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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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Relton SD, Chi GC, Lotery AJ, West RM, McKibbin M. Associations with baseline visual acuity in 12,414 eyes starting treatment for neovascular AMD. Eye (Lond) 2023; 37:1652-1658. [PMID: 36028762 PMCID: PMC10219991 DOI: 10.1038/s41433-022-02208-x] [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: 11/17/2021] [Revised: 07/17/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS To determine baseline visual acuity before the start of treatment for neovascular age-related macular degeneration (AMD), compare median and visual acuity states between treatment sites and investigate the association of socio-demographic and clinical characteristics with baseline acuity. METHODS Anonymised demographic and clinical data, collected as part of routine clinical care, were extracted from electronic medical records at treating National Health Service (NHS) Trusts. Analyses were restricted to eyes with baseline visual acuity recorded at treatment initiation. Associations with baseline acuity were investigated using multivariate linear regression. RESULTS Analysis included 12,414 eyes of 9116 patients at 13 NHS Trusts. Median baseline acuity was LogMAR 0.46 (interquartile range = 0.26-0.80) and 34.5% of eyes had good acuity, defined as LogMAR ≤0.3. Baseline acuity was positively associated with second-treated eye status, younger age, lower socio-economic deprivation, independent living, and female sex. There was little evidence of association between baseline acuity and distance to the nearest treatment centre, systemic or ocular co-morbidity. Despite case-mix adjustments, there was evidence of significant variation of baseline visual acuity between sites. CONCLUSIONS Despite access to publicly funded treatment within the NHS, variation in visual acuity at the start of neovascular AMD treatment persists. Identifying the characteristics associated with poor baseline acuity, targeted health awareness campaigns, professional education, and pathway re-design may help to improve baseline acuity, the first eye gap, and visual acuity outcomes.
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Affiliation(s)
- S D Relton
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - G C Chi
- Genentech, South San Francisco, CA, USA
| | - A J Lotery
- University Hospital Southampton NHS Foundation Trust, Leeds, UK
| | - R M West
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - M McKibbin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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A model to quantify the influence of treatment patterns and optimize outcomes in nAMD. Sci Rep 2022; 12:2789. [PMID: 35181697 PMCID: PMC8857272 DOI: 10.1038/s41598-022-06362-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/28/2022] [Indexed: 12/14/2022] Open
Abstract
Neovascular age-related macular degeneration (nAMD) is a progressive retinal disease that often leads to severe and permanent vision loss. Early initiation of anti-vascular endothelial growth factor (anti-VEGF) therapy has been shown to preserve vision in nAMD patients. Concurrently, treatment outcomes in real-world are inferior to those reported in clinical trials. The most likely reasons observed are fewer treatment-intensity in routine clinical practice than in clinical trials. The other possibility could be the delay in starting treatment and the re-treatment interval. Although a negative impact of aforementioned parameters seems obvious, quantitative impact measures remain elusive in a real-world setting due to a lack of an ‘optimal treatment’ control group. To overcome this shortcoming, we developed, validated, and applied a model to assess and quantify the impact of anti-VEGF administration variables on visual acuity development in a prospective nAMD patient cohort. The model was further applied to probe the impact of the COVID-19 pandemic on visual progressions in nAMD patients. The presented model paves the way to systematically explore and evaluate realistic interventions in the current treatment paradigm, that can be adopted in routine clinical care.
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Outer Retinal Layer Thickening Predicts the Onset of Exudative Neovascular Age-Related Macular Degeneration. Am J Ophthalmol 2021; 231:19-27. [PMID: 34058152 DOI: 10.1016/j.ajo.2021.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess changes in outer retinal layer (ORL) thickness before the development of exudative macular neovascularization (MNV) in eyes with age-related macular degeneration. DESIGN Retrospective observational case series. METHODS Eyes with age-related macular degeneration that eventually developed exudative MNV followed with sequential optical coherence tomography for ≥2 years before the exudation occurred were enrolled. The ORL thickness was automatically calculated by the optical coherence tomography software for each sector of the early treatment diabetic retinopathy study map at each follow-up visit. The ORL thickness change from baseline to the day when the exudative MNV developed was compared between sectors that eventually developed exudative MNV and those that did not. RESULTS Forty-seven eyes (47 patients) were included. At baseline (24 ± 3 months before exudative MNV), mean (standard deviation) ORL thickness of sectors that eventually developed exudative MNV was similar to that of sectors that did not (85.2 [8.2] µm vs 86.8 [5.7] µm, P = .08). ORL thickness significantly increased in sectors that developed exudative MNV compared with those that did not (+5.8 [10.4] µm vs -2.8 [3.6] µm, P < .01). The regression model based on these data predicted an increase in ORL thickness from baseline of +4.2% 55 days and +11.1% 30 days before exudative MNV was detected. The ORL thickness of areas that did not develop exudative MNV did not change. CONCLUSION Thickening of the ORL begins in the area where exudative MNV will develop long before the exudation, accelerating significantly in the last 2 months. The occurrence of exudative MNV could be predicted by 2 months using this simple analysis.
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Wahl AM, Musaeus KD, Sørensen TL, Kristiansen M. Reasons for late diagnosis of neovascular age-related macular degeneration: a mixed-methods study. Acta Ophthalmol 2021; 99:e443-e445. [PMID: 33073483 DOI: 10.1111/aos.14568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/03/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Anna M. Wahl
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences Department of Public Health Center for Healthy Aging University of Copenhagen Copenhagen Denmark
| | - Katrine D. Musaeus
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences Department of Public Health Center for Healthy Aging University of Copenhagen Copenhagen Denmark
| | - Torben L. Sørensen
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
| | - Maria Kristiansen
- Faculty of Health and Medical Sciences Department of Public Health Center for Healthy Aging University of Copenhagen Copenhagen Denmark
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Goldberg RA, Hill LF, Davis T, Ruiz CQ. Impact of Delayed Time to Treatment on Visual Outcomes in Neovascular AMD: Data From the HARBOR Study. Ophthalmic Surg Lasers Imaging Retina 2021; 52:62-69. [PMID: 33626166 DOI: 10.3928/23258160-20210201-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 11/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine the potential impact on visual outcomes of delayed treatment initiation in patients with neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS Post hoc analysis of anti-vascular endothelial growth factor treatment-naïve patients with nAMD from HARBOR. Time to treatment was defined as first ranibizumab injection date minus screening date. Comparisons were made between the prompt (≤ 6 days) versus delayed (> 10 days) treatment groups. Main outcome measures were best-corrected visual acuity (BCVA) change over time, BCVA, number of ranibizumab injections, and proportion of 3-line gainers/losers. RESULTS In HARBOR, more than 50% of patients received their first injection within 7 days of screening, with mean (median) time to treatment of 4.6 (5) and 15.9 (14) days for the prompt and delayed treatment groups, respectively. Mean (95% confidence interval [CI]) BCVA change from baseline to Month 24 was 9.1 (7.4-10.8) and 8.8 (6.7-10.8) Early Treatment Diabetic Retinopathy Study letters in the prompt (n = 395) and delayed (n = 230) treatment groups, respectively. Mean (95% CI) total number of ranibizumab injections for the as-needed arms was 12.4 (11.6-13.3) and 11.4 (10.3-12.4) for the prompt and delayed treatment groups, respectively. CONCLUSION In HARBOR, time from screening to first ranibizumab injection did not seem to significantly affect mean BCVA change or number of injections. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:62-69.].
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Mintz J, Labiste C, DiCaro MV, McElroy E, Alizadeh R, Xu K. Teleophthalmology for age-related macular degeneration during the COVID-19 pandemic and beyond. J Telemed Telecare 2020; 28:670-679. [PMID: 32990152 PMCID: PMC9444820 DOI: 10.1177/1357633x20960636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION COVID-19 has disrupted how ophthalmic practice is conducted worldwide. One patient population that may suffer from poor outcomes during the pandemic are those with age-related macular degeneration (AMD). Many practices are performing some form of teleophthalmology services for their patients, and guidance is needed on how to maintain continuity of care amongst patients with AMD using teleophthalmology. METHODS A literature search was conducted, ending 1 August 2020, to identify AMD outcomes and telecare management strategies that could be used during the COVID-19 pandemic. RESULTS 237 total articles were retrieved, 56 of which were included for analysis. Four American Academy of Ophthalmology and Center for Disease Control web resources were also included. DISCUSSION Risk-stratification models have been developed that let providers readily screen existing patients for their future risk of neovascular AMD (nAMD). When used with at-home monitoring devices to detect nAMD, providers may be able to determine who should be contacted via teleophthalmology for screening. Telemedicine triage can be used for new complaints of vision loss to determine who should be referred to a retinal specialist for management of suspected nAMD. To increase access and provider flexibility, smartphone fundus photography images sent to a centralized teleophthalmology service can aid in the detection of nAMD. Considerations should also be made for COVID-19 transmission, and teleophthalmology can be used to screen patients for the presence of COVID-19 prior to in-person office visits. Teleophthalmology has additional utility in connecting with nursing home, rural, and socioeconomically disadvantaged patients in the post-pandemic period.
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Affiliation(s)
- Joel Mintz
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Chase Labiste
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Michael V DiCaro
- College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Evan McElroy
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Reza Alizadeh
- Department of Ophthalmology, University of Arizona, Tucson, Arizona, USA
| | - Kunyong Xu
- Department of Ophthalmology, University of Arizona, Tucson, Arizona, USA
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8
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Gale RP, Mahmood S, Devonport H, Patel PJ, Ross AH, Walters G, Downey L, El-Sherbiny S, Freeman M, Berry S, Jain N. Action on neovascular age-related macular degeneration (nAMD): recommendations for management and service provision in the UK hospital eye service. Eye (Lond) 2020; 33:1-21. [PMID: 30926932 PMCID: PMC6474281 DOI: 10.1038/s41433-018-0300-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This publication and the expert roundtable meeting on which the article is based were sponsored by Bayer plc. Prescribing information for Eylea® (aflibercept solution for injection) can be found at the end of the article. This report by a group of UK retina specialists and health professionals considers best practice recommendations for the management of sight-threatening neovascular age-related macular degeneration (nAMD), based on collective experience and expertise in routine clinical practice. The authors provide an update for ophthalmologists, allied healthcare professionals and commissioners on practice principles for optimal patient care and service provision standards. Refinement of care pathways for nAMD has improved access to intravitreal anti-vascular endothelial growth factor therapy but there are still variations in care and reported outcomes between clinic centres. Innovative organisational models of service provision allow providers to better match capacity with increasing demand. The authors review the recent NICE guideline for diagnosis and management of AMD, considerations for switching therapies and stopping treatment and need for regular monitoring of non-affected fellow eyes in patients with unilateral nAMD. Actions for delivery of high-quality care and to improve long-term patient outcomes are discussed. Local pathways need to detail nAMD target time to treat, maintenance of review intervals to ensure proactive treatment regimens are delivered on time and appropriate discharge for patients deemed low risk or no longer benefiting from treatment. Actual visual acuity outcomes achieved and maintenance of the level of vision when disease stability is achieved are considered good measures for judging the quality of care in the treatment of patients with nAMD. Robust community referral pathways must be in place for suspected reactivation of choroidal neovascularisation and rapid referral for second eye involvement. Practical considerations for intravitreal injection therapy are outlined.
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Affiliation(s)
- Richard P Gale
- The Action on nAMD Group, Birmingham, UK. .,The York Hospital, York, UK.
| | - Sajjad Mahmood
- The Action on nAMD Group, Birmingham, UK.,Manchester Royal Eye Hospital, Manchester, UK
| | - Helen Devonport
- The Action on nAMD Group, Birmingham, UK.,Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Praveen J Patel
- The Action on nAMD Group, Birmingham, UK.,National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Adam H Ross
- The Action on nAMD Group, Birmingham, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Gavin Walters
- The Action on nAMD Group, Birmingham, UK.,Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Louise Downey
- The Action on nAMD Group, Birmingham, UK.,Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Samer El-Sherbiny
- The Action on nAMD Group, Birmingham, UK.,South Warwickshire NHS Foundation Trust, Warwickshire, UK
| | - Mary Freeman
- The Action on nAMD Group, Birmingham, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Simon Berry
- The Action on nAMD Group, Birmingham, UK.,Simon Berry Optometrist, Durham, UK
| | - Nitin Jain
- The Action on nAMD Group, Birmingham, UK.,Bayer, Reading, UK
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9
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Systematic review: non-adherence and non-persistence in intravitreal treatment. Graefes Arch Clin Exp Ophthalmol 2020; 258:2077-2090. [PMID: 32572607 PMCID: PMC7550304 DOI: 10.1007/s00417-020-04798-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Intravitreal injection of VEGF inhibitors has become the standard of care for different macular diseases within the last years resulting in improved visual outcomes. Under real-life conditions, however, the necessity for frequent retreatments and reexaminations poses a burden for patients and treatment centers. Non-adherence and non-persistence to intravitreal treatment may lead to inferior clinical outcomes, and knowledge of contributing factors is crucial to improve adherence. This systematic review analyzes current literature for potential factors involved in non-adherence and non-persistence. Methods A systematic search was conducted in PubMed and Embase including three different aspects of intravitreal injection therapy: (1) diseases with intravitreal injections as treatment, (2) intravitreal injection, and (3) aspects of therapy adherence or therapy persistence. Data from identified quantitative studies were further extracted and grouped according to WHO criteria (condition, socio-economy, therapy, patient, and health system). The methodological quality of identified studies was graded. Identified qualitative studies (i.e., interviews) were descriptively analyzed and their findings narratively reported. Results Twenty-four publications were included. In 16 of those publications, a quantitative data analysis was conducted, analyzing factors associated with non-adherence. Worse visual acuity at baseline and unfavorable development of visual acuity, higher age, and greater distance to the treatment center were associated with non-adherence, while there was inconsistent evidence for an association of comorbidity. In qualitative studies, high follow-up/treatment burden, fear and anxiety, disappointed patient expectations, and lack of motivation to continue treatment were reported as reasons for non-persistence. Conclusions Knowledge of potential barriers in IVT treatment may improve adherence and potentially clinical results. Improvements can be achieved particularly in the healthcare complex (organizational improvements) and the “patient” complex by establishing realistic expectations. Recurrent education of the patient may be necessary. Electronic supplementary material The online version of this article (10.1007/s00417-020-04798-2) contains supplementary material, which is available to authorized users.
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10
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Parfitt A, Boxell E, Amoaku WM, Bradley C. Patient-reported reasons for delay in diagnosis of age-related macular degeneration: a national survey. BMJ Open Ophthalmol 2019; 4:e000276. [PMID: 31750395 PMCID: PMC6830468 DOI: 10.1136/bmjophth-2019-000276] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 08/08/2019] [Accepted: 09/09/2019] [Indexed: 12/01/2022] Open
Abstract
Objectives To investigate whether people with age-related macular degeneration (AMD) are able to self-detect symptoms and, if so, what symptoms they experience, from whom they first seek help, whether help is sought within the 1 week recommended by the Royal College of Ophthalmologists’ guidelines and reasons for any delay. Methods and analysis A retrospective, cross-sectional survey design. Postal surveys were sent to 4000 members of the UK Macular Society. Inclusion criteria were participants aged >50 years at diagnosis of AMD with diagnosis after August 2008; criteria were met by 621 respondents. The main outcome was reasons for delays in diagnosis for wet AMD. Data were analysed using χ2 and conventional content analysis. Results Only one third (n=199; 32%) of respondents were able to self-detect symptoms. In line with national guidance, over half (n=131; 64%) of those self-detecting symptoms sought help promptly. For those whose initial diagnosis was delayed more than 1 week, 27% had potentially treatable wet AMD requiring urgent treatment to prevent vision loss. Reasons for delay reflected individual & service-related issues, including AMD not being detected in the initial consultation, and individuals not perceiving the urgency for symptom investigation. Conclusion In practice most patients sought help within 1 week; however, potentially sight-damaging delays occurred from symptom onset to diagnosis. Suggestions for reducing delay include increasing population awareness of AMD symptoms, the need for urgent detection and close monitoring for AMD and signposting patients to appropriate support services to ensure prompt detection of any future signs of wet AMD.
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Affiliation(s)
- Alice Parfitt
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK.,Health Psychology Research Ltd, Royal Holloway University of London, Egham, UK
| | - Emily Boxell
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK
| | - Winfried M Amoaku
- Academic Ophthalmology, University of Nottingham, Nottingham, UK.,'B' Floor Eye and ENT Centre, University Hospital, QMC, Nottingham, UK
| | - Clare Bradley
- Health Psychology Research Ltd, Royal Holloway University of London, Egham, UK
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11
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Fasler K, Fu DJ, Moraes G, Wagner S, Gokhale E, Kortuem K, Chopra R, Faes L, Preston G, Pontikos N, Patel PJ, Tufail A, Lee AY, Balaskas K, Keane PA. Moorfields AMD database report 2: fellow eye involvement with neovascular age-related macular degeneration. Br J Ophthalmol 2019; 104:684-690. [PMID: 31611234 DOI: 10.1136/bjophthalmol-2019-314446] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/18/2019] [Accepted: 08/16/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Neovascular age-related macular degeneration (nAMD) is frequently bilateral, and previous reports on 'fellow eyes' have assumed sequential treatment after a period of treatment of the first eye only. The aim of our study was to analyse baseline characteristics and visual acuity (VA) outcomes of fellow eye involvement with nAMD, specifically differentiating between sequential and non-sequential (due to macular scarring in the first eye) antivascular endothelial growth factor treatment and timelines for fellow eye involvement. METHODS Retrospective, electronic medical record database study of the Moorfields AMD database of 6265 patients/120 286 single entries with data extracted between 21 October 2008 and 9 August 2018. The data set for analysis consisted of 1180 sequential, 807 non-sequential and 3410 unilateral eyes. RESULTS Mean VA (ETDRS letters±SD) of sequentially treated fellow eyes at baseline was significantly higher (63±13), VA gain over 2 years lower (0.37±14) and proportion of eyes with good VA (≥70 letters) higher (46%) than the respective first eyes (baseline VA 54±16, VA gain at 2 years 5.6±15, percentage of eyes with good VA 39%). Non-sequential fellow eyes showed baseline characteristics and VA outcomes similar to first eyes. Fellow eye involvement rate was 32% at 2 years, and median time interval to fellow eye involvement was 71 (IQR: 27-147) weeks. CONCLUSION This report shows that sequentially treated nAMD fellow eyes have better baseline and final VA than non-sequentially treated eyes after 2 years of treatment. Sequentially treated eyes also had a greater proportion with good VA after 2 years.
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Affiliation(s)
- Katrin Fasler
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Dun Jack Fu
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gabriella Moraes
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Siegfried Wagner
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Eesha Gokhale
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Karsten Kortuem
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,University Eye Hospital, Ludwig Maximilians University, Munich, Germany
| | - Reena Chopra
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Livia Faes
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Department of Ophthalmology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Gabriella Preston
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Nikolas Pontikos
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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