorders: A Clinically Focused Guide to Current Technology and Future Applications. Ann Biomed Eng 2024; 52:178-207. [PMID: 37861913 DOI: 10.1007/s10439-023-03379-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Head-mounted visualization technology, often in the form of virtual, augmented, and mixed reality (VAMR), has revolutionized how visual disorders may be approached clinically. In this manuscript, we review the available literature on VAMR for visual disorders and provide a clinically oriented guide to how VAMR technology has been deployed for visual impairments. The chief areas of clinical investigation with VAMR are divided include (1) vision assessment, (2) vision simulation, and (3) vision rehabilitation. We discuss in-depth the current literature of these areas in VAMR and upcoming/future applications to combat the detrimental impact of visual impairment worldwide.
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Affiliation(s)
- Nasif Zaman
- Human-Machine Perception Laboratory, University of Nevada, Reno, NV, USA
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin 4, Ireland.
| | - Mouayad Masalkhi
- University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, University of Nevada, Reno, NV, USA
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Peterson CL, Yap CL, Tan TF, Tan LLY, Sim KT, Ong L, Tan ZK, Tan YW, Man R, Fenwick E, Cheung G, Lamoureux E, Tan ACS. Monocular and Binocular Visual Function Assessments and Activities of Daily Living Performance in Age-Related Macular Degeneration. Ophthalmol Retina 2024; 8:32-41. [PMID: 37648064 DOI: 10.1016/j.oret.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the relationship between specific monocular and binocular visual function (VF) assessments with binocularly performed activities of daily living task tests (ADLTTs) in patients with age-related macular degeneration (AMD) and healthy controls. DESIGN Prospective case-control cohort study. SUBJECTS Thirty-six AMD patients and 36 controls. METHOD Visual field assessments included monocular and binocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), and monocular microperimetry testing for mean macula sensitivity, mean retina sensitivity (MRS), fixation area, and fixation distance from fovea (FDF). Age-related macular degeneration lesion area and sensitivity were measured on OCT and microperimetry, respectively. Participants performed 4 validated ADLTTs with binocular BCVA: (1) reading; (2) item-search; (3) money-counting; and (4) multi-step drink-making tasks. MAIN OUTCOME MEASURES Spearman correlations and multivariate regression analysis, adjusted for age, sex, and potential correlation between the 2 eyes, were used to assess the relationship between monocular and binocular VF assessments, and ADLTT performance in both groups. RESULTS Age-related macular degeneration patients had poorer VF (BCVA, CS, mean macula sensitivity, and MRS) compared with healthy controls. Monocular BCVA in both better- and worse-vision eyes was moderately correlated with the binocular reading speed and money-counting tasks in participants with AMD. In AMD, monocular worse eye CS, MRS, AMD lesion area on OCT, and lesion sensitivity on microperimetry showed moderate correlations to various ADLTTs, such as reading, money-counting, and drink-making. Similar findings were found in our AMD cohort on multivariate regression analysis. Fewer significant correlations were observed for the better-vision eye, whereas no correlations were observed for healthy controls between VF parameters and ADLTTs. In contrast, significant associations were observed between binocular BCVA and CS with binocular ADLTTs (reading and item-search tasks) but not in AMD patients. CONCLUSION Although monocular BCVA remains the most common measure of VF, CS and microperimetry testing also show significant correlations with ADLTTs performance in AMD patients, and should be considered as complimentary VF-outcome measures in both clinical and research settings. Unlike healthy subjects, AMD patients do not rely on binocular VF for ADLTT function, with the worse-vision eye impacting binocular ADLTT function more than the better-vision eye. Therefore, the worse-vision eye should not be neglected during the management of AMD. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Claire L Peterson
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | | | - Ting Fang Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore
| | | | | | - Lisa Ong
- Singapore National Eye Centre, Singapore
| | | | - Yan Wen Tan
- Department of Occupational Therapy, Singapore General Hospital, Singapore
| | - Ryan Man
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Eva Fenwick
- Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Gemmy Cheung
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Anna C S Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore.
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Gershoni A, Barayev E, Daood RH, Yogev M, Gal-Or O, Reitblat O, Tsessler M, Schaap Fogler M, Tuuminen R, Ehrlich R. Anatomical and Functional Outcomes with Prompt versus Delayed Initiation of Anti-VEGF in Exudative Age-Related Macular Degeneration. J Clin Med 2023; 13:111. [PMID: 38202118 PMCID: PMC10779608 DOI: 10.3390/jcm13010111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To investigate the correlation between time from diagnosis of treatment-naïve exudative age-related macular degeneration (AMD) to the introduction of anti-VEGF treatment and anatomical and functional outcomes. DESIGN Retrospective cohort study. METHODS Included were treatment-naïve exudative AMD patients who presented to a single tertiary medical center between 2012 and 2018. All patients were treated within the first 30 days of their diagnosis with three monthly intravitreal injections of bevacizumab. Patients were divided into three groups: group 1 (prompt anti-VEGF) were injected with bevacizumab within ten days, group 2 (intermediate anti-VEGF) within 11-20 days, and group 3 (delayed anti-VEGF) within 21-30 days from diagnosis. Baseline characteristics and clinical outcomes were compared up to two years from treatment. RESULTS 146 eyes of 146 patients were included. Sixty-eight patients were in the prompt anti-VEGF group, 31 in the intermediate anti-VEGF group, and 47 in the delayed anti-VEGF group. Following the induction phase of three intravitreal bevacizumab injections, the mean central subfield macular thickness (328.0 ± 115.4 µm vs. 364.6 ± 127.2 µm vs. 337.7 ± 150.1 µm, p = 0.432) and the best-corrected visual acuity (0.47 ± 0.38 vs. 0.59 ± 0.48 vs. 0.47 ± 0.44 logMAR units, p = 0.458) were comparable between the prompt, intermediate and delayed anti-VEGF groups. Anatomical and functional outcomes, treatment burden, number of relapses and eyes with second-line anti-VEGF therapy were comparable between the groups at both 1-year and 2-year timepoints. CONCLUSIONS Our real-world evidence data emphasize that even if anti-VEGF induction cannot be initiated promptly within ten days from diagnosis of naïve exudative AMD, the visual and anatomical prognosis of the patients may not worsen if the treatment is started within one month of diagnosis.
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Affiliation(s)
- Assaf Gershoni
- Ophthalmology Division, Rabin Medical Center, Petach Tikva 49414, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Edward Barayev
- Ophthalmology Division, Rabin Medical Center, Petach Tikva 49414, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Rabeea H. Daood
- Ophthalmology Division, Rabin Medical Center, Petach Tikva 49414, Israel
| | - Maureen Yogev
- Ophthalmology Division, Rabin Medical Center, Petach Tikva 49414, Israel
| | - Orly Gal-Or
- Ophthalmology Division, Rabin Medical Center, Petach Tikva 49414, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Olga Reitblat
- Ophthalmology Division, Rabin Medical Center, Petach Tikva 49414, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Maria Tsessler
- Ophthalmology Division, Rabin Medical Center, Petach Tikva 49414, Israel
| | - Michal Schaap Fogler
- Ophthalmology Division, Rabin Medical Center, Petach Tikva 49414, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, 00170 Helsinki, Finland
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotkantie 41, 48210 Kotka, Finland
| | - Rita Ehrlich
- Ophthalmology Division, Rabin Medical Center, Petach Tikva 49414, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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9
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Choi K, Park SJ, Han S, Mun Y, Lee DY, Chang DJ, Kim S, Yoo S, Woo SJ, Park KH, Suh HS. Patient-Centered Economic Burden of Exudative Age-Related Macular Degeneration: Retrospective Cohort Study. JMIR Public Health Surveill 2023; 9:e49852. [PMID: 38064251 PMCID: PMC10746973 DOI: 10.2196/49852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/01/2023] [Accepted: 10/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Exudative age-related macular degeneration (AMD), one of the leading causes of blindness, requires expensive drugs such as anti-vascular endothelial growth factor (VEGF) agents. The long-term regular use of effective but expensive drugs causes an economic burden for patients with exudative AMD. However, there are no studies on the long-term patient-centered economic burden of exudative AMD after reimbursement of anti-VEGFs. OBJECTIVE This study aimed to evaluate the patient-centered economic burden of exudative AMD for 2 years, including nonreimbursement and out-of-pocket costs, compared with nonexudative AMD using the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). METHODS This retrospective cohort study was conducted using the OMOP CDM, which included 2,006,478 patients who visited Seoul National University Bundang Hospital from June 2003 to July 2019. We defined the exudative AMD group as patients aged >50 years with a diagnosis of exudative AMD and a prescription for anti-VEGFs or verteporfin. The control group was defined as patients aged >50 years without a diagnosis of exudative AMD or a prescription for anti-VEGFs or verteporfin. To adjust for selection bias, controls were matched by propensity scores using regularized logistic regression with a Laplace prior. We measured any medical cost occurring in the hospital as the economic burden of exudative AMD during a 2-year follow-up period using 4 categories: total medical cost, reimbursement cost, nonreimbursement cost, and out-of-pocket cost. To estimate the average cost by adjusting the confounding variable and overcoming the positive skewness of costs, we used an exponential conditional model with a generalized linear model. RESULTS We identified 931 patients with exudative AMD and matched 783 (84.1%) with 2918 patients with nonexudative AMD. In the exponential conditional model, the total medical, reimbursement, nonreimbursement, and out-of-pocket incremental costs were estimated at US $3426, US $3130, US $366, and US $561, respectively, in the first year and US $1829, US $1461, US $373, and US $507, respectively, in the second year. All incremental costs in the exudative AMD group were 1.89 to 4.25 and 3.50 to 5.09 times higher in the first and second year, respectively, than those in the control group (P<.001 in all cases). CONCLUSIONS Exudative AMD had a significantly greater economic impact (P<.001) for 2 years on reimbursement, nonreimbursement, and out-of-pocket costs than nonexudative AMD after adjusting for baseline demographic and clinical characteristics using the OMOP CDM. Although economic policies could relieve the economic burden of patients with exudative AMD over time, the out-of-pocket cost of exudative AMD was still higher than that of nonexudative AMD for 2 years. Our findings support the need for expanding reimbursement strategies for patients with exudative AMD given the significant economic burden faced by patients with incurable and fatal diseases both in South Korea and worldwide.
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Affiliation(s)
- Kyungseon Choi
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sola Han
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Yongseok Mun
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Da Yun Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Jin Chang
- Department of Ophthalmology and Visual Science, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Kim
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hae Sun Suh
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, Republic of Korea
- College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
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10
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Mollan SP, Fu DJ, Chuo CY, Gannon JG, Lee WH, Hopkins JJ, Hughes C, Denniston AK, Keane PA, Cantrell R. Predicting the immediate impact of national lockdown on neovascular age-related macular degeneration and associated visual morbidity: an INSIGHT Health Data Research Hub for Eye Health report. Br J Ophthalmol 2023; 107:267-274. [PMID: 34518162 PMCID: PMC9887382 DOI: 10.1136/bjophthalmol-2021-319383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Predicting the impact of neovascular age-related macular degeneration (nAMD) service disruption on visual outcomes following national lockdown in the UK to contain SARS-CoV-2. METHODS AND ANALYSIS This retrospective cohort study includes deidentified data from 2229 UK patients from the INSIGHT Health Data Research digital hub. We forecasted the number of treatment-naïve nAMD patients requiring anti-vascular endothelial growth factor (anti-VEGF) initiation during UK lockdown (16 March 2020 through 31 July 2020) at Moorfields Eye Hospital (MEH) and University Hospitals Birmingham (UHB). Best-measured visual acuity (VA) changes without anti-VEGF therapy were predicted using post hoc analysis of Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD trial sham-control arm data (n=238). RESULTS At our centres, 376 patients were predicted to require anti-VEGF initiation during lockdown (MEH: 325; UHB: 51). Without treatment, mean VA was projected to decline after 12 months. The proportion of eyes in the MEH cohort predicted to maintain the key positive visual outcome of ≥70 ETDRS letters (Snellen equivalent 6/12) fell from 25.5% at baseline to 5.8% at 12 months (UHB: 9.8%-7.8%). Similarly, eyes with VA <25 ETDRS letters (6/96) were predicted to increase from 4.3% to 14.2% at MEH (UHB: 5.9%-7.8%) after 12 months without treatment. CONCLUSIONS Here, we demonstrate how combining data from a recently founded national digital health data repository with historical industry-funded clinical trial data can enhance predictive modelling in nAMD. The demonstrated detrimental effects of prolonged treatment delay should incentivise healthcare providers to support nAMD patients accessing care in safe environments. TRIAL REGISTRATION NUMBER NCT00056836.
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Affiliation(s)
- Susan P Mollan
- Ophthalmology, University Hospitals Birmingham, Birmingham, UK
| | - Dun Jack Fu
- Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | | | - Wen Hwa Lee
- Action Against Age-Related Macular Degeneration, Oxford, UK
| | | | | | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Pearse A Keane
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Hwang S, Kang SW, Kim SJ, Han K, Kim BS, Jung W, Lim DH, Shin DW. Impact of Age-Related Macular Degeneration and Related Visual Disability on the Risk of Depression: A Nationwide Cohort Study. Ophthalmology 2023; 130:615-623. [PMID: 36717001 DOI: 10.1016/j.ophtha.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To evaluate the prospective association of age-related macular degeneration (AMD) and related visual disability (VD) with the risk of depression. DESIGN This nationwide population-based cohort study used authorized clinical data provided by the Korean National Health Insurance Service. PARTICIPANTS A total of 3 599 589 individuals older than 50 years participated in the Korean National Health Screening Program in 2009. METHODS Age-related macular degeneration diagnosis and the presence of accompanying VD were verified using diagnostic codes and disability registration data. Data on covariates, including age, sex, income level, residential area, systemic comorbidities, and behavioral factors, were collected from health screening results and claims data. Patients were followed up until December 2019, and incident cases of depression were identified using registered diagnostic codes. The prospective association of AMD and related VD with new-onset depression was investigated using the multivariable-adjusted Cox proportional hazard model. MAIN OUTCOME MEASURES Hazard ratios and 95% confidence intervals (CIs) for depression development according to the presence of AMD and VD. RESULTS During an average follow-up period of 8.52 years, 1 037 088 patients received new diagnoses of depression. Patients with previous diagnoses of AMD showed a greater risk of new-onset depression, with a hazard ratio of 1.15 (95% CI, 1.13-1.17) compared with the control group in the fully adjusted model. Patients with AMD and accompanying VD showed a further increased risk of depression, with a hazard ratio of 1.23 (95% CI, 1.16-1.30). CONCLUSIONS Individuals with a diagnosis of AMD have a higher risk of depression developing in the future. The risk of depression is increased further in patients with AMD who demonstrate VD. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Bong Sung Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Wonyoung Jung
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
| | - Dong Wook Shin
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea; Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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12
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Vichare N, Pushkar K, Agrawal M, Jindal I. Vision related quality-of-life among patients with traumatic or non-traumatic ocular disease and its association with the Rights of Persons with Disabilities Act: Unveiling-the-hidden. Indian J Ophthalmol 2022; 70:4245-4250. [PMID: 36453325 PMCID: PMC9940580 DOI: 10.4103/ijo.ijo_1530_22] [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] [Indexed: 12/12/2022] Open
Abstract
Purpose To assess vision-related quality of life (VrQoL) in cases with visual loss after ocular trauma (OT) or non-traumatic ocular disease (NTOD) using the National Eye Institute's 25-Item Visual Function Questionnaire 25 (VFQ-25) and its association with visual disability % (VD%) based on the Rights of Persons with Disabilities (RPwD) Act, 2016. Methods This was a prospective observational study conducted among cases with ocular morbidity in either or both eyes with a visual acuity of ≤6/24. VFQ-25 questionnaire was administered to measure QoL scores. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 23. P < 0.05 was taken as significant. Results Eighty-eight respondents completed the questionnaire. Mean age of participants was 40.272 ± 9.35 years (range: 23-55 years). Forty-three (48.9%) and 45 (51.1%) participants had OT and NTOD, respectively. The most common cause was traumatic optic neuropathy (21.6%) followed by corneal causes (19.4%). Low visual QoL scores were reported in all the cases (57.52 ± 16.08). Between OT and NTOD, a significant difference in terms of age (P = 0.001) and general vision (P = 0.03) was seen. Lowest scores were for driving. Based on VD%, 77 cases had ≤40 and the rest had >40% VD with a significant difference in overall mean scores (P = 0.03), specifically in domains of general vision (P = 0.00), near activities (P = 0.00), and driving (P = 0.007). QoL was decreased in each subscale of ≤40%VD group, who faced the same predicament everywhere as by the cases with more disability. Conclusion Ocular morbidity is associated with low QoL, predominantly in domains like general vision, near activities and driving. The RPwD Act leaves out a huge population with VD without any government benefits. One might need to consider other vision-related factors also to provide them with social, psychological, and employment benefits.
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Affiliation(s)
- Nitin Vichare
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Kumar Pushkar
- Department of Community Medicine, Command Hospital, Pune, India
| | - Mohini Agrawal
- Department of Ophthalmology, Command Hospital, Pune, India,Correspondence to: Dr. Mohini Agrawal, Department of Ophthalmology, Command Hospital, Pune - 411 040, Maharashtra, India. E-mail:
| | - Imroz Jindal
- Department of Orthopaedics, Armed Forces Medical College, Pune, India
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13
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Weinstein O, Cohen AD, Levy J, Zloto O, Freud T, Krieger I, Comaneshter D, Shemesh R. Anxiety in Patients with Neovascular Age-related Macular Degeneration. Ophthalmic Epidemiol 2022; 30:286-292. [PMID: 35815775 DOI: 10.1080/09286586.2022.2090007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The main objective of the study is to investigate the prevalence of anxiety in patients with neovascular age-related macular degeneration (nAMD). METHODS A retrospective cross-sectional study of 3 304 nAMD patients and 16 515 age- and gender-matched controls. The proportions of patients with anxiety were compared between the groups using univariate analyses and a multivariate logistic regression model. Proportion of anxiety in patients with nAMD was compared with the proportion of anxiety in controls, matched for age and gender. Data was obtained from the largest health maintenance organization in Israel (Clalit Health Services) with 4 200 000 members. RESULTS The mean age of patients was 79.7 years; 54.8% were females; Anxiety was more common in patients with nAMD (13.2%) compared to the control group (10.2%) (OR 1.3; 95%CI 1.2-1.5). Multivariate logistic regression analysis revealed a significant association between anxiety and nAMD (OR 1.3; 95% CI: 1.2-1.5), adjusted for age, gender, and socio-economic status. CONCLUSION Our study demonstrated that anxiety is more common in patients with nAMD compared to a control group. Physicians treating patients with nAMD should be aware of this association, in order to provide appropriate care for the anxiety associated with nAMD.
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Affiliation(s)
- Orly Weinstein
- Faculty of Health Sciences Ben-Gurion University of the Negev
| | - Arnon D Cohen
- Hospitals Division Clalit Health Services, Tel Aviv.,Siaal Research Center for Family Medicine and Primary Care Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva Israel.,Chief Physician office, Central Headquarters Clalit Health services, Tel Aviv Israel
| | - Jaime Levy
- Department of Ophthalmology Hadassah Medical Center
| | - Ofira Zloto
- Goldschleger Eye Institute Sheba Medical center Tel-Hashomer Israel.,"Sackler" School of Medicine Tel Aviv University, Tel Aviv Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva Israel
| | - Israel Krieger
- "Sackler" School of Medicine Tel Aviv University, Tel Aviv Israel.,"Shalvata" Mental Health Center Hod Hasharon Israel
| | | | - Rachel Shemesh
- Goldschleger Eye Institute Sheba Medical center Tel-Hashomer Israel
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Dunbar HMP, Behning C, Abdirahman A, Higgins BE, Binns AM, Terheyden JH, Zakaria N, Poor S, Finger RP, Leal S, Holz FG, Schmid M, Crabb DP, Rubin GS, Luhmann UFO. Repeatability and Discriminatory Power of Chart-Based Visual Function Tests in Individuals With Age-Related Macular Degeneration: A MACUSTAR Study Report. JAMA Ophthalmol 2022; 140:780-789. [PMID: 35737401 PMCID: PMC9227684 DOI: 10.1001/jamaophthalmol.2022.2113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Question Under multicenter, multiexaminer conditions, do simple chart-based assessments of visual function (VF) have sufficient repeatability and discrimination in people with age-related macular degeneration (AMD) to be considered as measures for future clinical trial end points? Findings In this cross-sectional study including 245 people with AMD and 56 healthy, age-similar control individuals, best-corrected visual acuity, low-luminance visual acuity, Moorfields Acuity Test, contrast sensitivity, and International Reading Speed Test had adequate repeatability but limited power to discriminate between no AMD and intermediate AMD (iAMD). Meaning The findings suggest that the chart-based tests included in this study perform sufficiently well to be considered as potential measures for clinical trial end points; their prognostic power to predict conversion from iAMD to late AMD needs to be examined with longitudinal data. Importance There is a need for validated clinical end points that are reliably able to quantify potential therapeutic effects of future treatments targeting age-related macular degeneration (AMD) before the onset of serious visual impairment. Objective To assess the reliability and discriminatory power of 5 simple chart-based visual function (VF) tests as potential measures for clinical trial end points with regulatory and patient-access intention in intermediate AMD (iAMD). Design, Setting, and Participants This international noninterventional study took place at 18 tertiary ophthalmology departments across Europe. Participants were recruited between April 2018 and March 2020 and were identified during routine clinical review. Participants with no AMD and early AMD were recruited from hospital staff, friends, and family of participants with AMD and via referrals from community ophthalmologists and optometrists. The repeatability and discriminatory power of 5 simple chart-based assessments of VF (best-corrected visual acuity [BCVA], low-luminance visual acuity [LLVA], Moorfields Acuity Test [MAT], Pelli-Robson Contrast Sensitivity [CS], and International Reading Speed Test [IReST]) were assessed in a repeated-measures design. VF assessments were performed on day 0 and day 14. Participants with early AMD, iAMD, late AMD, and no AMD were recruited. Main Outcomes and Measures Intraclass correlation coefficients (ICCs) and Bland-Altman 95% limits of agreement (LoA) were computed to assess repeatability. Area under the receiver operating characteristic curves (AUCs) determined the discriminatory ability of all measures to classify individuals as having no AMD or iAMD and to differentiate iAMD from its neighboring disease states. Results A total of 301 participants (mean [SD] age, 71 [7] years; 187 female participants [62.1%]) were included in the study. Thirty-four participants (11.3%) had early AMD, 168 (55.8%) had iAMD, 43 (14.3%) had late AMD, and 56 (18.6%) had no AMD. ICCs for all VF measures ranged between 0.88 and 0.96 when all participants were considered, indicating good to excellent repeatability. All measures displayed excellent discrimination between iAMD and late AMD (AUC, 0.92-0.99). Early AMD was indistinguishable from iAMD on all measures (AUC, 0.54-0.64). CS afforded the best discrimination between no AMD and iAMD (AUC, 0.77). Under the same conditions, BCVA, LLVA, and MAT were fair discriminators (AUC, 0.69-0.71), and IReST had poor discrimination (AUC, 0.57-0.61). Conclusions and Relevance BCVA, LLVA, MAT, CS, and IReST had adequate repeatability in this multicenter, multiexaminer setting but limited power to discriminate between no AMD and iAMD. The prognostic power of these variables to predict conversion from iAMD to late AMD is being examined in the ongoing longitudinal part of the MACUSTAR study.
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Affiliation(s)
- Hannah M P Dunbar
- Department of Visual Neuroscience and Function, University College London Institute of Ophthalmology, London, United Kingdom.,Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Charlotte Behning
- Medical Faculty, Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Amina Abdirahman
- Department of Visual Neuroscience and Function, University College London Institute of Ophthalmology, London, United Kingdom
| | - Bethany E Higgins
- Department of Optometry and Visual Sciences, School of Health Sciences, City, University London, London, United Kingdom
| | - Alison M Binns
- Department of Optometry and Visual Sciences, School of Health Sciences, City, University London, London, United Kingdom
| | - Jan H Terheyden
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Nadia Zakaria
- Translational Medicine, Novartis Institute for Biomedical Research, Cambridge, Massachusetts
| | - Stephen Poor
- Ophthalmology Research, Novartis Institute for Biomedical Research, Cambridge, Massachusetts
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- Medical Faculty, Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - David P Crabb
- Department of Optometry and Visual Sciences, School of Health Sciences, City, University London, London, United Kingdom
| | - Gary S Rubin
- Department of Visual Neuroscience and Function, University College London Institute of Ophthalmology, London, United Kingdom.,Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Ulrich F O Luhmann
- Roche Pharmaceutical Research and Early Development, Translational Medicine Ophthalmology, Roche Innovation Center Basel, Switzerland
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15
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Kato A, Yasukawa T, Sugita I, Yoshida M, Nozaki M, Hirano Y, Kondo J, Abe T, Sugita K, Okita T, Morita H, Takase N, Ogura Y. Mental Status and Feasibility of an Intravitreal Ranibizumab Treat-and-Extend Regimen in Patients with Neovascular Age-Related Macular Degeneration. Adv Ther 2022; 39:1403-1416. [PMID: 35112307 DOI: 10.1007/s12325-022-02052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anti-vascular endothelial growth factor (VEGF) therapy is the first-choice treatment for neovascular age-related macular degeneration (nvAMD); however, patients often are burdened physically, financially, and mentally. We investigated the relationship between mental status and feasibility of an intravitreal ranibizumab treat-and-extend (TAE) regimen for nvAMD. METHODS In this prospective, multicenter study, 75 patients with nvAMD received ranibizumab intravitreally in a TAE regimen. After two monthly injections, the injection intervals were extended step-by-step to 6, 8, 12, and 16 weeks in eyes with dry maculas on optical coherence tomography (OCT) and, if exudation persisted or relapsed, shortened by one step. The best corrected visual acuity (BCVA) measurement and OCT were performed at baseline and on the same days of the scheduled injections. At baseline, all patients completed a survey, the Hospital Anxiety and Depression Scale (HADS), regarding mental burden. At week 52, patients on the TAE regimen for 1 year completed the HADS and a questionnaire designated to assess treatment-associated mental status. RESULTS Fifty-one patients (68%) completed the 1-year TAE regimen; 24 eyes (32%) discontinued the TAE regimen because of the rescue treatment, difficulty in completing clinical visits, or financial burden. In 51 eyes on the TAE regimen for 1 year, the mean BCVAs improved from 64.3 letters at baseline to 71.6 letters at week 52. The mean anxiety and depression scores on HADS decreased significantly (p < 0.01) after the 1-year treatment. Women tended to have higher anxiety scores, possibly associated with fear of injection and recurrence, while some men had higher depression scores potentially associated with financial burden, difficulty in completing clinical visits, and subsequent interruption of the TAE regimen especially in eyes with low treatment efficacy. CONCLUSIONS A TAE regimen of intravitreal ranibizumab injections preserves vision in eyes with nvAMD and reduces mental burden associated with disease relapse. TRIAL REGISTRATION This clinical study was registered retrospectively on December 22, 2014 with the ClinicalTrials.gov identifier NCT02321839.
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Affiliation(s)
- Aki Kato
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Tsutomu Yasukawa
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Munenori Yoshida
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Miho Nozaki
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshio Hirano
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | | | - Hiroshi Morita
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriaki Takase
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuichiro Ogura
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Sarda SP, Heyes A, Bektas M, Thakur T, Chao W, Intorcia M, Wronski S, Jones DL. Humanistic and Economic Burden of Geographic Atrophy: A Systematic Literature Review. Clin Ophthalmol 2021; 15:4629-4644. [PMID: 34916775 PMCID: PMC8667751 DOI: 10.2147/opth.s338253] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Geographic atrophy (GA), the advanced form of dry age-related macular degeneration, can result in irreversible blindness over time. We performed a systematic literature review to assess the humanistic and economic burden of GA. METHODS Predefined search terms were used to identify studies in PubMed, Embase, and Cochrane Library; conference abstracts also were searched. RESULTS Of 1111 unique studies identified, 25 studies on humanistic burden, 4 on economic burden, and 3 on both humanistic and economic burden of GA were included. Vision-related functioning and health-related quality of life (HRQOL) are poor in patients with GA. HRQOL is commonly measured using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25); patients with GA have significantly lower composite and subscale scores for near activities, distance activities, dependency, driving, social functioning, mental health, role difficulties, color vision, and peripheral vision than individuals without GA. Driving is a particular concern, and inability to drive affects dependency. Vision-related quality of life (VRQOL) declines as GA progresses. While we identified only 7 reports describing the economic burden of GA, its direct costs may be substantial. In a US study, mean cost to the payer per patient with GA was $11,533 in the year after diagnosis. A multinational study estimated annualized total direct costs of €1772 per patient with GA, mainly driven by diagnostic tests and procedures (€1071). Patients with GA are at increased risk of falls and fractures, potentially increasing direct costs. Only one study evaluated indirect costs, estimating ~$24.4 billion in yearly lost wages among people with severe vision loss due to GA or drusen ≥125 μm. CONCLUSION GA represents a significant humanistic burden. Evidence on the economic impact of GA is limited; characterizing the economic burden of GA requires further research. Interventions that reduce GA-related disability may improve HRQOL and reduce indirect costs.
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Affiliation(s)
| | - Anne Heyes
- RTI Health Solutions, Research Triangle Park, NC, 27709, USA
| | - Meryem Bektas
- RTI Health Solutions, Research Triangle Park, NC, 27709, USA
| | - Tanvee Thakur
- RTI Health Solutions, Research Triangle Park, NC, 27709, USA
| | - Wendy Chao
- Apellis Pharmaceuticals, Waltham, MA, 02451, USA
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Lee HC, Nam H, Kang D, Yeom MI. Depression, Anxiety, Somatization Disorder, and Adjustment Disorder in Older Patients with Exudative Age-related Macular Degeneration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.8.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: The aim of this study was to analyze the prevalence of depression, anxiety, somatization disorder, and adjustment disorder in older patients diagnosed with exudative age-related macular degeneration (AMD) and to evaluate the relationship between exudative AMD and psychological disease.Methods: The 2016 Health Insurance Review and Assessment Service-Aged Patient Sample was applied in this study. The subjects were divided into two groups: AMD patients undergoing intravitreal injection treatment and a control group. Comorbidities were evaluated using the Charlson Comorbidity Index.Results: A total of 1,319,052 subjects were selected, of which 3,134 were in the exudative AMD group receiving intravitreal injections. The average age of the subjects was 74.7 ± 6.7 years, and 41.8% were male. In patients with exudative AMD, the prevalence of depression, anxiety, somatization disorder, and adjustment disorder were 16%, 20%, 0.5%, and 0.4%, respectively; in particular, the prevalence of depression and adjustment disorder were significantly higher than in the control group. In multivariate regression analysis, exudative AMD was a significant factor of depression (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.08-1.31, p < 0.001) and adjustment disorder (OR 2.47, 95% CI 1.47-4.18, p < 0.001). However, the association between AMD and anxiety or somatization disorder was not statistically significant.Conclusions: Exudative AMD showed a significant association with psychiatric disease, such as depression, and requires close clinical attention.
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Impact of neovascular age-related macular degeneration: burden of patients receiving therapies in Japan. Sci Rep 2021; 11:13152. [PMID: 34162934 PMCID: PMC8222235 DOI: 10.1038/s41598-021-92567-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
The chronic eye disorder, neovascular age-related macular degeneration (nAMD), is a common cause of permanent vision impairment and blindness among the elderly in developed countries, including Japan. This study aimed to investigate the disease burden of nAMD patients under treatment, using data from the Japan National Health and Wellness surveys 2009–2014. Out of 147,272 respondents, 100 nAMD patients reported currently receiving treatment. Controls without nAMD were selected by 1:4 propensity score matching. Healthcare Resource Utilisation (HRU), Health-Related Quality of Life (HRQoL), and work productivity loss were compared between the groups. Regarding HRU, nAMD patients had significantly increased number of visits to any healthcare provider (HCP) (13.8 vs. 8.2), ophthalmologist (5.6 vs. 0.8), and other HCP (9.5 vs. 7.1) compared to controls after adjusting for confounding factors. Additionally, nAMD patients had reduced HRQoL and work productivity, i.e., reduced physical component summary (PCS) score (46.3 vs. 47.9), increased absenteeism (18.14% vs. 0.24%), presenteeism (23.89% vs. 12.44%), and total work productivity impairment (33.57% vs. 16.24%). The increased number of ophthalmologist visits were associated with decreased PCS score, increased presenteeism and total work productivity impairment. The current study highlighted substantial burden for nAMD patients, requiring further attention for future healthcare planning and treatment development.
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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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20
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Maaswinkel IM, van der Aa HPA, van Rens GHMB, Beekman ATF, Twisk JWR, van Nispen RMA. Mastery and self-esteem mediate the association between visual acuity and mental health: a population-based longitudinal cohort study. BMC Psychiatry 2020; 20:461. [PMID: 32972387 PMCID: PMC7513319 DOI: 10.1186/s12888-020-02853-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/03/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND With deteriorating eyesight, people often become dependent on others for many aspects of their daily lives. As a result, they feel less 'in control' and experience lower self-esteem. Lower sense of mastery and self-esteem are known to predict depression, but their roles in people with visual impairment have only marginally been investigated. Therefore, this study aimed to determine the influence of mastery and self-esteem on the relationship between visual acuity and mental health. METHODS A longitudinal cohort study was performed using data from the Longitudinal Aging Study Amsterdam (LASA), collected between 2001 and 2012. A community-based population of 2599 older adults were included, who were randomly selected from population registers. Outcomes of interest were the Pearlin Mastery Scale, Rosenberg Self-Esteem Scale, Center for Epidemiologic Studies - Depression scale and the Hospital Anxiety Depression Scale - Anxiety subscale. Linear mixed models were used to establish the association between visual acuity and mental health over time. RESULTS Mean age was 72 years, 56% was female and 1.2% qualified as having low vision. Visual impairment was associated with a lower sense of mastery (β = - 0.477, p < 0.001), lower self-esteem (β = - 0.166, p = 0.008) and more depression (β = 0.235, p < 0.001). No significant association between visual acuity and anxiety was found. The relationship between visual acuity and depression was mediated by self-esteem (25%) and sense of mastery (79%). CONCLUSIONS Vision loss was associated with depression. This association was mediated by self-esteem and sense of mastery. This provides us with new possibilities to identify, support and treat those at risk for developing depression by aiming to increase their self-esteem and sense of mastery.
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Affiliation(s)
- I. M. Maaswinkel
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - H. P. A. van der Aa
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - G. H. M. B. van Rens
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.414480.d0000 0004 0409 6003Elkerliek Hospital, Ophthalmology, Helmond, The Netherlands
| | - A. T. F. Beekman
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Specialized Mental Health Care, Research and Innovation, Amsterdam, The Netherlands
| | - J. W. R. Twisk
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - R. M. A. van Nispen
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Figueras-Roca M, Sabater-Cruz N, Hereu M, Sánchez-Dalmau B, Gómez M, Adán A, Font D. Integración de la oftalmología primaria en el ámbito hospitalario: análisis comparativo de resultados. Aten Primaria 2020; 52:281-282. [PMID: 31776043 PMCID: PMC7118566 DOI: 10.1016/j.aprim.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marc Figueras-Roca
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | | | - Mireia Hereu
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, España
| | - Bernardo Sánchez-Dalmau
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Mónica Gómez
- Departamento de Estrategia y Planificación, Hospital Clínic, Barcelona, España
| | - Alfredo Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - David Font
- Departamento de Estrategia y Planificación, Hospital Clínic, Barcelona, España
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22
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Patel PJ, Ziemssen F, Ng E, Muthutantri A, Silverman D, Tschosik EA, Cantrell RA. Burden of Illness in Geographic Atrophy: A Study of Vision-Related Quality of Life and Health Care Resource Use. Clin Ophthalmol 2020; 14:15-28. [PMID: 32021065 PMCID: PMC6955611 DOI: 10.2147/opth.s226425] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/25/2019] [Indexed: 01/16/2023] Open
Abstract
Purpose To gain comprehensive information on the burden of illness due to geographic atrophy (GA). Methods This cross-sectional study with a retrospective chart review involved patients aged ≥70 years with physician-confirmed bilateral symptomatic GA due to age-related macular degeneration (GA group), as well as patients of similar age with no ophthalmic condition that in the opinion of the investigator affected visual function (non-GA group). Data relating to patients’ current disease status and sociodemographics were self-reported on patient questionnaires at study entry and extracted from patient charts. Historical data on health care resource utilization (HCRU) were also collected via patient questionnaires and retrospective chart review (GA group only). Overall vision-related functioning and quality of life (QoL) were compared between the GA and non-GA groups using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) composite and subscales, and change in vision over the past year was assessed using the Global Rating of Change Scale. Results Vision-related functioning and QoL were poorer in patients with vs without GA (n=137 vs 52), as demonstrated by significantly lower NEI-VFQ-25 composite score (mean, 53.1 vs 84.5 points, respectively; P<0.001), as well as lower subscale scores for near activities, distance activities, dependency, driving, social functioning, mental health, role difficulties, color vision, and peripheral vision. Substantially more patients with GA than without GA reported worsening in vision over the past year (82% vs 25%, respectively; odds ratio, 13.55; P<0.001). In the GA group, associated mean annual costs for direct ophthalmological resource use per patient amounted to €1772 (mostly for tests/procedures), and for indirect ophthalmological resource use, €410 (mostly for general practitioner visits). Conclusion Patients with GA experience a poorer level of vision-related function and QoL than their peers, especially in relation to driving. GA is also associated with notable HCRU/associated costs, mostly direct costs attributed to diagnostic tests/procedures.
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Affiliation(s)
- Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, and University College London Institute of Ophthalmology, London, UK
| | | | - Eugene Ng
- Institute of Eye Surgery, UPMC Whitfield and Waterford Institute of Technology, Waterford, Ireland
| | | | - David Silverman
- Roche Products Limited, Welwyn Garden City, Hertfordshire, UK
| | | | - Ronald A Cantrell
- Genentech, Inc., A Member of the Roche Group, South San Francisco, CA, USA
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23
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Kurtul BE, Ozer PA. Neutrophil-to-lymphocyte ratio in ocular diseases: a systematic review. Int J Ophthalmol 2019; 12:1951-1958. [PMID: 31850181 DOI: 10.18240/ijo.2019.12.18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/18/2019] [Indexed: 12/30/2022] Open
Abstract
AIM To summarize the results of studies investigating neutrophil-to-lymphocyte ratio (NLR) and to identify the role of NLR in ocular diseases. METHODS With the aim of identifying the studies related to NLR, a search was conducted on http://www.ncbi.nlm.nih.gov/pubmed by utilizing the key words "neutrophil lymphocyte ratio, ocular diseases, and eye diseases" up to February 2018. All of the original articles were assessed according to date of publications, countries, clinics and topics. Studies about ocular inflammatory diseases were evaluated according to their qualifications, review methods and results. RESULTS A total of 4473 publications, including original research articles and reviews were screened. The number of publications was shown a regular logarithmic increase over the years. The majority of studies were performed by clinics in Turkey and many of these publications were performed by oncology and cardiology clinics. A total of 75 publications were identified to be about ocular diseases. CONCLUSION Elevated NLR as a cheap, reproducible, and readily available marker could be used as a diagnostic and/or prognostic marker in ocular diseases.
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Affiliation(s)
- Bengi Ece Kurtul
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay 31040, Turkey
| | - Pinar Altiaylik Ozer
- Department of Ophthalmology, Ufuk University Faculty of Medicine, Ankara 06830, Turkey
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24
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Kim S, Park SJ, Byun SJ, Park KH, Suh HS. Incremental economic burden associated with exudative age-related macular degeneration: a population-based study. BMC Health Serv Res 2019; 19:828. [PMID: 31718629 PMCID: PMC6852978 DOI: 10.1186/s12913-019-4666-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The exudative age-related macular degeneration (AMD) causes considerable healthcare costs for patients and healthcare system, which are expected to grow as the population ages. The objective of this study was to assess the incremental economic burden of exudative AMD by comparing total healthcare costs between the exudative AMD group and non-AMD group to understand economic burden related to exudative AMD. METHODS This retrospective cohort study used the National Health Insurance Service database including the entire Korean population. Exudative AMD group included individuals with at least one claim for ranibizumab and one claim using the registration code for exudative AMD (V201). Non-AMD group was defined as individuals without any claims regarding the diagnostic code of H35.3 or ranibizumab. The exudative AMD group and non-AMD group were matched using a propensity-score model. Incremental healthcare resource utilization and healthcare costs were measured during a one-year follow-up by employing econometric models: ordinary least squares (OLS) with log transformation and heteroscedastic retransformation; and generalized linear model (GLM) with a log link function and gamma distribution. RESULTS A total of 7119 exudative AMD patients were matched to 7119 non-AMD patients. The number of outpatient visits was higher in the exudative AMD group (P-value < 0.0001), while the length of hospitalization was shorter in exudative AMD group (P-value < 0.0001). Exudative AMD patients had total costs 2.13 times (95%CI, 2.08-2.17) greater than non-AMD group using OLS, and total costs 4.06 times (95%CI, 3.82-4.31) greater than non-AMD group using GLM. Annual incremental total costs were estimated as $5519 (OLS) and $3699 (GLM). CONCLUSIONS Exudative AMD was associated with significantly increased healthcare costs compared to the non-AMD group. Attention is needed to manage the socioeconomic burden of exudative AMD.
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Affiliation(s)
- Siin Kim
- College of Pharmacy, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.,School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hae Sun Suh
- College of Pharmacy, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan, Republic of Korea.
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25
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Vision-related quality of life after pars plana vitrectomy with or without combined cataract surgery for idiopathic macular hole patients. Int Ophthalmol 2019; 39:2775-2783. [PMID: 31144239 DOI: 10.1007/s10792-019-01124-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the influence of vision-related quality of life (VR-QOL) after pars plana vitrectomy (PPV) with or without combined cataract surgery for idiopathic macular hole (IMH) patients. METHODS This prospective consecutive case series study included 53 eyes of 53 consecutive IMH patients who were divided into two groups: 34 eyes underwent PPV combined with cataract surgery (combined group), 19 eyes only underwent PPV (vitrectomy group). Clinical data were collected at baseline and 3 and 6 months after surgery, respectively, including VR-QOL evaluated by The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25), logarithm of minimal angle of resolution best-corrected visual acuity (logMAR BCVA) using ETDRS chart, severity of metamorphopsia evaluated by M-Charts, contrast sensitivity evaluated by functional acuity contrast test, MH diameter detected by SD-OCT and lens opacity assessment evaluated by Lens Opacity Classification System III (LOCS III). ANOVA and LSD, Wilcoxon signed-rank test were used to compare the difference in logMAR BCVA, metamorphopsia scores, contrast sensitivity, LOCS III scores and VFQ-25 scores between three time points; Spearman's rank correlation test was used to test the correlations between logMAR BCVA, metamorphopsia scores, contrast sensitivity, LOCS III scores and VFQ-25 scores. RESULTS All eyes had achieved an anatomical success after surgery in both groups. BCVA (logMAR), metamorphopsia and contrast sensitivity were significantly improved at month 3 and month 6 (p = < 0.005). VFQ-25 composite and four subscale scores (general vision, near activities, distant activities, role difficulties) were significantly improved in combined group at month 6 compared with baseline (p = 0.011, 0.001, 0.003, < 0.001, 0.009). VFQ-25 composite and two subscale scores (general vision, role difficulties) were significantly and negatively correlated with logMAR BCVA (p = 0.046, 0.011, 0.012) and metamorphopsia (p = 0.009, 0.002, < 0.001) in combined group. VFQ-25 composite and four subscale scores (general vision, near activities, distance activities, mental health) were significantly improved in vitrectomy group at month 3 compared with baseline (p = 0.014, 0.047, 0.011, 0.018, 0.037). VFQ-25 composite score and mental health score were significantly decreased in vitrectomy group at month 6 compared with month 3 (p = 0.031, 0.029) and were significantly and negatively correlated with LOCS III score (p = 0.047, 0.017) at month 6. CONCLUSION Visual function and VR-QOL were significantly improved after successful macular hole surgery. The fluctuation of VR-QOL after surgery was attributed to the progression of the lens opacity. PPV combined with cataract surgery can help macular hole patients to maintain stable VR-QOL improvement by degrees.
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Inan S, Cetinkaya E, Duman R, Dogan I, Inan UÜ. Quality of life among patients with age-related severe macular degeneration assessed using the NEI-VFQ, HADS-A, HADS-D and SF-36 tests. A cross-sectional study. SAO PAULO MED J 2019; 137:25-32. [PMID: 31116266 PMCID: PMC9721220 DOI: 10.1590/1516-3180.2018.0195071218] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/07/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Exudative age-related macular degeneration (e-AMD) may cause severe central vision loss. Patients with e-AMD can experience difficulties in daily basic activities and suffer from psychological problems. Our aim was to assess quality of life (QoL) and anxiety and depression status among patients with e-AMD. DESIGN AND SETTING Cross-sectional study in a state university. METHODS We included 200 e-AMD patients and 120 age and gender-matched controls. We assessed QoL using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and the Short Form (SF)-36 test; and anxiety and depression status using the Hospital Anxiety Depression Scales A and D (HADS-A and HADS-D). RESULTS The mean ages in the e-AMD and control groups were 68.40 ± 9.8 and 66.31 ± 8.98, respectively. Visual acuity among e-AMD patients was 0.37 ± 0.31 and 0.39 ± 0.32 in the right and left eyes, respectively. The e-AMD patients performed significantly worse than the controls in NEI-VFQ-25 (P < 0.05 for all items). The proportions of e-AMD patients scoring higher than the cutoffs in HADS-A and HADS-D were significantly higher than among the controls (41.5% versus 12.5% and 63.5% versus 27.5%; P < 0.001). The e-AMD patients had significantly lower mean scores than the controls for each of the SF-36 QoL items (P < 0.001). The NEI-VFQ-25 scores were significantly lower among patients with bilateral e-AMD than among those with unilateral disease (P < 0.05 for all). The HADS scores were positively correlated with duration of e-AMD and patient age, but negatively with vision levels (P < 0.05 for all items). CONCLUSION The e-AMD patients had higher depression and anxiety scores and lower QoL scores.
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Affiliation(s)
- Sibel Inan
- MD. Assistant Professor, Department of Ophthalmology, Afyon Kocatepe Üniversitesi (AKÜ) Tıp Fakültesi, Afyonkarahisar, Turkey.
| | - Ersan Cetinkaya
- MD. Ophthalmologist, Department of Ophthalmology, Manisa Devlet Hastanesi, Manisa, Turkey.
| | - Resat Duman
- MD. Assistant Professor, Department of Ophthalmology, Afyon Kocatepe Üniversitesi (AKÜ) Tıp Fakültesi, Afyonkarahisar, Turkey.
| | - Ismet Dogan
- PhD. Professor,Department of Clinic Biostatistics, Afyon Kocatepe Üniversitesi (AKÜ) Tıp Fakültesi, Afyonkarahisar, Turkey.
| | - Umit Übeyt Inan
- MD. Professor, Department of Ophthalmology, PARKHAYAT Hastanesi, Afyonkarahisar, Turkey.
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More P, Almuhtaseb H, Smith D, Fraser S, Lotery AJ. Socio-economic status and outcomes for patients with age-related macular degeneration. Eye (Lond) 2019; 33:1224-1231. [PMID: 30858565 DOI: 10.1038/s41433-019-0393-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 01/15/2019] [Accepted: 02/07/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To explore disparities in severity of baseline disease, treatment completion, and treatment outcomes among patients with wet age-related macular degeneration (AMD) receiving anti-vascular endothelial growth factor therapy by socio-economic status (SES) and distance from home to hospital. STUDY DESIGN Retrospective cohort study. METHODS Data from clinic records of 756 wet AMD patients receiving treatment for wet AMD with aflibercept between May 2013 and Jan 2017 were obtained. Area SES (using Index of Multiple Deprivation (IMD) 2015) and distance from hospital (dichotomized > = 10 vs. <10 km) were derived from anonymized postcodes. Univariate and multivariable logistic regression models were used to identify associations of area deprivation and distance from hospital at baseline-with visual acuity (VA) at baseline-treatment completion, and treatment outcome. RESULTS Living in the most deprived compared with less deprived areas was associated with a significantly higher risk of presenting with severe reduction in VA (OR = 3.59; 95% CI = 1.39-9.27; P = .01). This association was maintained after adjustment for age, gender, and distance from hospital. On univariate analysis, delayed treatment completion was more likely in those living in most deprived areas (OR = 2.80; 95% CI = 1.21-6.47; P = .04), though this association was attenuated after adjustment for age, gender, and distance from hospital. No association was observed between SES and treatment outcomes or between distance from hospital and baseline VA, treatment completion or treatment outcome. CONCLUSION This study found poorer baseline VA among people with wet AMD from more deprived areas. This work suggests a need for earlier identification of AMD among more deprived populations.
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Affiliation(s)
- Pradnya More
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Dianna Smith
- Department of Geography, University of Southampton, Southampton, UK
| | - Simon Fraser
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK.
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Nimmagadda K, Weiland JD. Retinotopic Responses in the Visual Cortex Elicited by Epiretinal Electrical Stimulation in Normal and Retinal Degenerate Rats. Transl Vis Sci Technol 2018; 7:33. [PMID: 30402340 PMCID: PMC6213779 DOI: 10.1167/tvst.7.5.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/24/2018] [Indexed: 01/31/2023] Open
Abstract
Purpose Electronic retinal prostheses restore vision in people with outer retinal degeneration by electrically stimulating the inner retina. We characterized visual cortex electrophysiologic response elicited by electrical stimulation of retina in normally sighted and retinal degenerate rats. Methods Nine normally sighted Long Evans and 11 S334ter line 3 retinal degenerate (rd) rats were used to map cortical responses elicited by epiretinal electrical stimulation in four quadrants of the retina. Six normal and six rd rats were used to compare the dendritic spine density of neurons in the visual cortex. Results The rd rats required higher stimulus amplitudes to elicit responses in the visual cortex. The cortical electrically evoked responses (EERs) for both healthy and rd rats show a dose-response characteristic with respect to the stimulus amplitude. The EER maps in healthy rats show retinotopic organization. For rd rats, cortical retinotopy is not well preserved. The neurons in the visual cortex of rd rats show a 10% higher dendritic spine density than in the healthy rats. Conclusions Cortical activity maps, produced when epiretinal stimulation is applied to quadrants of the retina, exhibit retinotopy in normal but not rd rats. This is likely due to a combination of degeneration of the retina and increased stimulus thresholds in rd, which broadens the activated area of the retina. Translational Relevance Loss of retinotopy is evident in rd rats. If a similar loss of retinotopy is present in humans, retinal prostheses design must include flexibility to account for patient specific variability.
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Affiliation(s)
- Kiran Nimmagadda
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA.,USC - Caltech MD/PhD Program, Los Angeles, CA, USA
| | - James D Weiland
- Department of Biomedical Engineering, The University of Michigan, Ann Arbor, MI, USA.,Department of Ophthalmology and Visual Sciences, The University of Michigan, Ann Arbor, MI, USA
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Utility values for age-related macular degeneration patients in Korea. PLoS One 2018; 13:e0201399. [PMID: 30063734 PMCID: PMC6067739 DOI: 10.1371/journal.pone.0201399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/13/2018] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Age-related macular degeneration (AMD) is one of the most important causes of blindness globally and may lead to decreased quality of life. Utility values for AMD patients according to sociodemographic and clinical characteristics have been little-studied, particularly among Asian populations. METHODS A total of 1,283 AMD patients were identified from the Korean National Health and Nutrition Examination Survey from 2008 to 2012. A 45-degree digital retinal image for each eye was used to identify AMD patients. The utility values, calculated by the three level version of EuroQol-5D, of AMD patients according to sociodemographic and clinical characteristics were determined. The Kruskal-Wallis test was used to identify factors associated with reduced utility values among AMD patients. RESULTS The mean utility value for AMD patients was 0.8765. Patients who were older (mean utility value 0.8339), were women (0.8488), had lower education levels (0.8287), were not employed (0.8467), and had lower household income (0.8022) had lower utility values (all p values <0.001). Utility values did not significantly differ according to AMD subtype (p value 0.729), likely due to the lack of enough power as only 48 patients had late AMD. Patients with lower best-eye visual acuity (BEVA) had lower utility values compared to those with high BEVA, even among those with high worst-eye visual acuity (WEVA) (p value <0.001). CONCLUSION Sociodemographic factors and visual acuity are important factors in determining the quality of life among AMD patients. Preserving BEVA, regardless of WEVA, may be associated with improved quality of life.
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Maloca P, Hasler PW, Barthelmes D, Arnold P, Matthias M, Scholl HPN, Gerding H, Garweg J, Heeren T, Balaskas K, de Carvalho JER, Egan C, Tufail A, Zweifel SA. Safety and Feasibility of a Novel Sparse Optical Coherence Tomography Device for Patient-Delivered Retina Home Monitoring. Transl Vis Sci Technol 2018; 7:8. [PMID: 30050725 PMCID: PMC6058910 DOI: 10.1167/tvst.7.4.8] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/06/2018] [Indexed: 12/31/2022] Open
Abstract
Purpose To study a novel and fast optical coherence tomography (OCT) device for home-based monitoring in age-related macular degeneration (AMD) in a small sample yielding sparse OCT (spOCT) data and to compare the device to a commercially available reference device. Methods In this prospective study, both eyes of 31 participants with AMD were included. The subjects underwent scanning with an OCT prototype and a spectral-domain OCT to compare the accuracy of the central retinal thickness (CRT) measurements. Results Sixty-two eyes in 31 participants (21 females and 10 males) were included. The mean age was 79.6 years (age range, 69–92 years). The mean difference in the CRT measurements between the devices was 4.52 μm (SD ± 20.0 μm; range, −65.6 to 41.5 μm). The inter- and intrarater reliability coefficients of the OCT prototype were both >0.95. The laser power delivered was <0.54 mW for spOCT and <1.4 mW for SDOCT. No adverse events were reported, and the visual acuity before and after the measurements was stable. Conclusion This study demonstrated the safety and feasibility of this home-based OCT monitoring under real-life conditions, and it provided evidence for the potential clinical benefit of the device. Translational Relevance The newly developed spOCT is a valid and readily available retina scanner. It could be applied as a portable self-measuring OCT system. Its use may facilitate the sustainable monitoring of chronic retinal diseases by providing easily accessible and continuous retinal monitoring.
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Affiliation(s)
- Peter Maloca
- OCTlab, Department of Ophthalmology, University Hospital of Basel, Basel, Switzerland.,University of Basel, Department of Ophthalmology, Basel, Switzerland.,Moorfields Eye Hospital, London, UK
| | - Pascal W Hasler
- OCTlab, Department of Ophthalmology, University Hospital of Basel, Basel, Switzerland.,University of Basel, Department of Ophthalmology, Basel, Switzerland
| | - Daniel Barthelmes
- University of Zurich, Department of Ophthalmology, University Hospital, Zurich, Switzerland.,Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Patrik Arnold
- University of Applied Sciences Engineering and Information Technology, Institute for Human Centered Engineering OptoLab, Biel/Berne, Switzerland
| | - Mooser Matthias
- University of Applied Sciences Engineering and Information Technology, Institute for Human Centered Engineering OptoLab, Biel/Berne, Switzerland
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,University of Basel, Department of Ophthalmology, Basel, Switzerland.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Heinrich Gerding
- Pallas Kliniken AG, Olten, Switzerland.,Augenklinik der Universität Münster, Münster, Germany
| | - Justus Garweg
- Berner Augenklinik am Lindenhofspital and University of Bern, Bern, Switzerland
| | - Tjebo Heeren
- University College London, Institute of Ophthalmology, London, UK
| | - Konstantinos Balaskas
- Moorfields Ophthalmic Reading Centre, London, UK.,Moorfields Eye Hospital, London, UK
| | | | | | | | - Sandrine A Zweifel
- University of Zurich, Department of Ophthalmology, University Hospital, Zurich, Switzerland
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Schippert AC, Jelin E, Moe MC, Heiberg T, Grov EK. The Impact of Age-Related Macular Degeneration on Quality of Life and Its Association With Demographic Data: Results From the NEI VFQ-25 Questionnaire in a Norwegian Population. Gerontol Geriatr Med 2018; 4:2333721418801601. [PMID: 30263908 PMCID: PMC6149028 DOI: 10.1177/2333721418801601] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022] Open
Abstract
Objective: To describe vision-related quality of life (VRQoL) in a Norwegian population of patients with newly diagnosed neovascular age-related macular degeneration (nAMD), and to evaluate the association with demographic data of age, gender, and civil status (married, cohabitants/unmarried, not cohabitants). Method: The Norwegian version of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) questionnaire was administered to 145 patients recently diagnosed with nAMD. We used descriptive statistics and bivariate analysis to determine the distribution of demographic parameters and a possible association between demographic parameters and NEI VFQ-25 scores. Spearman correlation was employed to analyze the NEI VFQ-25 items and subscales scores. Results: Mean (SD) VFQ-25 total score was 78.5 (14.7). The scores per subscales varied from 64.7 to 89.7. No significant difference was revealed between demographic parameters and the NEI VFQ-25 items, except for one item (being with others) when comparing paired and nonpaired participants. Conclusion: In a Norwegian population with newly diagnosed nAMD, VRQoL is reported at a high baseline level. This is an important information for the health care personnel when discussing expectations during treatment with the patient. Age, gender, and civil status did not affect VRQoL.
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Affiliation(s)
- Ana Carla Schippert
- Oslo Metropolitan University, Norway
- Akershus University Hospital, Oslo,
Norway
| | - Elma Jelin
- Oslo University Hospital, Norway
- University of Oslo, Norway
| | - Morten C. Moe
- Oslo University Hospital, Norway
- University of Oslo, Norway
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van der Aa HPA, van Rens GHMB, Verbraak FD, Bosscha M, Koopmanschap MA, Comijs HC, Cuijpers P, van Nispen RMA. Economic evaluation of an e-mental health intervention for patients with retinal exudative diseases who receive intraocular anti-VEGF injections (E-PsEYE): protocol for a randomised controlled trial. BMJ Open 2017; 7:e018149. [PMID: 29146648 PMCID: PMC5695477 DOI: 10.1136/bmjopen-2017-018149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Because of the great potential of vascular endothelial growth factor inhibitors (anti-VEGF) for retinal exudative diseases, an increased number of patients receives this treatment. However, during this treatment, patients are subjected to frequent invasive intravitreal injections, and the effects on reversing the process of vision loss are uncertain, which may have negative consequences for patients' mental health. One in three patients experience at least mild symptoms of depression/anxiety. To support patients in dealing with these symptoms, an e-mental health intervention (called E-PsEYE) has been developed. E-PsEYE is based on cognitive-behavioural therapy (CBT) and contains nine modules. A stepped-care model with three steps will be used to deliver the intervention: (1) providing information and psychoeducation, (2) when symptoms of depression/anxiety persist, guided CBT is offered and supported by social workers from low vision rehabilitation services and (3) when symptoms still persist, patients are referred to their general practitioner. METHODS AND ANALYSIS An economic evaluation from a healthcare and societal perspective will be conducted alongside a multicentre randomised controlled trial in two parallel groups to evaluate whether E-PsEYE is cost-effective in comparison with usual care. Participants (n=174) will be 50 years or older, have retinal exudative diseases, receive anti-VEGF treatment and have mild symptoms of depression/anxiety (assessed prior to randomisation). Main outcome measures are: depression (Patient Health Questionnaire-9), anxiety (Hospital Anxiety and Depression Scale-Anxiety) and quality-adjusted life-years (determined with the Health Utility Index-3 and the EuroQol-5 dimensions). Five measurements take place: at baseline and after 3, 6, 9 and 12 months. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethics Committee of the VU University Medical Centre Amsterdam. It will provide new and essential information on the cost-effectiveness of an innovative intervention for a vulnerable population. Outcomes will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION http://www.trialregister.nl, identifier: NTR6337.
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Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ger H M B van Rens
- Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | - Frank D Verbraak
- Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Machteld Bosscha
- Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marc A Koopmanschap
- Department of Health Policy and Management/iMTA, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hannie C Comijs
- Department of Psychiatry, VUmc/GGZinGeest and the Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Prem Senthil M, Khadka J, Pesudovs K. Assessment of patient-reported outcomes in retinal diseases: a systematic review. Surv Ophthalmol 2017; 62:546-582. [DOI: 10.1016/j.survophthal.2016.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 02/03/2023]
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Sengul EA, Artunay O, Kockar A, Afacan C, Rasier R, Gun P, Yalcin NG, Yuzbasioglu E. Correlation of neutrophil/lymphocyte and platelet/lymphocyte ratio with visual acuity and macular thickness in age-related macular degeneration. Int J Ophthalmol 2017; 10:754-759. [PMID: 28546933 DOI: 10.18240/ijo.2017.05.16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/20/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the place of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in the diagnosis of and prognosis for neovascular age-related macular degeneration (AMD). METHODS One hundred AMD patients and 100 healthy controls were included in the study. Blood samples were obtained from the venous blood, which is used for routine analysis, and these samples were subjected to complete blood count. NLR was defined as the neutrophil count divided by the number of lymphocytes, and PLR was defined as the platelet count divided by the number of lymphocytes. RESULTS No statistically significant difference was observed between the two groups under consideration in terms of demographic features (P>0.05). The average NLR in the patient group was found to be significantly higher than that in the healthy control group (P<0.05). The average PLR was significantly higher in the patient group as compared to the control group (P<0.05). As best corrected visual acuity (BCVA) increased, both NLR and PLR decreased (significant negative correlations at 49.8% and 63.0%, respectively), whereas as central macular thickness (CMT) increased, both NLR and PLR increased (significant positive correlations at 59.3% and 70.0%, respectively). CONCLUSION NLR and PLR levels are higher among neovascular AMD patients as compared to healthy control group. NLR and PLR levels were found to be inversely proportional to BCVA and directly proportional to CMT.
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Affiliation(s)
- Elvan Alper Sengul
- Ophthalmology Department, Medical Faculty, Istanbul Bilim University, Istanbul 34381, Turkey
| | - Ozgur Artunay
- Ophthalmology Department, Haydarpasa Numune Training and Research Hospital, Istanbul 34668, Turkey
| | - Alev Kockar
- Ophthalmology Department, Medical Faculty, Istanbul Bilim University, Istanbul 34381, Turkey
| | - Ceyda Afacan
- Department of Statistics, Mimar Sinan Fine Arts University, Istanbul 34427, Turkey
| | - Rifat Rasier
- Ophthalmology Department, Medical Faculty, Istanbul Bilim University, Istanbul 34381, Turkey
| | - Palmet Gun
- Biochemistry Department, Medical Faculty, Istanbul Bilim University, Istanbul 34381, Turkey
| | - Nazli Gul Yalcin
- Ophthalmology Department, Medical Faculty, Istanbul Bilim University, Istanbul 34381, Turkey
| | - Erdal Yuzbasioglu
- Ophthalmology Department, Medical Faculty, Istanbul Bilim University, Istanbul 34381, Turkey
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Hunt NC, Hallam D, Karimi A, Mellough CB, Chen J, Steel DHW, Lako M. 3D culture of human pluripotent stem cells in RGD-alginate hydrogel improves retinal tissue development. Acta Biomater 2017; 49:329-343. [PMID: 27826002 DOI: 10.1016/j.actbio.2016.11.016] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 12/22/2022]
Abstract
No treatments exist to effectively treat many retinal diseases. Retinal pigmented epithelium (RPE) and neural retina can be generated from human embryonic stem cells/induced pluripotent stem cells (hESCs/hiPSCs). The efficacy of current protocols is, however, limited. It was hypothesised that generation of laminated neural retina and/or RPE from hiPSCs/hESCs could be enhanced by three dimensional (3D) culture in hydrogels. hiPSC- and hESC-derived embryoid bodies (EBs) were encapsulated in 0.5% RGD-alginate; 1% RGD-alginate; hyaluronic acid (HA) or HA/gelatin hydrogels and maintained until day 45. Compared with controls (no gel), 0.5% RGD-alginate increased: the percentage of EBs with pigmented RPE foci; the percentage EBs with optic vesicles (OVs) and pigmented RPE simultaneously; the area covered by RPE; frequency of RPE cells (CRALBP+); expression of RPE markers (TYR and RPE65) and the retinal ganglion cell marker, MATH5. Furthermore, 0.5% RGD-alginate hydrogel encapsulation did not adversely affect the expression of other neural retina markers (PROX1, CRX, RCVRN, AP2α or VSX2) as determined by qRT-PCR, or the percentage of VSX2 positive cells as determined by flow cytometry. 1% RGD-alginate increased the percentage of EBs with OVs and/or RPE, but did not significantly influence any other measures of retinal differentiation. HA-based hydrogels had no significant effect on retinal tissue development. The results indicated that derivation of retinal tissue from hESCs/hiPSCs can be enhanced by culture in 0.5% RGD-alginate hydrogel. This RGD-alginate scaffold may be useful for derivation, transport and transplantation of neural retina and RPE, and may also enhance formation of other pigmented, neural or epithelial tissue. STATEMENT OF SIGNIFICANCE The burden of retinal disease is ever growing with the increasing age of the world-wide population. Transplantation of retinal tissue derived from human pluripotent stem cells (PSCs) is considered a promising treatment. However, derivation of retinal tissue from PSCs using defined media is a lengthy process and often variable between different cell lines. This study indicated that alginate hydrogels enhanced retinal tissue development from PSCs, whereas hyaluronic acid-based hydrogels did not. This is the first study to show that 3D culture with a biomaterial scaffold can improve retinal tissue derivation from PSCs. These findings indicate potential for the clinical application of alginate hydrogels for the derivation and subsequent transplantation retinal tissue. This work may also have implications for the derivation of other pigmented, neural or epithelial tissue.
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Affiliation(s)
- Nicola C Hunt
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle NE1 3BZ, UK.
| | - Dean Hallam
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle NE1 3BZ, UK.
| | - Ayesha Karimi
- Cumberland Infirmary, North Cumbria University Hospitals NHS Trust, Carlisle CA2 7HY, UK
| | - Carla B Mellough
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle NE1 3BZ, UK.
| | - Jinju Chen
- School of Mechanical & Systems Engineering, Stephenson Building, Newcastle University, Newcastle upon Tyne, UK.
| | - David H W Steel
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle NE1 3BZ, UK; Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland SR2 9HP, UK.
| | - Majlinda Lako
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle NE1 3BZ, UK.
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Chen M, Lechner J, Zhao J, Toth L, Hogg R, Silvestri G, Kissenpfennig A, Chakravarthy U, Xu H. STAT3 Activation in Circulating Monocytes Contributes to Neovascular Age-Related Macular Degeneration. Curr Mol Med 2016; 16:412-23. [PMID: 27009107 PMCID: PMC4839497 DOI: 10.2174/1566524016666160324130031] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/07/2016] [Accepted: 03/19/2016] [Indexed: 12/05/2022]
Abstract
Infiltrating macrophages are critically involved in pathogenic angiogenesis such as neovascular age-related macular degeneration (nAMD). Macrophages originate from circulating monocytes and three subtypes of monocyte exist in humans: classical (CD14+CD16-), non-classical (CD14-CD16+) and intermediate (CD14+CD16+) monocytes. The aim of this study was to investigate the role of circulating monocyte in neovascular age-related macular degeneration (nAMD). Flow cytometry analysis showed that the intermediate monocytes from nAMD patients expressed higher levels of CX3CR1 and HLA-DR compared to those from controls. Monocytes from nAMD patients expressed higher levels of phosphorylated Signal Transducer and Activator of Transcription 3 (pSTAT3), and produced higher amount of VEGF. In the mouse model of choroidal neovascularization (CNV), pSTAT3 expression was increased in the retina and RPE/choroid, and 49.24% of infiltrating macrophages express pSTAT3. Genetic deletion of the Suppressor of Cytokine Signalling 3 (SOCS3) in myeloid cells in the LysM-Cre+/-:SOCS3fl/fl mice resulted in spontaneous STAT3 activation and accelerated CNV formation. Inhibition of STAT3 activation using a small peptide LLL12 suppressed laser-induced CNV. Our results suggest that monocytes, in particular the intermediate subset of monocytes are activated in nAMD patients. STAT3 activation in circulating monocytes may contribute to the development of choroidal neovascularisation in AMD.
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Affiliation(s)
- M Chen
- Wellcome-Wolfson Institute of Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | | | | | | | | | | | | | | | - H Xu
- Wellcome-Wolfson Institute of Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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Taylor DJ, Hobby AE, Binns AM, Crabb DP. How does age-related macular degeneration affect real-world visual ability and quality of life? A systematic review. BMJ Open 2016; 6:e011504. [PMID: 27913556 PMCID: PMC5168634 DOI: 10.1136/bmjopen-2016-011504] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/21/2016] [Accepted: 11/04/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To review systematically the evidence of age-related macular degeneration (AMD) affecting real-world visual ability and quality of life (QoL). To explore trends in specific topics within this body of the literature. DESIGN Systematic review. METHODS A systematic literature search was carried out using MEDLINE, EMBASE, CINAHL, PsycINFO, PsychARTICLES and Health and Psychosocial Instruments for articles published up to January 2015 for studies including people diagnosed with AMD, assessing real-world visual ability or QoL as an outcome. Two researchers screened studies for eligibility. Details of eligible studies including study design, characteristics of study population and outcomes measured were recorded in a data extraction table. All included studies underwent quality appraisal using the Mixed Methods Appraisal Tool 2011 Version (MMAT). RESULTS From 5284 studies, 123 were eligible for inclusion. A range of approaches were identified, including performance-based methods, quantitative and qualitative patient-reported outcome measures (PROMs). AMD negatively affects tasks including mobility, face recognition, perception of scenes, computer use, meal preparation, shopping, cleaning, watching TV, reading, driving and, in some cases, self-care. There is evidence for higher rates of depression among people with AMD than among community dwelling elderly. A number of adaptation strategies have been associated with AMD of varying duration. Much of the research fails to report the type of AMD studied (59% of included studies) or the duration of disease in participants (74%). Of those that do report type studied, the breakdown is as follows: wet AMD 20%, dry AMD 4% and both types 17%. CONCLUSIONS There are many publications highlighting the negative effects of AMD in various domains of life. Future research should focus on delivering some of this research knowledge into patient management and clinical trials and differentiating between the types of AMD.
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Affiliation(s)
- Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Angharad E Hobby
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Alison M Binns
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
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Haig J, Barbeau M, Ferreira A. Cost-effectiveness of ranibizumab in the treatment of visual impairment due to diabetic macular edema. J Med Econ 2016; 19:663-71. [PMID: 26882365 DOI: 10.3111/13696998.2016.1154566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective Ranibizumab, an anti-vascular endothelial growth factor designed for ocular use, has been deemed cost-effective in multiple indications by several Health Technology Assessment bodies. This study assessed the cost-effectiveness of ranibizumab monotherapy or combination therapy (ranibizumab plus laser photocoagulation) compared with laser monotherapy for the treatment of visual impairment due to diabetic macular edema (DME). Methods A Markov model was developed in which patients moved between health states defined by best-corrected visual acuity (BCVA) intervals and an absorbing 'death' state. The population of interest was patients with DME due to type 1 or type 2 diabetes mellitus. Baseline characteristics were based on those of participants in the RESTORE study. Main outputs were costs (in 2013 CA$) and health outcomes (in quality-adjusted life-years [QALYs]) and the incremental cost-effectiveness ratio (ICER) was calculated. This cost-utility analysis was conducted from healthcare system and societal perspectives in Quebec. Results From a healthcare system perspective, the ICERs for ranibizumab monotherapy and combination therapy vs laser monotherapy were CA$24 494 and CA$36 414 per QALY gained, respectively. The incremental costs per year without legal blindness for ranibizumab monotherapy and combination therapy vs laser monotherapy were CA$15 822 and CA$20 616, respectively. Based on the generally accepted Canadian ICER threshold of CA$50 000 per QALY gained, ranibizumab monotherapy and combination therapy were found to be cost-effective compared with laser monotherapy. From a societal perspective, ranibizumab monotherapy and combination therapy provided greater benefits at lower costs than laser monotherapy (ranibizumab therapy dominated laser therapy). Conclusions Ranibizumab monotherapy and combination therapy resulted in increased quality-adjusted survival and time without legal blindness and lower costs from a societal perspective compared with laser monotherapy.
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Affiliation(s)
| | - Martin Barbeau
- b Novartis Pharmaceuticals Canada Inc. , Dorval , QC , Canada
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van der Aa HPA, van Rens GHMB, Comijs HC, Margrain TH, Gallindo-Garre F, Twisk JWR, van Nispen RMA. Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial. BMJ 2015; 351:h6127. [PMID: 26597263 PMCID: PMC4655616 DOI: 10.1136/bmj.h6127] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY QUESTION Is stepped care compared with usual care effective in preventing the onset of major depressive, dysthymic, and anxiety disorders in older people with visual impairment (caused mainly by age related eye disease) and subthreshold depression and/or anxiety? METHODS 265 people aged ≥50 were randomly assigned to a stepped care programme plus usual care (n=131) or usual care only (n=134). Supervised occupational therapists, social workers, and psychologists from low vision rehabilitation organisations delivered the stepped care programme, which comprised watchful waiting, guided self help based on cognitive behavioural therapy, problem solving treatment, and referral to a general practitioner. The primary outcome was the 24 month cumulative incidence (seven measurements) of major depressive dysthymic and/or anxiety disorders (panic disorder, agoraphobia, social phobia, and generalised anxiety disorder). Secondary outcomes were change in symptoms of depression and anxiety, vision related quality of life, health related quality of life, and adaptation to vision loss over time up to 24 months' follow-up. STUDY ANSWER AND LIMITATIONS 62 participants (46%) in the usual care group and 38 participants (29%) from the stepped care group developed a disorder. The intervention was associated with a significantly reduced incidence (relative risk 0.63, 95% confidence interval 0.45 to 0.87; P=0.01), even if time to the event was taken into account (adjusted hazard ratio 0.57, 0.35 to 0.93; P=0.02). The number needed to treat was 5.8 (3.5 to 17.3). The dropout rate was fairly high (34.3%), but rates were not significantly different for the two groups, indicating that the intervention was as acceptable as usual care. Participants who volunteered and were selected for this study might not be representative of visually impaired older adults in general (responders were significantly younger than non-responders), thereby reducing the generalisability of the outcomes. WHAT THIS STUDY ADDS Stepped care seems to be a promising way to deal with depression and anxiety in visually impaired older adults. This approach could lead to standardised strategies for the screening, monitoring, treatment, and referral of visually impaired older adults with depression and anxiety. FUNDING, COMPETING INTERESTS, DATA SHARING Funded by ZonMw InZicht, the Dutch Organisation for Health Research and Development-InSight Society. There are no competing interests. Full dataset and statistical code are available from the corresponding author.Study registration www.trialregister.nl NTR3296.
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Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Ger H M B van Rens
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Hannie C Comijs
- Department of Psychiatry VUmc/GGZinGeest, 1081HL Amsterdam, Netherlands
| | - Tom H Margrain
- School of Optometry and Vision Sciences, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - Francisca Gallindo-Garre
- Department of Epidemiology and Biostatistics, VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
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van der Aa HPA, Krijnen-de Bruin E, van Rens GHMB, Twisk JWR, van Nispen RMA. Watchful waiting for subthreshold depression and anxiety in visually impaired older adults. Qual Life Res 2015; 24:2885-93. [PMID: 26085328 PMCID: PMC4615663 DOI: 10.1007/s11136-015-1032-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 12/21/2022]
Abstract
Purpose Immediate treatment of depression and anxiety may not always be necessary in resilient patients. This study aimed to determine remission rates of subthreshold depression and anxiety, incidence rates of major depressive and anxiety disorders, and predictors of these remission and incidence rates in visually impaired older adults after a three-month ‘watchful waiting’ period. Methods A pretest–posttest study in 265 visually impaired older adults (mean age 74 years), from outpatient low-vision rehabilitation services, with subthreshold depression and/or anxiety was performed as part of a randomised controlled trial on the cost-effectiveness of a stepped-care intervention. An ordinal logistic regression analysis was conducted. Main outcome measures were: (1) subthreshold depression and anxiety measured with the Centre for Epidemiologic Studies Depression Scale (CES-D) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and (2) depressive and anxiety disorders measured with the Mini International Neuropsychiatric Interview. Results After a three-month watchful waiting period, depression and anxiety decreased significantly by 3.8 (CES-D) and 1.4 points (HADS-A) (p < 0.001). Of all participants, 34 % recovered from subthreshold depression and/or anxiety and 18 % developed a depressive and/or anxiety disorder. Female gender [odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.28–0.86], more problems with adjustment to vision loss at baseline (OR 1.02, 95 % CI 1.00–1.03), more symptoms of depression and anxiety at baseline (OR 1.06, 95 % CI 1.02–1.10), and a history of major depressive, dysthymic, and/or panic disorder (OR 2.28, 95 % CI 1.28–4.07) were associated with lower odds of remitting from subthreshold depression and/or anxiety and higher odds of developing a disorder after watchful waiting. Conclusions Watchful waiting can be an appropriate step in managing depression and anxiety in visually impaired older adults. However, female gender, problems with adjustment to vision loss, higher depression and anxiety symptoms, and a history of a depressive or anxiety disorder confer a disadvantage. Screening tools may be used to identify patients with these characteristics, who may benefit more from higher intensity treatment or a shorter period of watchful waiting.
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Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Esther Krijnen-de Bruin
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Ger H M B van Rens
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- Department of Ophthalmology, Elkerliek Hospital, Wesselmanlaan 25, 5707 HA, Helmond, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Yuzawa M, Fujita K, Wittrup-Jensen KU, Norenberg C, Zeitz O, Adachi K, Wang EC, Heier J, Kaiser P, Chong V, Korobelnik JF. Improvement in Vision-Related Function with Intravitreal Aflibercept. Ophthalmology 2015; 122:571-8. [DOI: 10.1016/j.ophtha.2014.09.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 09/12/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022] Open
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Chen X, Thomson H, Cooke J, Scott J, Hossain P, Lotery A. Adult limbal neurosphere cells: a potential autologous cell resource for retinal cell generation. PLoS One 2014; 9:e108418. [PMID: 25271851 PMCID: PMC4182722 DOI: 10.1371/journal.pone.0108418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 08/27/2014] [Indexed: 01/15/2023] Open
Abstract
The Corneal limbus is a readily accessible region at the front of the eye, separating the cornea and sclera. Neural colonies (neurospheres) can be generated from adult corneal limbus invitro. We have previously shown that these neurospheres originate from neural crest stem/progenitor cells and that they can differentiate into functional neurons invitro. The aim of this study was to investigate whether mouse and human limbal neurosphere cells (LNS) could differentiate towards a retinal lineage both invivo and invitro following exposure to a developing retinal microenvironment. In this article we show that LNS can be generated from adult mice and aged humans (up to 97 years) using a serum free culture assay. Following culture with developing mouse retinal cells, we detected retinal progenitor cell markers, mature retinal/neuronal markers and sensory cilia in the majority of mouse LNS experiments. After transplantation into the sub-retinal space of neonatal mice, mouse LNS cells expressed photoreceptor specific markers, but no incorporation into host retinal tissue was seen. Human LNS cells also expressed retinal progenitor markers at the transcription level but mature retinal markers were not observed invitro or invivo. This data highlights that mouse corneal limbal stromal progenitor cells can transdifferentiate towards a retinal lineage. Complete differentiation is likely to require more comprehensive regulation; however, the accessibility and plasticity of LNS makes them an attractive cell resource for future study and ultimately therapeutic application.
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Affiliation(s)
- Xiaoli Chen
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Heather Thomson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Jessica Cooke
- School of Clinical Sciences, University of Bristol, Bristol Eye Hospital, Bristol, United Kingdom
| | - Jennifer Scott
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Parwez Hossain
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Andrew Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- * E-mail:
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Zhou L, Xing YQ, Li T, Li Y, Song XS, Li JZ. Meta-analysis of best corrected visual acuity after treatment for myopic choroidal neovascularisation. Int J Ophthalmol 2014; 7:720-5. [PMID: 25161950 DOI: 10.3980/j.issn.2222-3959.2014.04.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 03/04/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the best corrected visual acuity (BCVA) between Verteporfin with photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) in patients with myopic choroidal neovascularization (CNV). METHOD Published literature from Medline, Premedline, Embase and the Cochrane Library from inception until November 2013 were retrieved. All studies evaluating the BCVA between Verteporfin with PDT and intravitreal anti-VEGF for myopic CNV were included. The results were pooled using mean difference (MD), a corresponding 95% confidence interval (CI). RESULTS Finally, five studies enrolled 349 eyes were included in the meta-analysis. We inferred that the BCVA of myopic CNV after the treatment of anti-VEGF was significantly better compared with Verteporfin with PDT (MD=0.25, 95%CI:0.17-0.33, Z=5.97, P<0.00001). CONCLUSION This meta-analysis suggests that intravitreal anti-VEGF could have a better BCVA after treatment than Verteporfin with PDT for myopic CNV.
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Affiliation(s)
- Lin Zhou
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China ; Department of Ophthalmology, the Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi 445000, Hubei Province, China
| | - Yi-Qiao Xing
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Tuo Li
- Department of Ophthalmology, the Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi 445000, Hubei Province, China
| | - Yin Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China ; Department of Ophthalmology, the Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi 445000, Hubei Province, China
| | - Xiu-Sheng Song
- Department of Ophthalmology, the Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi 445000, Hubei Province, China
| | - Jia-Zhang Li
- Department of Ophthalmology, the Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi 445000, Hubei Province, China
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Garin N, Olaya B, Lara E, Moneta MV, Miret M, Ayuso-Mateos JL, Haro JM. Visual impairment and multimorbidity in a representative sample of the Spanish population. BMC Public Health 2014; 14:815. [PMID: 25103270 PMCID: PMC4139603 DOI: 10.1186/1471-2458-14-815] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/26/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In the context of population aging, visual impairment has emerged as a growing concern in public health. However, there is a need for further research into the relationship between visual impairment and chronic medical conditions in the elderly. The aim of our study was to examine the relationship between visual impairment and three main types of co-morbidity: chronic physical conditions (both at an independent and additive level), mental health and cognitive functioning. METHODS Data were collected from the COURAGE in Europe project, a cross-sectional study. A total of 4,583 participants from Spain were included. Diagnosis of chronic medical conditions included self-reported medical diagnosis and symptomatic algorithms. Depression and anxiety were assessed using CIDI algorithms. Visual assessment included objective distance/near visual acuity and subjective visual performance. Descriptive analyses included the whole sample (n = 4,583). Statistical analyses included participants aged over 50 years (n = 3,625; mean age = 66.45 years) since they have a significant prevalence of chronic conditions and visual impairment. Crude and adjusted binary logistic regressions were performed to identify independent associations between visual impairment and chronic medical conditions, physical multimorbidity and mental conditions. Covariates included age, gender, marital status, education level, employment status and urbanicity. RESULTS The number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR 1.75 (CI 1.38-2.23); OR 1.69 (CI 1.27-2.24)]. At an independent level, arthritis, stroke and diabetes were associated with poorer distance visual acuity results after adjusting for covariates [OR 1.79 (CI 1.46-2.21); OR 1.59 (CI 1.05-2.42); OR 1.27 (1.01-1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (CI 1.86-4.87)]. With regard to mental health, poor subjective visual acuity was associated with depression [OR 1.61 (CI 1.14-2.27); OR 1.48 (CI 1.03-2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning. CONCLUSIONS Arthritis, stroke and the co-occurrence of various chronic physical diseases are associated with higher prevalence of visual impairment. Visual impairment is associated with higher prevalence of depression and poorer cognitive function results. There is a need to implement patient-centered care involving special visual assessment in these cases.
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Affiliation(s)
- Noe Garin
- />Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr Antoni Pujades, 42, 08830 Barcelona, Sant Boi de Llobregat, Spain
- />Fundació Sant Joan de Déu, Santa Rosa, 39-57, 08950 Barcelona, Esplugues de Llobregat, Spain
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
| | - Beatriz Olaya
- />Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr Antoni Pujades, 42, 08830 Barcelona, Sant Boi de Llobregat, Spain
- />Fundació Sant Joan de Déu, Santa Rosa, 39-57, 08950 Barcelona, Esplugues de Llobregat, Spain
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
| | - Elvira Lara
- />Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr Antoni Pujades, 42, 08830 Barcelona, Sant Boi de Llobregat, Spain
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
| | - Maria Victoria Moneta
- />Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr Antoni Pujades, 42, 08830 Barcelona, Sant Boi de Llobregat, Spain
| | - Marta Miret
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
- />Department of Psychiatry, Universidad Autónoma de Madrid, Arzobispo Morcillo s/n, 28029 Madrid, Spain
| | - Jose Luis Ayuso-Mateos
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
- />Department of Psychiatry, Universidad Autónoma de Madrid, Arzobispo Morcillo s/n, 28029 Madrid, Spain
- />Instituto de Investigación Sanitaria Princesa (IP), Diego de León, 62, 28006 Madrid, Spain
| | - Josep Maria Haro
- />Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr Antoni Pujades, 42, 08830 Barcelona, Sant Boi de Llobregat, Spain
- />Fundació Sant Joan de Déu, Santa Rosa, 39-57, 08950 Barcelona, Esplugues de Llobregat, Spain
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
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Iida T, Narimatsu A, Adachi K, Wang EC. Anti-vascular Endothelial Growth Factor Outpatient Treatment Patterns in Patients with Exudative Age-related Macular Degeneration from a Japanese Hospital Claims Database. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2014; 2:41-52. [PMID: 37664082 PMCID: PMC10471391 DOI: 10.36469/9887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Purpose: To identify outpatient treatment patterns of patients with exudative age-related macular degeneration (AMD) who received approved anti-vascular endothelial growth factor (VEGF) therapy, using real-world data from hospitals in Japan. Methods: A hospital claims database was retrospectively reviewed for patients diagnosed with exudative AMD who were treated with anti-VEGF therapy in the outpatient setting between January 2010 and December 2012. Within a treatment period of at least 12 months, the frequency of anti-VEGF injections and AMD-related visits, and time intervals between AMD-related visits and anti-VEGF injections were captured for patients who had neither cataracts nor glaucoma. "Loading dose regimen" was defined as the first 2 or 3 monthly doses and "PRN maintenance regimen" (where PRN=pro re nata) was defined as the entire period of time after the loading doses had been administered. Results: Claims data were collected from a total of 219 patients from 13 of 126 hospitals: 217 treated with ranibizumab (8 received pegaptanib as well), 2 with aflibercept. Of these, 68 patients were treated for at least 12 months (all with ranibizumab PRN), and 29 had neither cataracts nor glaucoma and were included in the treatment pattern analysis. These 29 patients received a mean of 3.8 injections in the first 12 months and another 2.5 injections in the second 12 months of treatment. The average number of all outpatient visits was 16.1 in the first 12 months and 13.7 in the second 12 months, and an average of 11.6 days elapsed between injections and the previous outpatient monitoring visits using a PRN schedule. Conclusion: In a real-world setting in Japan, anti-VEGF PRN injections are administered less frequently than in clinical trials, and with time between monitoring and re-injection visits. Nonetheless, patients still visit the hospital frequently, which can significantly burden patients, caregivers, and healthcare providers.
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Affiliation(s)
- Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Aya Narimatsu
- Economics and Outcomes Research, Bayer Yakuhin Ltd., Osaka, Japan
| | - Kenji Adachi
- Economics and Outcomes Research, Bayer Yakuhin Ltd., Osaka, Japan
| | - Edward Cy Wang
- Economics and Outcomes Research, Bayer Yakuhin Ltd., Osaka, Japan
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Mitchell P, Bressler N, Doan QV, Dolan C, Ferreira A, Osborne A, Rochtchina E, Danese M, Colman S, Wong TY. Estimated cases of blindness and visual impairment from neovascular age-related macular degeneration avoided in Australia by ranibizumab treatment. PLoS One 2014; 9:e101072. [PMID: 24979237 PMCID: PMC4076243 DOI: 10.1371/journal.pone.0101072] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/02/2014] [Indexed: 11/21/2022] Open
Abstract
Intravitreal injections of anti-vascular endothelial growth factor agents, such as ranibizumab, have significantly improved the management of neovascular age-related macular degeneration. This study used patient-level simulation modelling to estimate the number of individuals in Australia who would have been likely to avoid legal blindness or visual impairment due to neovascular age-related macular degeneration over a 2-year period as a result of intravitreal ranibizumab injections. The modelling approach used existing data for the incidence of neovascular age-related macular degeneration in Australia and outcomes from ranibizumab trials. Blindness and visual impairment were defined as visual acuity in the better-seeing eye of worse than 6/60 or 6/12, respectively. In 2010, 14 634 individuals in Australia were estimated to develop neovascular age-related macular degeneration who would be eligible for ranibizumab therapy. Without treatment, 2246 individuals would become legally blind over 2 years. Monthly 0.5 mg intravitreal ranibizumab would reduce incident blindness by 72% (95% simulation interval, 70–74%). Ranibizumab given as needed would reduce incident blindness by 68% (64–71%). Without treatment, 4846 individuals would become visually impaired over 2 years; this proportion would be reduced by 37% (34–39%) with monthly intravitreal ranibizumab, and by 28% (23–33%) with ranibizumab given as needed. These data suggest that intravitreal injections of ranibizumab, given either monthly or as needed, can substantially lower the number of cases of blindness and visual impairment over 2 years after the diagnosis of neovascular age-related macular degeneration.
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Affiliation(s)
- Paul Mitchell
- Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Westmead, New South Wales, Australia
| | - Neil Bressler
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Quan V Doan
- Outcomes Insights, Inc., Westlake Village, California, United States of America
| | - Chantal Dolan
- CMD Consulting, Inc., Sandy, Utah, United States of America
| | | | | | - Elena Rochtchina
- Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Westmead, New South Wales, Australia
| | - Mark Danese
- Outcomes Insights, Inc., Westlake Village, California, United States of America
| | - Shoshana Colman
- Genentech, Inc., South San Francisco, California, United States of America
| | - Tien Y Wong
- Singapore Eye Research Institute, National University of Singapore, Singapore, Singapore; Centre for Eye Research Australia, University of Melbourne, Parkville, Victoria, Australia
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Dawson SR, Mallen CD, Gouldstone MB, Yarham R, Mansell G. The prevalence of anxiety and depression in people with age-related macular degeneration: a systematic review of observational study data. BMC Ophthalmol 2014; 14:78. [PMID: 24923726 PMCID: PMC4094542 DOI: 10.1186/1471-2415-14-78] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 06/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comorbid mental health problems have been shown to have an adverse effect on the quality of life of people with common eye disorders. This study aims to assess whether symptoms of anxiety and/or depression are more prevalent in people with age-related macular degeneration (AMD) than in people without this condition. METHODS A systematic search of electronic databases (Medline, CINAHL, EMBASE, PsycINFO) from inception to February 2012 was conducted to identify studies of AMD populations which measured symptoms of anxiety and/or depression. Reference checking of relevant articles was also performed. Data on the study setting, prevalence and how anxiety and depression were measured were extracted from the papers. Critical appraisal was performed using the Critical Appraisal Skills Programme (CASP) tools. RESULTS A total of 16 papers were included in the review, from an original search result of 597. The prevalence estimates, taken from nine cross-sectional and cohort studies, ranged from 15.7%-44% for depressive symptoms and 9.6%-30.1% for anxiety symptoms in people with AMD. The seven case-control studies found that people with AMD were more likely to experience symptoms of depression compared with those without AMD, but not more likely to experience symptoms of anxiety. CONCLUSIONS Overall, the evidence suggests that symptoms of depression are more prevalent amongst AMD populations than anxiety symptoms. The heterogeneity of the studies included in this review means that it is difficult to draw strong conclusions as to the true estimates of depression and anxiety symptoms in AMD populations and prevented formal meta-analysis. Further research which specifies clinical anxiety and gives clear definitions as to the type of AMD being investigated is required.
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Affiliation(s)
- Sarah R Dawson
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Christian D Mallen
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Matthew B Gouldstone
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Robert Yarham
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Gemma Mansell
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
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Wang X, Lamoureux E, Zheng Y, Ang M, Wong TY, Luo N. Health burden associated with visual impairment in Singapore: the Singapore epidemiology of eye disease study. Ophthalmology 2014; 121:1837-42. [PMID: 24768238 DOI: 10.1016/j.ophtha.2014.03.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/23/2014] [Accepted: 03/11/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the impact of visual impairment (VI) on health-related quality of life and to compare the health burden of VI and other health conditions in Singapore. DESIGN Population-based cross-sectional study. PARTICIPANTS We studied the 10 009 adults (3353 Chinese, 3397 Indians, and 3259 Malays) who underwent a comprehensive eye assessment and completed the European Quality of Life-5 Dimensions (EQ-5D) questionnaire in the Singapore Epidemiology of Eye Disease Study. METHODS We estimated the effects of VI, obesity, hypertension, diabetes, and hyperlipidemia on the EQ-5D index score using linear regression models and the association between VI and self-reported EQ-5D health problems using logistic regression models. We compared prevalence-based quality-adjusted life-year (QALY) loss associated with VI and other health conditions. For each condition, QALY loss was calculated for 100 000 persons in 1 year using associated reduction in EQ-5D index score estimated in regression analysis as disutility. MAIN OUTCOME MEASURES The EQ-5D index score and annual QALY loss. RESULTS The EQ-5D index score decreased with increasing VI severity in all 3 ethnicities. For example, after adjusting for sociodemographic characteristics, the difference in EQ-5D index score between adults with bilateral severe VI and those without VI was -0.044 (95% confidence interval [CI], -0.089 to 0.001) in Chinese, -0.127 (95% CI, -0.237 to -0.017) in Indians, and -0.085 (95% CI, -0.148 to -0.022) in Malays. In all 3 ethnicities, VI was associated with reporting of problems in mobility (e.g., odds ratio [OR], 3.69 for Chinese with bilateral severe VI; 95% CI, 1.21-12.13) and usual activities (e.g., OR, 6.51 for Chinese with bilateral severe VI; 95% CI, 1.59-26.58). In Indians, VI was also associated with anxiety or depression (e.g., OR, 2.68 for bilateral severe VI; 95% CI, 1.11-6.50). The annual QALY loss associated with VI was 511.8 in Chinese, 608.8 in Indians, and 706.7 in Malays, greater than that associated with other health conditions examined in this study. CONCLUSIONS Visual impairment is associated with substantial health burden among Asians in Singapore. The relatively high burden of VI highlights the importance of VI prevention. The ethnic difference exhibited in this burden warrants further study.
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Affiliation(s)
- Xingzhi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Republic of Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Republic of Singapore; Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia; Duke-NUS, Graduate Medical School, Republic of Singapore
| | - Yingfeng Zheng
- Singapore Eye Research Institute, Republic of Singapore; Department of Ophthalmology, National University of Singapore, Republic of Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Republic of Singapore
| | - Tien Yin Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Republic of Singapore; Singapore Eye Research Institute, Republic of Singapore; Department of Ophthalmology, National University of Singapore, Republic of Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Republic of Singapore.
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Dilokthornsakul P, Chaiyakunapruk N, Ruamviboonsuk P, Ratanasukon M, Ausayakhun S, Tungsomeroengwong A, Pokawattana N, Chanatittarat C. Health resource utilization and the economic burden of patients with wet age-related macular degeneration in Thailand. Int J Ophthalmol 2014; 7:145-51. [PMID: 24634881 DOI: 10.3980/j.issn.2222-3959.2014.01.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 10/14/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To determine healthcare resource utilization and the economic burden associated with wet age-related macular degeneration (AMD) in Thailand. METHODS This study included patients diagnosed with wet AMD that were 60 years old or older, and had best corrected visual acuity (BCVA) measured at least two times during the follow-up period. We excluded patients having other eye diseases. Two separate sub-studies were conducted. The first sub-study was a retrospective cohort study; electronic medical charts were reviewed to estimate the direct medical costs. The second sub-study was a cross-sectional survey estimating the direct non-medical costs based on face-to-face interviews using a structured questionnaire. For the first sub-study, direct medical costs, including the cost of drugs, laboratory, procedures, and other treatments were obtained. For the second sub-study, direct non-medical costs, e.g. transportation, food, accessories, home renovation, and caregiver costs, were obtained from face-to-face interviews with patients and/or caregivers. RESULTS For the first sub-study, sixty-four medical records were reviewed. The annual average number of medical visits was 11.1±6.0. The average direct medical costs were $3 604±4 530 per year. No statistically-significant differences of the average direct medical costs among the BCVA groups were detected (P=0.98). Drug costs accounted for 77% of total direct medical costs. For direct non-medical costs, 67 patients were included. Forty-eight patients (71.6%) required the accompaniment of a person during the out-patient visit. Seventeen patients (25.4%) required a caregiver at home. The average direct non-medical cost was $2 927±6 560 per year. There were no statistically-significant differences in the average costs among the BCVA groups (P=0.74). Care-giver cost accounted for 87% of direct non-medical costs. CONCLUSION Our study indicates that wet AMD is associated with a substantial economic burden, especially concerning drug and care-giver costs.
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Affiliation(s)
- Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand ; Discipline of Pharmacy, Monash University Malaysia, Selangor 46150, Malaysia ; School of Population Health, University of Queensland, Brisbane QLD 4072, Australia ; School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53706, USA
| | | | - Mansing Ratanasukon
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Somsanguan Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiangmai University, Chiangmai 50200, Thailand
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