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Ricardi F, Borrelli E, Boscia G, Gelormini F, Marica V, Conte F, Viggiano P, Marolo P, Bandello F, Reibaldi M. Relationship of Topographic Distribution of Macular Atrophy Secondary to Neovascular AMD and Reading Performance. Invest Ophthalmol Vis Sci 2024; 65:44. [PMID: 38289615 PMCID: PMC10833051 DOI: 10.1167/iovs.65.1.44] [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: 05/01/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Purpose The purpose of this study was to provide a topographical assessment of macular atrophy in successfully treated neovascular age-related macular degeneration (AMD) eyes to investigate determinants of monocular reading performance. Methods A total of 60 participants (60 eyes) with previously treated neovascular AMD and absence of optical coherence tomography (OCT) signs of exudation were enrolled. Reading performance was assessed monocularly using Radner charts. The following variables were obtained: (i) the reading acuity was defined as the logarithm of the reading acuity determination (LogRAD), at the smallest sentence, a patient is able to read in less than 30 seconds; (ii) the maximum reading speed was defined as the fastest time achieved and is calculated in words per minute (wpm). OCT images were reviewed for the presence of macular atrophy within the central, 4 inner and 4 outer Early Treatment Diabetic Retinopathy Study (ETDRS) grid subfields. Contributory factors affecting reading performance were examined using univariable and multivariable linear mixed model considering reading acuity and reading speed as dependent variables. Results Median (interquartile range [IQR]) values were 0.53 (IQR = 0.17) LogRAD for reading acuity, and 144 (60) wpm for maximum reading speed. Thirty-five out of 60 (58.3%) eyes were characterized by the presence of macular atrophy. In multiple regression analysis, reading acuity was significantly associated with presence of macular atrophy in the foveal central circle (P = 0.024). Conversely, the maximum reading speed was associated with presence of macular atrophy in the inner-right ETDRS subfield (P = 0.005). Conclusions We showed a significant relationship between presence and location of macular atrophy and reading performance in neovascular AMD.
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Affiliation(s)
- Federico Ricardi
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, “City of Health and Science” Hospital, Turin, Italy
| | - Enrico Borrelli
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, “City of Health and Science” Hospital, Turin, Italy
| | - Giacomo Boscia
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, “City of Health and Science” Hospital, Turin, Italy
| | - Francesco Gelormini
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, “City of Health and Science” Hospital, Turin, Italy
| | - Valentina Marica
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, “City of Health and Science” Hospital, Turin, Italy
| | - Fabio Conte
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, “City of Health and Science” Hospital, Turin, Italy
| | - Pasquale Viggiano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Paola Marolo
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, “City of Health and Science” Hospital, Turin, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, “City of Health and Science” Hospital, Turin, Italy
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Enoch J, Ghulakhszian A, Sekhon M, Crabb DP, Taylor DJ, Dinah C. Exploring patient acceptability of emerging intravitreal therapies for geographic atrophy: A mixed-methods study. Eye (Lond) 2023; 37:3634-3642. [PMID: 37170013 PMCID: PMC10174603 DOI: 10.1038/s41433-023-02571-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND/OBJECTIVES The acceptability of emerging intravitreal therapies for patients with Geographic Atrophy (GA) is currently unknown. This study therefore aimed to investigate the extent to which regular intravitreal injections may be acceptable to GA patients. SUBJECTS/METHODS Thirty UK-based individuals with GA secondary to age-related macular degeneration (AMD), recruited from two London-based hospitals, were interviewed in April-October 2021 regarding acceptability of new GA treatments. Participants responded to a structured questionnaire, as well as open-ended questions in a semi-structured interview. The Theoretical Framework of Acceptability (TFA) informed framework analysis of the qualitative data. RESULTS Twenty participants (67%) were female, and median (interquartile range (IQR)) age was 83 (78, 87) years. 37% of participants had foveal centre-involving GA, and better eye median (IQR) logMAR visual acuity was 0.30 (0.17, 0.58). Data suggested that 18 participants (60% (95% CI: 41-79%)) would accept the treatment, despite awareness of potential drawbacks. Eight participants (27% (95% CI: 10-43%) were ambivalent or undecided about treatment, and four (13%) (95% CI: 0-26%) would be unlikely to accept treatment. Reducing the frequency of injections from monthly to every other month increased the proportion of participants who considered the treatments acceptable. Conversely, factors limiting acceptability clustered around: the limited magnitude of treatment efficacy; concerns about side effects or the increased risk of neovascular AMD; and the logistical burden of regular clinic visits for intravitreal injections. Misunderstandings of potential benefits indicate the need for appropriately-designed patient education tools to support decision-making. CONCLUSIONS Our study suggests a majority of participants would be positive about intravitreal treatment for GA, in spite of potential burdens.
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Affiliation(s)
- Jamie Enoch
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Arevik Ghulakhszian
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK
| | - Mandeep Sekhon
- Population Health Research Institute, St George's, University of London, London, UK
| | - David P Crabb
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Deanna J Taylor
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Christiana Dinah
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK.
- Department of Brain Sciences, Imperial College, London, UK.
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Jung EH, Lindeke-Myers A, Jain N. Two-Year Outcomes After Variable Duration of Drug Cessation in Patients With Maculopathy Associated With Pentosan Polysulfate Use. JAMA Ophthalmol 2023; 141:260-266. [PMID: 36729449 PMCID: PMC9896370 DOI: 10.1001/jamaophthalmol.2022.6093] [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: 08/22/2022] [Accepted: 11/27/2022] [Indexed: 02/03/2023]
Abstract
Importance Prior retrospective studies have provided limited evidence on disease progression following drug cessation in patients with maculopathy associated with pentosan polysulfate (PPS). Objective To evaluate the 2-year evolution of maculopathy associated with PPS use after drug cessation. Design, Setting, and Participants This cohort study prospectively evaluated the natural history of patients with maculopathy associated with PPS use. Participants seen at the Emory Eye Center were enrolled between December 1, 2018, and December 1, 2019, and data were collected through November 30, 2021. Main Outcomes and Measures The main outcomes were changes in visual function and structure. Visual function was assessed annually with refraction and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), mesopic microperimetry, and dark adaptometry. Structural outcomes included presence and extent of complete retinal pigment epithelium and outer retinal atrophy (cRORA), macular central subfield thickness (CST), and subfoveal choroidal thickness (SFCT). Results Of the 12 participants (23 eyes), 11 (91.7%) were female (1 [8.3%] male), 11 (91.7%) were White (1 [8.3%] Black), and median (IQR) age at enrollment was 58 (47-64) years. Median (IQR) time from PPS discontinuation to initial visit was 0.6 (0.4-1.9) years. Median baseline ETDRS BCVA letter score was 83 (Snellen equivalent, 20/20) (IQR, 80-86.5 [20/25-20/20]), with a median 2-year change of -3 (IQR, -6 to -0.5; P = .08). Four eyes (17.4%) had a letter score decline of 15 or more, all associated with progressive cRORA. Median change in microperimetry average threshold was -3.5 dB (IQR, -4.1 to -2.5 dB; P = .001), and percent reduced threshold was 32.5% (IQR, 20.3%-52.8%; P = .004). Nine eyes (39%) had macular cRORA at baseline, with a median linearized growth rate of 0.23 mm/y (IQR, 0.22-0.25 mm/y). Two eyes (8.7%) without atrophy at baseline developed new-onset cRORA. Median baseline CST was 284 μm (IQR, 253-291 μm), with a median 2-year change of -5 μm (IQR, -13 to 0.5 μm; P = .0497). Median 2-year change in SFCT was 1 μm (IQR, -18 to 16 μm; P = .91). Conclusions and Relevance The findings of this cohort study suggest that functional and structural deficits continue to progress in PPS-associated maculopathy even after drug cessation. Additional study is needed to determine whether these findings can be generalized to other patients with PPS-associated maculopathy and whether longer follow-up could determine subsequent disease course.
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Affiliation(s)
- Emily H. Jung
- Emory University School of Medicine, Atlanta, Georgia
| | - Aaron Lindeke-Myers
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Nieraj Jain
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
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Complement Mediators in Development to Treat Age-Related Macular Degeneration. Drugs Aging 2022; 39:107-118. [PMID: 35050489 DOI: 10.1007/s40266-021-00914-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/03/2022]
Abstract
Over recent years, great attention has been paid to the role of the complement system in the pathogenesis of age-related macular degeneration (AMD). In particular, several studies have highlighted a link between AMD development and complement dysregulation, which can probably be explained as a complement cascade hyperactivation resulting from the presence of a series of risk factors such as aging; smoking; obesity; alcohol consumption; exposure to pesticides, industrial chemicals, or pollution; and other causes of oxidative stress. This hypothesis has been mainly supported by the presence of complement mediators as constituents of drusen, representing one of the earliest and most characteristic signs of retinal damage in AMD. Additionally, activated complement mediators and some complement regulators, such as vitronectin, have been found not only in the drusen and adjacent retinal areas but also in the peripheral blood of patients with AMD. Therefore, we aim to provide a review of recently studied complement factors to highlight their role in the pathogenesis of AMD and to evaluate new potential therapeutic strategies.
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Künzel SH, Lindner M, Sassen J, Möller PT, Goerdt L, Schmid M, Schmitz-Valckenberg S, Holz FG, Fleckenstein M, Pfau M. Association of Reading Performance in Geographic Atrophy Secondary to Age-Related Macular Degeneration With Visual Function and Structural Biomarkers. JAMA Ophthalmol 2021; 139:1191-1199. [PMID: 34591067 DOI: 10.1001/jamaophthalmol.2021.3826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance As a disabling and frequent disease, geographic atrophy secondary to age-related macular degeneration (AMD) constitutes an important study subject. Emerging clinical trials require suitable end points. The characterization and validation of reading performance as a functional outcome parameter is warranted. Objective To prospectively evaluate reading performance in geographic atrophy and to assess its association with established visual function assessments and structural biomarkers. Design, Setting, and Participants The noninterventional, prospective natural history Directional Spread in Geographic Atrophy study included patients with geographic atrophy secondary to AMD who were recruited at the University Hospital in Bonn, Germany. Participants were enrolled from June 2013 to June 2016. Analysis began December 2019 and ended January 2021. Main Outcomes and Measures Reading acuity and reading speed were assessed using Radner charts. Longitudinal fundus autofluorescence and infrared reflectance images were semiautomatically annotated for geographic atrophy, followed by extraction of shape-descriptive variables. Linear mixed-effects models were applied to investigate the association of those variables with reading performance. Results A total of 150 eyes of 85 participants were included in this study (median [IQR] age, 77.9 [72.4-82.1] years; 51 women [60%]; 34 men [40%]). Reading performance was impaired with a median (IQR) monocular reading acuity of 0.9 (0.4-1.3) logarithm of the reading acuity determination and a reading speed of 52.8 (0-123) words per minute. In the multivariable cross-sectional analysis, best-corrected visual acuity, area of geographic atrophy in the central Early Treatment Diabetic Retinopathy Study (ETDRS) subfield, classification of noncenter vs center-involving geographic atrophy, and area of geographic atrophy in the inner-right ETDRS subfield showed strongest associations with reading acuity (cross-validated R2for reading acuity = 0.69). Regarding reading speed, the most relevant variables were best-corrected visual acuity, low-luminance visual acuity, area of geographic atrophy in the central ETDRS subfield, in the inner-right ETDRS subfield, and in the inner-upper ETDRS subfield (R2 for reading speed = 0.67). In the longitudinal analysis, a similar prediction accuracy for reading performance was determined (R2 for reading acuity = 0.73; R2 for reading speed = 0.70). Prediction accuracy did not improve when follow-up time was added as an independent variable. Binocular reading performance did not differ from reading performance in the better-seeing eye. Conclusions and Relevance The association of reading acuity and speed with visual functional and structural biomarkers supports the validity of reading performance as a meaningful end point in clinical trials. These findings suggest that measures in clinical and low-vision care for patients with geographic atrophy should focus primarily on the better-seeing eye.
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Affiliation(s)
| | - Moritz Lindner
- Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Institute for Physiology and Pathophysiology, Department of Neurophysiology, Philipps-University Marburg, Marburg, Germany
| | - Josua Sassen
- Institute for Numerical Simulation, University of Bonn, Bonn, Germany
| | | | - Lukas Goerdt
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland
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Caswell D, Caswell W, Carlton J. Seeing Beyond Anatomy: Quality of Life with Geographic Atrophy. Ophthalmol Ther 2021; 10:367-382. [PMID: 34089491 PMCID: PMC8319273 DOI: 10.1007/s40123-021-00352-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/12/2021] [Indexed: 10/28/2022] Open
Abstract
Quality of life (QoL) is a complex idea without a clear consensus definition. Generally speaking, QoL refers to several subjective measures of wellbeing that vary by individual and circumstance. QoL can decline noticeably as a disease progresses. This is particularly true for geographic atrophy (GA), an advanced form of age-related macular degeneration. GA leads to vision loss for which there is no currently approved pharmacological treatment. There is a lack of qualitative, patient-driven research on QoL in GA. There is also limited information available to both patients and physicians about GA, existing support groups and available assistive technologies. To address this, we have collated the experiences of a person with GA and those of her partner and carer with the current literature on QoL in GA. We have also outlined some of the wide range of developing technologies available to help people with GA carry out daily tasks and hobbies. It is clear that support, whether through informal or structured care, is vital to the wellbeing of people with GA. Despite this, the general public are often unaware of care work, which may result in this integral role being undervalued and under acknowledged. Furthermore, it is apparent that the general public have fundamental misunderstandings around what vision loss entails and are unaware that blindness is a vast spectrum. This feeds into the seemingly paradoxical mix of isolation and dependence on others that often results from GA and vision loss. Through this qualitative examination of a patient's experiences, we hope to inform and educate both patients and physicians about GA as well as precipitate discussion around the frameworks that should be in place to support both newly diagnosed and long-term patients with GA and other retinal diseases. Seeing beyond anatomy: quality of life with geographic atrophy (WMV 29479 kb).
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Affiliation(s)
- Dolores Caswell
- Canadian National Institute for the Blind, Toronto, Ontario, Canada
- Patient author, Vancouver, British Columbia, Canada
| | | | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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Borkenstein AF, Borkenstein EM, Persson S, Muus G, Nielsen NV. Improving Outcomes for Patients with Age-Related Macular Degeneration and Cataracts: The Importance of Including an Assessment of Activities of Daily Life (ADL). Clin Ophthalmol 2021; 15:3333-3339. [PMID: 34408391 PMCID: PMC8364374 DOI: 10.2147/opth.s327274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/27/2021] [Indexed: 01/12/2023] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of blindness in the developing world. AMD causes a substantial burden on patients, reducing independence, their ability to conduct daily activities, and increasing rates of cognitive decline and depression. There is a significant unmet need for patients with AMD, which will grow as the population ages and rates of disease increase. In the past, many studies have demonstrated a benefit when coexisting cataract formation is treated by removing the cloudy lens. AMD-lenses are intraocular implants designed to improve visual acuity in patients with AMD, avoiding the need for cumbersome manual vision aids and magnifiers. Many IOLs have been investigated in AMD, with differing mechanisms aimed at overcoming visual impairment. Most AMD studies use Early Treatment Diabetic Retinopathy Study (ETDRS) chart-based assessments of vision, but BCVA does not correlate with lesion size or pattern, especially in geographic atrophy, and may not be the most appropriate measure to effectively assess vision defects in AMD before or after a cataract surgery. One option is a simple functional assessment of vision related to activities of daily living (ADL), based on a reproducible, task-based questionnaire. The test consists of 6 assessments of ADL to be completed by patients before and after cataract surgery. Experiences highlight the importance of including an assessment of ADL in patients receiving an implant, which gives an effective measure of patient satisfaction. We would welcome the use of similar questionnaires in larger studies of patients, to validate its utility in a broader patient population. In this review article, we (Scandinavian-Austrian-cooperation) summarize lenses designed for implantation in patients with AMD, and how best to improve outcomes through proper patient selection, appropriate vision evaluation using quality-of-life related assessment, and pre- and post-operative care.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein & Borkenstein, Private Practice at Privatklinik der Kreuzschwestern Graz, Graz, 8010, Austria
| | - Eva-Maria Borkenstein
- Borkenstein & Borkenstein, Private Practice at Privatklinik der Kreuzschwestern Graz, Graz, 8010, Austria
| | - Sara Persson
- Skånes universitetssjukhus Malmö, Malmö, 214 28, Sweden
| | - Gustav Muus
- Øjenhospitalet Danmark, Charlottenlund, 2920, Denmark
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Scholl HPN, Boyer D, Giani A, Chong V. The use of neuroprotective agents in treating geographic atrophy. Ophthalmic Res 2021; 64:888-902. [PMID: 34153966 DOI: 10.1159/000517794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/12/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - David Boyer
- Retina-Vitreous Associates Medical Group, Los Angeles, California, USA
| | - Andrea Giani
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Victor Chong
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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Semenov EP, Sheplock R, Roman AJ, McGuigan DB, Swider M, Cideciyan AV, Jacobson SG. Reading Performance in Blue Cone Monochromacy: Defining an Outcome Measure for a Clinical Trial. Transl Vis Sci Technol 2020; 9:13. [PMID: 33344057 PMCID: PMC7726588 DOI: 10.1167/tvst.9.13.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Blue cone monochromacy (BCM), a congenital X-linked retinal disease caused by mutations in the OPN1LW/OPN1MW gene cluster, is under consideration for intravitreal gene therapy. Difficulties with near vision tasks experienced by these patients prompted this study of reading performance as a potential outcome measure for a future clinical trial. Methods Clinically and molecularly diagnosed patients with BCM (n = 17; ages 15–63 years) and subjects with normal vision (n = 22; ages 18–72 years) were examined with the MNREAD acuity chart for both uniocular and binocular conditions. Parameters derived from the measurements in patients were compared with normal data and also within the group of patients. Intersession, interocular and between-subject variabilities were determined. The frequent complaint of light sensitivity in BCM was examined by comparing results from black text on a white background (regular polarity) versus white on black (reverse polarity) conditions. Results MNREAD curves of print size versus reading speed were right-shifted compared with normal in all patients with BCM. All parameters in patients with BCM indicated abnormal reading performance. Intersession variability was slightly higher in BCM than in normal, but comparable with results previously reported for other patients with maculopathies. There was a high degree of disease symmetry in reading performance in this BCM cohort. Reverse polarity showed better reading parameters than regular polarity in 82% of the patients. Conclusions MNREAD measures of reading performance in patients with BCM would be a worthy and robust secondary outcome in a clinical trial protocol, given its dual purpose of quantifying macular vision and addressing an important quality of life issue. Translational Relevance Assessment of an outcome for a clinical trial.
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Affiliation(s)
- Evelyn P Semenov
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Sheplock
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Alejandro J Roman
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - David B McGuigan
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Malgorzata Swider
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Artur V Cideciyan
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel G Jacobson
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
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Heier JS, Pieramici D, Chakravarthy U, Patel SS, Gupta S, Lotery A, Lad EM, Silverman D, Henry EC, Anderesi M, Tschosik EA, Gray S, Ferrara D, Guymer R. Visual Function Decline Resulting from Geographic Atrophy: Results from the Chroma and Spectri Phase 3 Trials. Ophthalmol Retina 2020; 4:673-688. [PMID: 32199866 DOI: 10.1016/j.oret.2020.01.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess visual function outcomes to 48 weeks in patients with bilateral geographic atrophy (GA) secondary to age-related macular degeneration included in 2 interventional clinical trials: relationship to baseline lesion size, outcomes by baseline lesion characteristic subgroups, and correlation of visual function outcomes with GA area. DESIGN The Chroma and Spectri studies (ClinicalTrials.gov identifiers, NCT02247479 and NCT02247531, respectively) were identically designed phase 3, double-masked, multicenter, randomized, sham injection-controlled clinical trials that evaluated intravitreal lampalizumab in GA. PARTICIPANTS Eligible patients were 50 years of age or older with well-demarcated bilateral GA (lesion size, 1-7 disc areas) without evidence of or previous treatment for choroidal neovascularization in either eye and best-corrected visual acuity (BCVA) letter score of 49 letters or more (≥1 GA lesion within 250 μm of foveal center if BCVA ≥79 letters). METHODS Patients (pooled n = 1881) were randomized 2:1:2:1 to lampalizumab every 4 weeks, sham every 4 weeks, lampalizumab every 6 weeks, or sham every 6 weeks. Sham arms were pooled for analysis. MAIN OUTCOME MEASURES Functional end points included change in BCVA from baseline to week 48, low-luminance visual acuity, mesopic microperimetry (number of absolute scotomatous points, mean macular sensitivity), binocular and monocular maximum reading speed, and 2 validated patient-reported outcome measures: Functional Reading Independence Index and 25-item National Eye Institute Visual Function Questionnaire. RESULTS Enlargement of GA area, approximately 2 mm2/year on average across all treatment groups in each study, was accompanied by overall deterioration in all functional end points. No statistically significant differences were found between lampalizumab or sham arms for changes from baseline in functional assessment scores. Of visual function tests, only microperimetry outcomes were correlated moderately with GA lesion area when assessed cross-sectionally at baseline and week 48. CONCLUSIONS Chroma and Spectri provide a unique data set of functional end points in GA that are relevant for future clinical trials. Patients with bilateral GA experienced a consistent decline in visual function over 48 weeks, but measures of visual function were not correlated strongly with GA lesion area. It is not possible to predict visual function outcomes from GA lesion size.
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Affiliation(s)
| | | | - Usha Chakravarthy
- Centre for Public Health, Queen's University of Belfast, Belfast, United Kingdom
| | - Sunil S Patel
- Ophthalmology Specialists of Texas, PLLC, and Integrated Clinical Research, LLC, Abilene, Texas
| | - Sunil Gupta
- Retina Specialty Institute, Pensacola, Florida
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | | | - Erin C Henry
- Genentech, Inc., South San Francisco, California
| | - Majid Anderesi
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | | | - Sarah Gray
- Genentech, Inc., South San Francisco, California
| | | | - Robyn Guymer
- Centre for Eye Research Australia, Department of Surgery, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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Kashani AH, Uang J, Mert M, Rahhal F, Chan C, Avery RL, Dugel P, Chen S, Lebkowski J, Clegg DO, Hinton DR, Humayun MS. Surgical Method for Implantation of a Biosynthetic Retinal Pigment Epithelium Monolayer for Geographic Atrophy: Experience from a Phase 1/2a Study. Ophthalmol Retina 2019; 4:264-273. [PMID: 31786135 DOI: 10.1016/j.oret.2019.09.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the intraoperative methods and anatomic results for subretinal implantation of an investigational human embryonic stem cell-derived retinal pigment epithelium (RPE) monolayer seeded on a synthetic substrate (California Project to Cure Blindness Retinal Pigment Epithelium 1 [CPCB-RPE1]) in geographic atrophy (GA). DESIGN Single-arm, open label, prospective, nonrandomized, Phase 1/2a study. PARTICIPANTS Advanced non-neovascular age-related macular degeneration (NNAMD). METHODS The worse-seeing eye (≤20/200) of each subject underwent subretinal implantation of a single 3.5×6.25 mm CPCB-RPE1 implant with a preplanned primary end point of safety and efficacy at 365 days. Commercially available 23-gauge vitrectomy equipment, custom surgical forceps, and operating microscope with or without intraoperative OCT (iOCT) were used. Exact Wilcoxon rank-sum tests and Spearman rank correlation coefficients were used to assess the association of the percentage of the GA area covered by the implant with patient and surgery characteristics. The partial Spearman correlation coefficient was calculated for the correlation between duration of surgery and baseline GA size after adjustment for surgeon experience. MAIN OUTCOME MEASURES Intraoperative exploratory measures are reported, including area of GA covered by implant, subretinal position of implant, duration of surgery, and incidence of adverse events. Operative recordings and reports were used to determine exploratory outcome measures. RESULTS Sixteen subjects were enrolled with a median age of 78 years (range, 69-85 years). Median duration of the surgery for all subjects was 160 minutes (range, 121-466 minutes). Intraoperative OCT was used to guide subretinal placement in 9 cases. Intraoperative OCT was potentially useful in identifying pathology not evident with standard intraoperative visualization. Median GA area at baseline was 13.8 mm2 (range, 6.0-46.4 mm2), and median GA area left uncovered by the implant was 1.7 mm2 (range, 0-20.4 mm2). On average, 86.9% of the baseline GA area was covered by the implant. In 5 subjects, >90% of the GA area was covered. Baseline GA size was inversely correlated with percentage of GA area covered by the implant (rs=-0.72; P = 0.002). No unanticipated serious adverse events related to the implant or surgery were reported. CONCLUSIONS Surgical implantation of CPCB-RPE1 targeted to the area of GA in subjects with advanced NNAMD is feasible in an outpatient setting. Intraoperative OCT is not necessary but potentially useful in identifying subretinal pathology and confirming implant location.
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Affiliation(s)
- Amir H Kashani
- USC Roski Eye Institute, USC Institute for Biomedical Therapeutics and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Jeremy Uang
- USC Roski Eye Institute, USC Institute for Biomedical Therapeutics and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Melissa Mert
- Southern California Clinical and Translational Science Institute, University of Southern California, Department of Preventative Medicine (Biostatistics), Los Angeles, California
| | - Firas Rahhal
- Retina-Vitreous Associates Medical Group, Beverly Hills, California
| | - Clement Chan
- Southern California Desert Retina Consultants, Palm Desert, California
| | - Robert L Avery
- California Retinal Consultants, Santa Barbara, California
| | - Pravin Dugel
- Retinal Consultants of Arizona, Phoenix, Arizona
| | | | - Jane Lebkowski
- Regenerative Patch Technologies LLC, Portola Valley, California
| | - Dennis O Clegg
- Center for Stem Cell Biology and Engineering, University of California, Santa Barbara, California
| | - David R Hinton
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mark S Humayun
- USC Roski Eye Institute, USC Institute for Biomedical Therapeutics and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Biomedical Engineering, Denney Research Center, University of Southern California, Los Angeles, California.
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