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Baby B, McKinnon A, Patterson K, Patel H, Sharma R, Carter C, Griffin R, Burns C, Chang F, Guilcher SJ, Lee L, Fadaleh SA, Patel T. Tools to measure barriers to medication management capacity in older adults: a scoping review. BMC Geriatr 2024; 24:285. [PMID: 38532328 DOI: 10.1186/s12877-024-04893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Medication management capacity is a crucial component of medication adherence, particularly among older adults. Various factors, including physical abilities, cognitive functions, sensory capabilities, motivational, and environmental factors, influence older adults' ability to manage medications. It is, therefore, crucial to identify appropriate tools that allow clinicians to determine which factors may impact medication management capacity and, consequently, nonadherence to medications. PURPOSE 1)To identify tools that measure physical, cognitive, sensory (vision, hearing, touch), motivational, and environmental barriers to medication self-management in older adults, and 2) to understand the extent to which these tools assess various barriers. METHODS The scoping review was conducted using Arksey and O'Malley's scoping review framework and the PRISMA Extension for Scoping Reviews checklist. In June 2022, the relevant literature was identified by searching PubMed (MEDLINE), Ovid Embase, Ovid IPA, EBSCOhost CINAHL, APA PsycINFO, and Scopus. RESULTS AND DISCUSSION In total, 7235 studies were identified. Following the removal of duplicates, 4607 articles were screened by title and abstract, of which 4253 did not meet the inclusion criteria. Three reviewers reviewed the full texts of the remaining 354 articles; among them, 41 articles, 4 theses and 1 conference abstract met the inclusion criteria. From the included studies, 44 tools were identified that measured a combination of physical, cognitive, sensory, motivational, and environmental barriers (n=19) or only cognition (n=13), vision (n=5), environmental factors (n=3), auditory (n=1), and motivational factors (n=1). The review also examined the psychometric properties of the identified tools and found that most of them had reported validity and reliability data. Several tools have demonstrated promise in assessing a combination of barriers with validity and reliability. These tools include the Self-Medication Assessment Tool (SMAT), ManageMed Screening (MMS), Self-Medication Risk Assessment Tool (RAT), HOME-Rx revised, and Medication Management Ability Assessment (MMAA). CONCLUSION This scoping review identified 44 validated tools to measure various challenges that older adults encounter with medication management. However, no tool measures all five barriers (physical, cognitive, sensory, motivational, and environmental) to medication-taking at home. Therefore, utilizing a combination of tools would be most appropriate to measure these different aspects comprehensively. Further research is needed to develop a new comprehensive tool that simultaneously measures various barriers to medication self-management.
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Affiliation(s)
- Bincy Baby
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Hawa Patel
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Rishabh Sharma
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Caitlin Carter
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Ryan Griffin
- National Research Council Canada, Ottawa, ON, Canada
| | - Catherine Burns
- Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Feng Chang
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Sara Jt Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Sara Abu Fadaleh
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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Lu ZL, Zhao Y, Lesmes LA, Dorr M. Quantification of expected information gain in visual acuity and contrast sensitivity tests. Sci Rep 2023; 13:16795. [PMID: 37798305 PMCID: PMC10556053 DOI: 10.1038/s41598-023-43913-1] [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: 06/06/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
We make use of expected information gain to quantify the amount of knowledge obtained from measurements in a population. In the first application, we compared the expected information gain in the Snellen, ETDRS, and qVA visual acuity (VA) tests, as well as in the Pelli-Robson, CSV-1000, and qCSF contrast sensitivity (CS) tests. For the VA tests, ETDRS generated more expected information gain than Snellen. Additionally, the qVA test with 15 rows (or 45 optotypes) generated more expected information gain than ETDRS, whether scored with VA threshold alone or with both VA threshold and VA range. Regarding the CS tests, CSV-1000 generated more expected information gain than Pelli-Robson, and the qCSF test with 25 trials generated more expected information gain than CSV-1000, whether scored with AULCSF or with CSF at six spatial frequencies. The active learning-based qVA and qCSF tests have the potential to generate more expected information gain than traditional paper chart tests. Although we have specifically applied it to compare VA and CS tests, expected information gain is a general concept that can be used to compare measurements in any domain.
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Affiliation(s)
- Zhong-Lin Lu
- Division of Arts and Sciences, NYU Shanghai, Shanghai, China.
- Center for Neural Science and Department of Psychology, New York University, 4 Washington Place, New York, NY, 10003, USA.
- NYU-ECNU Institute of Brain and Cognitive Neuroscience at NYU Shanghai, Shanghai, China.
| | - Yukai Zhao
- Center for Neural Science, New York University, New York, USA
| | | | - Michael Dorr
- Adaptive Sensory Technology Inc., San Diego, CA, USA
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Hilmers J, Straßer T, Bach M, Stingl K, Zrenner E. Quantification of the Dynamic Visual Acuity Space at Real-World Luminances and Contrasts: The VA-CAL Test. Transl Vis Sci Technol 2022; 11:12. [PMID: 35420645 PMCID: PMC9034710 DOI: 10.1167/tvst.11.4.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Best-corrected visual acuity (BCVA) is assessed at a single standardized luminance with maximum optotype contrast, not reflecting the constantly changing daily-life viewing conditions. For a more realistic estimation of visual performance at varying object contrasts (Cs) and ambient luminances (ALs), we developed a new VA test, VA-CAL. Methods Landolt-C-rings between 18% and 95% Weber contrast, were presented at 1 m distance (8 Alternative Forced Choice) on a 5.7 degree field in the middle of a frosted glass screen (66 degrees), back-lit by 3060 LEDs (generating ambient luminances between 0-10,000 cd/m²). Visual acuity (VA) was measured in 14 normally sighted participants twice for 8 conditions of ambient luminance and 6 conditions of contrast using a QUEST staircase procedure. Results VA improved continuously up to an ambient luminance of 3000 to 5000 cd/m² (best mean VA ± SEM: -0.47 ± 0.03 logMAR at C = 95%, AL = 3000 cd/m²), followed by a decline of VA at higher luminances with good test-retest variability. As expected, reduced contrast leads to a lower VA (worst mean VA ± SEM: -0.03 ± 0.03 logMAR at C = 18%, AL = 0 cd/m²). A 3D plot of these data shows the VA space (VAS) extending between the contrast and luminance axes, which describes the dynamics of VA continuously changing under varying everyday life conditions. Conclusions VA-CAL, an automated device and procedure, allows for simultaneous evaluation of VA at various contrast-luminance combinations, thus providing a more comprehensive assessment of spatial vision problems not seen with standard BCVA tests. Translational Relevance The new BCVA test VA-CAL incorporates a range of everyday contrast and ambient luminance conditions for a more realistic description of visual performance.
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Affiliation(s)
- Julian Hilmers
- Institute for Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
| | - Torsten Straßer
- Institute for Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
- University Eye Hospital Tuebingen, Tuebingen, Germany
| | - Michael Bach
- Eye Center, Medical Center – Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Eberhart Zrenner
- Institute for Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
- University Eye Hospital Tuebingen, Tuebingen, Germany
- Werner Reichardt Centre for Integrative Neuroscience (CIN), Tuebingen, Germany
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Evaluating an automated machine learning model that predicts visual acuity outcomes in patients with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2022; 260:2461-2473. [PMID: 35122132 PMCID: PMC9325856 DOI: 10.1007/s00417-021-05544-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/10/2021] [Accepted: 12/27/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose Neovascular age-related macular degeneration (nAMD) is a major global cause of blindness. Whilst anti-vascular endothelial growth factor (anti-VEGF) treatment is effective, response varies considerably between individuals. Thus, patients face substantial uncertainty regarding their future ability to perform daily tasks. In this study, we evaluate the performance of an automated machine learning (AutoML) model which predicts visual acuity (VA) outcomes in patients receiving treatment for nAMD, in comparison to a manually coded model built using the same dataset. Furthermore, we evaluate model performance across ethnic groups and analyse how the models reach their predictions. Methods Binary classification models were trained to predict whether patients’ VA would be ‘Above’ or ‘Below’ a score of 70 one year after initiating treatment, measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The AutoML model was built using the Google Cloud Platform, whilst the bespoke model was trained using an XGBoost framework. Models were compared and analysed using the What-if Tool (WIT), a novel model-agnostic interpretability tool. Results Our study included 1631 eyes from patients attending Moorfields Eye Hospital. The AutoML model (area under the curve [AUC], 0.849) achieved a highly similar performance to the XGBoost model (AUC, 0.847). Using the WIT, we found that the models over-predicted negative outcomes in Asian patients and performed worse in those with an ethnic category of Other. Baseline VA, age and ethnicity were the most important determinants of model predictions. Partial dependence plot analysis revealed a sigmoidal relationship between baseline VA and the probability of an outcome of ‘Above’. Conclusion We have described and validated an AutoML-WIT pipeline which enables clinicians with minimal coding skills to match the performance of a state-of-the-art algorithm and obtain explainable predictions. Supplementary Information The online version contains supplementary material available at 10.1007/s00417-021-05544-y.
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Kauser F, Amitava AK, Saxena J, Raza SA, Masood A, Alam MS. Saving space: Comparing mini - logMAR with standard logMAR visual acuity. Indian J Ophthalmol 2021; 69:48-51. [PMID: 33323571 PMCID: PMC7926132 DOI: 10.4103/ijo.ijo_2391_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Assessing visual acuity (VA) is the cornerstone of an ophthalmic workup and needs VA charts in a four or six meters space. The objective of this study was to compare the performance of distant VA (DVA) on one meter mini-logMAR (MLM) with a standard six meter logMAR (SLM) chart. Methods: We developed a MLM chart to be used at 1 m with +1.0 D spectacles, by reducing the SLM chart designed for 6 meters, to 1/6th its size, using AutoCAD version 2014. On an initial cohort, we obtained DVA on the two charts by optometrist trainees, masked to the outcomes on the different tests. We performed regression and checked agreement between the two measurements. Subsequently, on a new cohort, we validated the performance of the MLM. Results: Of the 56 initial subjects, mean DVA with SLM was 0.44 ± 0.13 and with MLM was 0.45 ± 0.13; mean difference of -0.01 ± 0.02, 95%CI: 0.007 to 0.018; P < 0.0001 on paired t-test. There was a significant correlation: r = 0.99; r2 = 0.98, P < 0.0001. On an average, DVA with MLM was less than a letter worse than with SLM. The regression formula obtained: SLM DVA = -0.1312 + 1.0014 x (MLM DVA). The validation study revealed no significant difference (P = 0.29) between the predicted standard DVA calculated by the regression formula and the actual standard. Conclusion: We suggest that we can deduce distance logMAR VA from a mini-logMAR chart as devised and used by us. This will take less space, be portable and allow congenial interaction with patients.
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Affiliation(s)
- Farnaz Kauser
- Institute of Ophthalmology, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - Abadan K Amitava
- Institute of Ophthalmology, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - Juhi Saxena
- Institute of Ophthalmology, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - S Aisha Raza
- Institute of Ophthalmology, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - Anam Masood
- Institute of Ophthalmology, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - Md Shahid Alam
- Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
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Correlation of macular sensitivity measures and visual acuity to vision-related quality of life in patients with age-related macular degeneration. BMC Ophthalmol 2021; 21:149. [PMID: 33757447 PMCID: PMC7988949 DOI: 10.1186/s12886-021-01901-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/11/2021] [Indexed: 01/18/2023] Open
Abstract
Background Visual acuity is commonly used as a functional outcome measure in patients with age-related macular degeneration (AMD), despite having a weak correlation with self-perceived visual quality of life. Microperimetry is a useful method of detecting loss of macular function. We wanted to investigate the relationship between these two objective visual outcome measures and subjective vision-related quality of life, finding out which objective measure is more patient-relevant. Methods Fifty-one consecutive patients with AMD were recruited to the study. Participants were required to complete the Visual Function Questionnaire 39, the Early Treatment Diabetic Retinopathy Study visual acuity examination and a microperimetry assessment using the Micro Perimeter 3. One patient withdrew consent and seven patients dropped out due to cooperation difficulties under microperimetry. Forty-three patients with AMD were included in the study: twenty-eight patients with late AMD (exudative AMD) and fifteen patients with early (non-exudative) AMD. The right eye was included as standard, as was the eye with the best-corrected visual acuity. Results There was a higher correlation between vision-related quality of life and macular sensitivity (r = 0.458; p = 0.014) than between vision-related quality of life and visual acuity (r = 0.446; p = 0.018) in patients with late AMD. There was a positive correlation between vision-related quality of life and macular sensitivity in patients with early AMD (r = 0.542; p = 0.037) while the correlation between vision-related quality of life and visual acuity in these patients was not statistically significant. Composite score (r = 0.469; p = 0.012) correlated highest with the nasal outer macular sub-region and near-distance activities score (r = 0.652; p < 0.001) correlated highest with the nasal inner macular sub-region in patients with late AMD. Correlations between composite score and macular sub-regions in patients with early AMD were not significant, but near-distance activities score correlated with the nasal outer macular sub-region in these patients (r = 0.469; p = 0.012). Conclusions Macular sensitivity as measured using microperimetry correlates with vision-related quality of life in early AMD and in late AMD, showing it to be a patient-relevant outcome measure. Furthermore, the nasal sub-regions of the macula appear to be preferred retinal loci in patients with AMD. (338 words) Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01901-x.
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Tiraset N, Poonyathalang A, Padungkiatsagul T, Deeyai M, Vichitkunakorn P, Vanikieti K. Comparison of Visual Acuity Measurement Using Three Methods: Standard ETDRS Chart, Near Chart and a Smartphone-Based Eye Chart Application. Clin Ophthalmol 2021; 15:859-869. [PMID: 33664563 PMCID: PMC7924116 DOI: 10.2147/opth.s304272] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To validate the Rosenbaum near vision card (Near Chart) and a smartphone-based visual acuity (VA) test (Eye Chart) against a standard retro-illuminated Early Treatment Diabetic Retinopathy Study (ETDRS) chart within participants. Materials and Methods A cross-sectional study of participants aged ≥18 years was conducted. VA was measured in all participants using the ETDRS chart, Near Chart and smartphone-based Eye Chart application, respectively. VA was converted to logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Eyes with ETDRS VA worse than 1.0 logMAR (20/200) were excluded. The main outcome measures were levels of agreement between VA measured using the Near Chart or Eye Chart application vs the ETDRS chart. Results A total of 295 eyes of 151 participants were included. One hundred participants (66.2%) were female and the mean age was 64.3 ± 12.5 years. Educational level was high school or below for 49% of participants and at Bachelor's degree or above for 51%. The median logMAR VAs of all eyes tested using the ETDRS chart, Near Chart and Eye Chart application were 0.1, 0.0 and 0.1, respectively. The median VA difference between the Near Chart vs ETDRS chart and Eye Chart application vs ETDRS chart was 0.0 logMAR in both cases for both the right eye (OD) and left eye (OS). Intraclass correlation coefficient (ICC) demonstrated a strong positive correlation between VA tested with the Near Chart vs ETDRS chart (OD: ICC=0.85; p<0.001, OS: ICC=0.77; p<0.001) and Eye Chart application vs ETDRS chart (OD: ICC=0.88; p<0.001, OS: ICC=0.74; p<0.001). Conclusion VA measurements with the Near Chart and smartphone-based Eye Chart application corresponded well to the standard ETDRS chart, suggesting potential utility of alternative portable VA tests for in-office or remote vision monitoring, particularly during periods of physical distancing such as the Coronavirus disease 2019 (COVID-19) era.
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Affiliation(s)
- Nanida Tiraset
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anuchit Poonyathalang
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Montakarn Deeyai
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Polathep Vichitkunakorn
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kavin Vanikieti
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Lee SP, Hsu YW, Andrew L, Davis T, Johnson C. Fear of falling avoidance behavior affects the inter-relationship between vision impairment and diminished mobility in community-dwelling older adults. Physiother Theory Pract 2020; 38:686-694. [PMID: 32543314 DOI: 10.1080/09593985.2020.1780656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Age-related decline in vision may contribute to the development of fear of falling (FOF) behavior and reduced mobility, which are related to increased fall risk in older adults. PURPOSE To investigate the inter-relationship between vision impairment, physical mobility performance, and FOF behavior in community-dwelling older adults. METHODS A total of 400 participants from community centers (267 females; age = 74.8 (6.4), range = 65-97 years) participated in this cross-sectional study. Presence of age-related eye diseases (e.g. macular degeneration, cataracts, glaucoma, and retinopathy) and visual acuity (VA) was assessed. Physical mobility and FOF avoidance behavior were assessed using the Timed Up-and-Go (TUG) test and the Fear of Falling Avoidance Behavior Questionnaire (FFABQ). The inter-relationships between parameters were analyzed using mediation model analysis. RESULTS Significant decreases in mobility performance were observed in those with eye disease (eye disease = 9.56 [5.2] sec, no eye disease = 8.54 [2.75] sec; p = .037) and FOF avoidance behavior (avoiders = 12.87 [6.04] sec, non-avoiders = 8.51 [3.56] sec; p < .001). Furthermore, FOF behavior was found to significantly influence the inter-relationship between presence of eye disease and TUG performance (p = .004). VA alone had no significant effect on mobility (p = .69). CONCLUSION The presence of eye disease and the associated FOF behavior was related to decreased mobility and potentially increased fall risk. We recommend clinicians to inquire about the presence of eye disease and FOF behavior to identify risk factors related to falls in older adults.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.,Department of Physical Therapy, Asia University, Taichung, Taiwan
| | - Ya-Wen Hsu
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Lauren Andrew
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.,Synergy Physical Therapy, Henderson, NV, USA
| | - Talia Davis
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA
| | - Christian Johnson
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.,Department of Rehabilitation Services, Boulder City Hospital, Boulder City, NV, USA
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Tourbah A, Gout O, Vighetto A, Deburghgraeve V, Pelletier J, Papeix C, Lebrun-Frenay C, Labauge P, Brassat D, Toosy A, Laplaud DA, Outteryck O, Moreau T, Debouverie M, Clavelou P, Heinzlef O, De Sèze J, Defer G, Sedel F, Arndt C. MD1003 (High-Dose Pharmaceutical-Grade Biotin) for the Treatment of Chronic Visual Loss Related to Optic Neuritis in Multiple Sclerosis: A Randomized, Double-Blind, Placebo-Controlled Study. CNS Drugs 2018; 32:661-672. [PMID: 29808469 PMCID: PMC6061426 DOI: 10.1007/s40263-018-0528-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chronic visual loss is a disabling feature in patients with multiple sclerosis (MS). It was recently shown that MD1003 (high-dose pharmaceutical-grade biotin or hdPB) may improve disability in patients with progressive MS. OBJECTIVE The aim of this study was to evaluate whether MD1003 improves vision compared with placebo in MS patients with chronic visual loss. METHODS The MS-ON was a 6-month, randomized, double-blind, placebo-controlled study with a 6-month open-label extension phase. Adult patients with MS-related chronic visual loss of at least one eye [visual acuity (VA) below 0.5 decimal chart] were randomized 2:1 to oral MD1003 300 mg/day or placebo. The selected eye had to show worsening of VA within the past 3 years following either acute optic neuritis (AON) or slowly progressive optic neuropathy (PON). The primary endpoint was the mean change from baseline to month 6 in VA measured in logarithm of the minimum angle of resolution (logMAR) at 100% contrast of the selected eye. Visually evoked potentials, visual field, retinal nerve fiber layer (RNFL) thickness, and health outcomes were also assessed. RESULTS Ninety-three patients received MD1003 (n = 65) or placebo (n = 28). The study did not meet its primary endpoint, as the mean change in the primary endpoint was nonsignificantly larger (p = 0.66) with MD1003 (- 0.061 logMAR, + 3.1 letters) than with placebo (- 0.036 logMAR, + 1.8 letters). Pre-planned subgroup analyses showed that 100% contrast VA improved by a mean of + 2.8 letters (- 0.058 logMAR) with MD1003 and worsened by - 1.5 letters (+ 0.029 logMAR) with placebo (p = 0.45) in the subgroup of patients with PON. MD1003-treated patients also had nonsignificant improvement in logMAR at 5% contrast and in RNFL thickness and health outcome scores when compared with placebo-treated patients. There was no superiority of MD1003 vs placebo in patients with AON. The safety profile of MD1003 was similar to that of placebo. CONCLUSIONS MD1003 did not significantly improve VA compared with placebo in patients with MS experiencing chronic visual loss. An interesting trend favoring MD1003 was observed in the subgroup of patients with PON. Treatment was overall well tolerated. TRIAL REGISTRATION EudraCT identifier 2013-002112-27. ClinicalTrials.gov Identifier: NCT02220244 FUNDING: MedDay Pharmaceuticals.
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Affiliation(s)
- Ayman Tourbah
- Department of Neurology, Faculty of Medicine, CHU de Reims, URCA, Reims, France.
- LPN EA 2027, Université Paris 8, Saint-Denis, France.
| | - Olivier Gout
- Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Alain Vighetto
- Lyon Neuroscience Research Center (CRNL), ImpAct, INSERM U1028, CNRS, UMR5292, Lyon 1 University, Lyon, France
- Department of Neurology, Hopital Neurologigue, Hospices Civils de Lyon, Bron, France
| | | | - Jean Pelletier
- Department of Neurology, APHM, Hôpital de la Timone, Marseille, France
- UMR 7339, CRMBM, CNRS, Aix-Marseille Université, Marseille, France
| | - Caroline Papeix
- Department of Neurology, GH Pitié Salpêtrière, Paris, France
| | | | - Pierre Labauge
- Department of Neurology, CHU de Montpellier, Montpellier, France
| | - David Brassat
- INSERM U1043, Centre de Resource et de Competence SEP, Hopital Pierre Paul Riquet, Université de Toulouse, Toulouse, France
| | - Ahmed Toosy
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square Multiple Sclerosis Centre, University College London, London, UK
| | - David-Axel Laplaud
- UMR 1064, INSERM, Centre de Recherche en Transplantation et Immunologie, Université de Nantes, Nantes, France
- Service Neurologie, CHU Nantes, Nantes, France
| | - Olivier Outteryck
- Department of Neurology, CHU de Lille, University of Lille, Lille, France
| | - Thibault Moreau
- Department of Neurology, University Hospital of Dijon, Dijon, France
| | | | - Pierre Clavelou
- Department of Neurology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Heinzlef
- Department of Neurology, Centre Hospitalier de Poissy, Saint Germain, France
| | - Jérôme De Sèze
- INSERM 1434, Department of Neurology, Clinical Investigation Center, CHU de Strasbourg, Strasbourg, France
| | - Gilles Defer
- Department of Neurology, CHU de Caen, Caen, France
| | | | - Carl Arndt
- Department of Ophthalmology, Faculty of Medicine, CHU de Reims, URCA, Reims, France
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