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Scheffer M, Menting J, Boeije H, van Nispen R, van Dulmen S. Understanding healthcare communication in age-related macular degeneration care: A mixed-methods review of patients' perspectives. Surv Ophthalmol 2024; 69:646-660. [PMID: 38499047 DOI: 10.1016/j.survophthal.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment among people aged 50 years and older. Earlier research has indicated that the communication process between patients and healthcare professionals (HCPs) leaves considerable room for improvement in AMD care. Effective communication is essential to enhance trust in the professional and understanding of the diagnosis and treatment, and decrease anxiety and stress related to illness. We review patients' experiences, needs and preferences regarding information provision, communication style of the HCP and shared decision-making. We conducted a systematic search in PubMed, Embase, PsycINFO, CINAHL and Web of Science. Study quality was assessed using standard checklists of quality measures. Our search returned 31 eligible articles. Findings indicated current deficits in information provision for people with AMD. Patients were often ill-informed regarding the chronic character of the condition, treatment duration, nutrition, and visual aids and low vision rehabilitation. Many patients were not actively involved during the decision-making process. Altogether, patients with AMD are faced with challenges in terms of patient-HCP communication. Methods of providing information and discussing possible options for care need to be further investigated and improved for this patient group.
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Affiliation(s)
- Mariska Scheffer
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands; Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands.
| | - Juliane Menting
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Hennie Boeije
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Ruth van Nispen
- Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands; Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Cheng BT, Kim AB, Lyon AT, Mirza RG. Disease Awareness Among Patients With Age-Related Macular Degeneration: Patterns and Predictors. JOURNAL OF VITREORETINAL DISEASES 2024; 8:58-66. [PMID: 38223766 PMCID: PMC10786073 DOI: 10.1177/24741264231210078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Purpose: To examine the prevalence and predictors of patient awareness of their disease in adults with age-related macular degeneration (AMD). Methods: This study analyzed 5553 adults 40 years or older in the 2005-2008 National Health and Nutrition Examination Survey who underwent retinal imaging. AMD was determined based on retinal images. Patient awareness of their AMD was assessed by a self-reported AMD diagnosis. Multivariable logistic regression models were constructed to examine the association of patient awareness of their AMD with sociodemographic characteristics and specific AMD lesion types on retinal imaging. Results: AMD was identified in 425 of the adults surveyed (6.5%) (95% confidence interval [CI], 5.5%-7.5%), including 87.7% (95% CI, 82.9%-92.5%) with early AMD and 12.3% (95% CI, 7.5%-17.1%) with late AMD. Among adults with either type of AMD on retinal imaging, 17.5% (95% CI, 13.1%-22.0%) were aware of their disease, which included 11.6% (95% CI, 8.4%-14.9%) with early AMD and 59.2% (95% CI, 43.1%-75.3%) with late AMD (P < .0001). In the same group, those aged 60 years or older (odds ratio [OR], 33.46; 95% CI, 7.67-146.03) and with a best-corrected visual acuity of 20/40 or worse (OR, 4.63; 95% CI, 2.95-7.26) had higher awareness of their AMD diagnosis, whereas Hispanic (OR, 0.28; 95% CI, 0.09-0.88) vs White adults and those who did not speak English at home (OR, 0.05; 95% CI, 0.01-0.41) had lower awareness of their diagnosis. Conclusions: Fewer than 1 in 5 adults with AMD were aware of their personal diagnosis, including fewer than 3 in 5 adults with late AMD. Older adults and those with worse vision were more likely to know they have AMD, whereas Hispanic adults and those who did not speak English at home were less likely. Efforts to increase patients' awareness of their AMD may improve rates of follow-up and prevent vision loss.
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Affiliation(s)
- Brian T. Cheng
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Wills Eye Hospital, Philadelphia, PA, USA
| | - Anne B. Kim
- Department of Ophthalmology, Rush University Medical College, Chicago, IL, USA
| | - Alice T. Lyon
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rukhsana G. Mirza
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Datseris I, Bouratzis N, Kotronis C, Datseris I, Tzanidaki ME, Rouvas A, Gouliopoulos N. One-year outcomes of resveratrol supplement with aflibercept versus aflibercept monotherapy in wet age-related macular degeneration. Int J Ophthalmol 2023; 16:1496-1502. [PMID: 37724273 PMCID: PMC10475632 DOI: 10.18240/ijo.2023.09.17] [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: 03/01/2023] [Accepted: 07/17/2023] [Indexed: 09/20/2023] Open
Abstract
AIM To determine the one-year outcomes of resveratrol oral supplement in patients suffering from wet age-related macular degeneration (AMD). METHODS Fifty naïve and previously untreated patients suffering from wet AMD, were randomly assigned in two subgroups of 25 patients each. All the participants were treated with 3 monthly intravitreal injections of 2.0 mg aflibercept (IAIs) followed by injections "according to need", while in one group the patients also received daily two tablets of resveratrol oral supplement. Prior to treatment initiation, a complete ophthalmological examination, including best corrected visual acuity (BCVA) and contrast sensitivity evaluation, optical coherence tomography (OCT) scans, fundus autofluorescence (FAF), fluorescein angiography, indocyanine green angiography, and OCT angiography (OCTA), was performed to every participant, while all of them completed the Hospital Anxiety and Depression Scale (HADS) questionnaire, in order to assess their quality of life (QoL) status. The patients were assessed monthly for 1y with FAF, and OCT or OCTA; the main endpoints were the number IAIs, the changes in BCVA, in contrast sensitivity, and in patients' QoL status. RESULTS No significant differences were present between the groups regarding the baseline demographic and clinical data. Over the 12-month period, a similar number of IAIs was applied in both groups (4.52±1.00 vs 4.28±0.90, P=0.38), while the rest of the clinical data also did not differ significantly after the completion of the study period. However, for HADS Depression (11.88±2.51 vs 8.28±1.54, P<0.001) and HADS Anxiety (11.92±2.52 vs 7.76±1.51, P<0.001) questionnaires values, the score was significantly better in patients who received resveratrol supplements. Moreover, a statistically significant difference was detected in the mean change from baseline values of contrast sensitivity (0.17±0.19 vs 0.35±0.24, P=0.005), HADS Depression (0.08±1.38 vs -3.88±1.48, P<0.001), and HADS Anxiety (0.36±1.98 vs -5.12±2.70, P<0.001) scores, in favour of the patients treated with resveratrol supplements. CONCLUSION The resveratrol oral supplement is a complementary treatment in cases of wet AMD, highlighting its effectiveness in improving patients' QoL status.
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Affiliation(s)
| | - Nikolaos Bouratzis
- Specialized Eye Hospital “Ophthalmiatreion” Athinon, Athens 10672, Greece
| | - Charalambos Kotronis
- 2 Department of Ophthalmology, Medical School of University of Athens, “Attikon” University Hospital, Athens 12462, Greece
| | | | | | - Alexandros Rouvas
- 2 Department of Ophthalmology, Medical School of University of Athens, “Attikon” University Hospital, Athens 12462, Greece
| | - Nikolaos Gouliopoulos
- 2 Department of Ophthalmology, Medical School of University of Athens, “Attikon” University Hospital, Athens 12462, Greece
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4
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Talks SJ, Daien V, Mitchell P, Aslam T, Barratt J, Biberger A, Lamoureux EL, Hirst C, Sylvanowicz M, Finger RP. The Patient Voice in Neovascular Age-Related Macular Degeneration: Findings from a Qualitative Study. Ophthalmol Ther 2022; 12:561-575. [PMID: 36525220 PMCID: PMC9756919 DOI: 10.1007/s40123-022-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Visual impairment resulting from diseases such as neovascular age-related macular degeneration (nAMD) may cause behavioural, environmental, psychological, and logistical challenges that could act as barriers to effective uptake and sustainability of treatment with anti-vascular endothelial growth factor agents (anti-VEGFs). Understanding emotions and experiences of patients with nAMD may help inform the determinants of adherence, and could contribute to improvements in ophthalmic outcomes and quality of life. METHODS Seventeen patients with nAMD receiving anti-VEGF injections were enrolled from three clinics: one each in France (n = 5), Germany (n = 6), and the UK (n = 6). Patients' health information and treatment characteristics were collected. Individual phone interviews were conducted by experienced health care interviewers. Transcripts were analysed thematically. RESULTS Patients (53% female) had a mean age of 77 years. Bilateral anti-VEGF injections were received by 24% (n = 4); and most (76%, n = 13) were adherent to their treatment. Patient emotions at diagnosis ranged from happiness at learning about the treatment for nAMD to being terrified of receiving an injection in the eye. Most patients mentioned feeling anxious and fearful before their first injection despite receiving reassurance. After the first injection, these feelings and apprehension abated for many, but not all. With the goal of maintaining the best possible vision, few (24%, n = 4) patients reported more than one missed appointment, and most had never considered stopping treatment. No patient reported additional assistance beyond family support; however, many had difficulties with recreational and domestic activities and had developed coping strategies. CONCLUSION This study provides insights on patients' emotions related to their experience of nAMD and its management, highlighting the varying experiences between individuals. It shows the importance of the patient's voice when considering patient care and management, and how the nature and timing of interventions can improve the experience of living with and managing nAMD.
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Affiliation(s)
- S. James Talks
- grid.420004.20000 0004 0444 2244Newcastle Eye Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vincent Daien
- grid.157868.50000 0000 9961 060XDepartment of Ophthalmology, University Hospital of Montpellier, Montpellier, France
| | - Paul Mitchell
- grid.1013.30000 0004 1936 834XUniversity of Sydney (Westmead Institute for Medical Research), Sydney, NSW Australia
| | - Tariq Aslam
- grid.416375.20000 0004 0641 2866Manchester Royal Eye Hospital, Manchester, UK ,grid.5379.80000000121662407University of Manchester, Manchester, UK
| | - Jane Barratt
- grid.511577.00000 0001 0942 4326International Federation on Ageing, Toronto, ON Canada
| | | | - Ecosse L. Lamoureux
- grid.272555.20000 0001 0706 4670Singapore Eye Research Institute, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Singapore, Singapore
| | - Ceri Hirst
- grid.483721.b0000 0004 0519 4932Bayer Consumer Care AG, Basel, Switzerland
| | | | - Robert P. Finger
- grid.10388.320000 0001 2240 3300Department of Ophthalmology, University of Bonn, Bonn, Germany
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Gori M, Bertonati G, Mazzoni E, Freddi E, Amadeo MB. The impact of COVID-19 on the everyday life of blind and sighted individuals. Front Psychol 2022; 13:897098. [PMID: 36389583 PMCID: PMC9650307 DOI: 10.3389/fpsyg.2022.897098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/27/2022] [Indexed: 12/01/2022] Open
Abstract
The COVID-19 pandemic caused unexpected and unavoidable changes in daily life worldwide. Governments and communities found ways to mitigate the impact of these changes, but many solutions were inaccessible to people with visual impairments. This work aimed to investigate how blind individuals subjectively experienced the restrictions and isolation caused by the COVID-19 pandemic. To this end, a group of twenty-seven blind and seventeen sighted people took part in a survey addressing how COVID-19 impacted life practically and psychologically, how it affected their daily habits, and how it changed their experiences of themselves and others. Results demonstrated that both sighted and blind individuals had a hard time adapting to the new situation. However, while sighted people struggled more with personal and social aspects, the frustration of the blind population derived mostly from more practical and logistical issues. Likely as consequences, results showed that blind people engaged more in their inner life and experienced fear and anger as main emotions. This study suggests that changes in life associated with COVID-19 have been subjectively experienced differently based on the presence or not of blindness, and that tailored future interventions should be considered to take care of the different needs of blind individuals.
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Affiliation(s)
- Monica Gori
- Unit for Visually Impaired People, Italian Institute of Technology, Genova, Italy
| | - Giorgia Bertonati
- Unit for Visually Impaired People, Italian Institute of Technology, Genova, Italy
- DIBRIS, Università degli studi di Genova, Genova, Italy
- *Correspondence: Giorgia Bertonati,
| | - Emanuela Mazzoni
- Unit for Visually Impaired People, Italian Institute of Technology, Genova, Italy
- PREPOS Studio Associato, Lucca, Italy
| | - Elisa Freddi
- Unit for Visually Impaired People, Italian Institute of Technology, Genova, Italy
| | - Maria Bianca Amadeo
- Unit for Visually Impaired People, Italian Institute of Technology, Genova, Italy
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Fonteh CN, Mathias MT, Mandava N, Manoharan N, Lynch AM, Navo R, Patnaik JL. Mental health and visual acuity in patients with age-related macular degeneration. BMC Ophthalmol 2022; 22:391. [PMID: 36183081 PMCID: PMC9526530 DOI: 10.1186/s12886-022-02602-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Visual acuity (VA) loss has been associated with depression in patients with age-related macular degeneration (AMD). However, previous studies did not incorporate subgroups of AMD when correlating VA and mental health. The goal of this study was to describe the relationship between VA and mental health questions in patients with different classifications of AMD, and to identify associations of mental health subscale scores. METHODS AMD patients classified by multi-modal imaging were recruited into an AMD registry. Habitual VA was obtained by ophthalmic technicians using the Snellen VA at distance. At enrollment, patients completed the NEI-VFQ-25, which includes 25 questions regarding the patient's visual functionality. Median with interquartile-range (IQR) scores on the mental health subscale of the VFQ were calculated by AMD classification and VA groups. Univariate and multivariable general linear models were used to estimate associations between mental health scores and variables of interest. RESULTS Eight hundred seventy-five patients were included in the study. Patients with bilateral geographic atrophy (GA) or bilateral GA and neovascular (NV) AMD scored lowest on the mental health subscales with a median (IQR) of 58.2 (38-88) and 59.3 (38-88). When stratified by VA, patients with a habitual VA of 20/200 or worse scored the lowest on mental health subscales scores: median of 43.8 (IQR: 31-62). Patients with a VA of 20/20 scored the highest: 87.5 (IQR: 81-94). Habitual VA of the better- and worse-seeing eye and AMD classification were significantly associated with mental health subscale scores (all p < 0.0001 in both the univariate and multivariable analysis, except the VA of the worse-seeing eye in multivariable model p = 0.027). Patients enrolled during the COVID pandemic had mental health scores that were 2.7 points lower than prior to the pandemic, but this difference was not significant in univariate (p = 0.300) or multivariable analysis (p = 0.202). CONCLUSION There is a significant association between mental health questionnaire scores and AMD classification, as well as VA in both the better and worse-seeing eyes in patients with AMD. It is important for clinicians to recognize feelings of worry/ frustration in these patients, so they can be appropriately referred, screened, and treated for mental health problems.
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Affiliation(s)
- Cheryl N. Fonteh
- grid.430503.10000 0001 0703 675XDepartment of Ophthalmology, University of Colorado School of Medicine, Aurora, CO USA ,grid.430503.10000 0001 0703 675XDivision of Ophthalmic Epidemiology, Department of Ophthalmology, University of Colorado School of Medicine, Mail Stop F731, 1675 Aurora Court, Aurora, CO 80045 USA
| | - Marc T. Mathias
- grid.430503.10000 0001 0703 675XDepartment of Ophthalmology, University of Colorado School of Medicine, Aurora, CO USA
| | - Naresh Mandava
- grid.430503.10000 0001 0703 675XDepartment of Ophthalmology, University of Colorado School of Medicine, Aurora, CO USA
| | - Niranjan Manoharan
- grid.430503.10000 0001 0703 675XDepartment of Ophthalmology, University of Colorado School of Medicine, Aurora, CO USA
| | - Anne M. Lynch
- grid.430503.10000 0001 0703 675XDepartment of Ophthalmology, University of Colorado School of Medicine, Aurora, CO USA
| | - Roxanne Navo
- grid.430503.10000 0001 0703 675XDepartment of Ophthalmology, University of Colorado School of Medicine, Aurora, CO USA
| | - Jennifer L. Patnaik
- grid.430503.10000 0001 0703 675XDepartment of Ophthalmology, University of Colorado School of Medicine, Aurora, CO USA
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Intérêt du dépistage systématique des affects dépressifs et du syndrome de Charles–Bonnet chez les patients atteints de DMLA. J Fr Ophtalmol 2022; 45:1069-1078. [DOI: 10.1016/j.jfo.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
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Gastaldello A, Giampieri F, Quiles JL, Navarro-Hortal MD, Aparicio S, García Villena E, Tutusaus Pifarre K, De Giuseppe R, Grosso G, Cianciosi D, Forbes-Hernández TY, Nabavi SM, Battino M. Adherence to the Mediterranean-Style Eating Pattern and Macular Degeneration: A Systematic Review of Observational Studies. Nutrients 2022; 14:nu14102028. [PMID: 35631175 PMCID: PMC9144566 DOI: 10.3390/nu14102028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/01/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Age-related macular degeneration (AMD) is a serious degenerative disease affecting the eyes, and is the main cause of severe vision loss among people >55 years of age in developed countries. Its onset and progression have been associated with several genetic and lifestyle factors, with diet appearing to play a pivotal role in the latter. In particular, dietary eating patterns rich in plant foods have been shown to lower the risk of developing the disease, and to decrease the odds of progressing to more advanced stages in individuals already burdened with early AMD. We systematically reviewed the literature to analyse the relationship between the adherence to a Mediterranean diet, a mainly plant-based dietary pattern, and the onset/progression of AMD. Eight human observational studies were analysed. Despite some differences, they consistently indicate that higher adherence to a Mediterranean eating pattern lowers the odds of developing AMD and decreases the risk of progression to more advanced stages of the disease, establishing the way for preventative measures emphasizing dietary patterns rich in plant-foods.
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Affiliation(s)
- Annalisa Gastaldello
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
| | - Francesca Giampieri
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 80200, Saudi Arabia
- Correspondence: (F.G.); (M.B.)
| | - José L. Quiles
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Department of Physiology, Institute of Nutrition and Food Technology “José Mataix”, Biomedical Research Centre, University of Granada, 18100 Granada, Spain; (M.D.N.-H.); (T.Y.F.-H.)
| | - María D. Navarro-Hortal
- Department of Physiology, Institute of Nutrition and Food Technology “José Mataix”, Biomedical Research Centre, University of Granada, 18100 Granada, Spain; (M.D.N.-H.); (T.Y.F.-H.)
| | - Silvia Aparicio
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Faculdade de Ciências Sociais e Humanas, Universidade Internacional do Cuanza Bairro Kaluanda, Cuito EN 250, Bié, Angola
| | - Eduardo García Villena
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Department de Salud, Universidad Internacional Iberoamericana Campeche, Campeche 24560, Mexico
| | - Kilian Tutusaus Pifarre
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Department de Salud, Universidad Internacional Iberoamericana Campeche, Campeche 24560, Mexico
| | - Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Giuseppe Grosso
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy;
| | - Danila Cianciosi
- Department of Clinical Sciences, Polytechnic University of Marche, 60131 Ancona, Italy;
| | - Tamara Y. Forbes-Hernández
- Department of Physiology, Institute of Nutrition and Food Technology “José Mataix”, Biomedical Research Centre, University of Granada, 18100 Granada, Spain; (M.D.N.-H.); (T.Y.F.-H.)
| | - Seyed M. Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran 1435916471, Iran;
| | - Maurizio Battino
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.G.); (J.L.Q.); (S.A.); (E.G.V.); (K.T.P.)
- Department of Clinical Sciences, Polytechnic University of Marche, 60131 Ancona, Italy;
- International Joint Research Laboratory of Intelligent Agriculture and Agri-Products Processing, Jiangsu University, Zhenjiang 212013, China
- Correspondence: (F.G.); (M.B.)
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Lundeen EA, Saydah S, Ehrlich JR, Saaddine J. Self-Reported Vision Impairment and Psychological Distress in U.S. Adults. Ophthalmic Epidemiol 2022; 29:171-181. [PMID: 33896341 PMCID: PMC10949979 DOI: 10.1080/09286586.2021.1918177] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Examine the relationship between vision impairment and psychological distress in adults ≥18 years. METHODS Using the 2016-2017 cross-sectional, U.S. National Health Interview Survey, we analyzed self-reported data (n = 57,644) on: Kessler psychological distress scores; general vision impairment (GVI), defined as difficulty seeing even when wearing glasses or contacts; and visual function impairment (VFI), measured using six visual function questions. Multinomial logistic regression was used to estimate adjusted odds ratios (aOR) for mild/moderate and serious psychological distress, by GVI and VFI status, and identify predictors of psychological distress among those with GVI or VFI. RESULTS Among adults, 10.6% (95% CI: 10.2, 11.0) had GVI; 11.6% (CI: 11.1, 12.0) had VFI. One in four adults with GVI had psychological distress (14.9% [CI: 13.8, 16.0] reported mild/moderate and 11.2% [CI: 10.2, 12.3] reported serious). Individuals with GVI, versus those without, had higher odds of mild/moderate (aOR = 2.24; CI: 2.00, 2.52) and serious (aOR = 3.41; CI: 2.96, 3.93) psychological distress; VFI had similar findings. Among adults with GVI, odds of serious psychological distress were higher for those aged 18-39 (aOR = 4.46; CI: 2.89, 6.90) or 40-64 (aOR = 6.09; CI: 4.33, 8.57) versus ≥65 years; smokers (aOR = 2.45; CI: 1.88, 3.18) versus non-smokers; physically inactive (aOR = 1.61; CI: 1.22, 2.11) versus active; and with arthritis (aOR = 2.18; CI: 1.66, 2.87) or chronic obstructive pulmonary disease (aOR = 1.65; CI: 1.15, 2.37) versus without. CONCLUSION Adults with self-reported vision impairment had higher odds of psychological distress. These findings may inform screening interventions to address psychological distress, particularly among younger working-age adults vision impairment.
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Affiliation(s)
- Elizabeth A Lundeen
- Division of Diabetes Translation (DDT, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sharon Saydah
- Division of Diabetes Translation (DDT, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, USA
| | - Jinan Saaddine
- Division of Diabetes Translation (DDT, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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10
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Association of Visual Impairment with Psychological Distress in Older Adults: A Survey of 105,092 Older People in Taiwan. J Clin Med 2022; 11:jcm11051458. [PMID: 35268549 PMCID: PMC8911337 DOI: 10.3390/jcm11051458] [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: 01/14/2022] [Revised: 02/21/2022] [Accepted: 03/05/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate the association between visual impairment (VI) and psychological distress (PD) among older adults in Taiwan. The present cohort study included participants aged >65 years who participated in a physical examination program. Participants were divided into two groups on the basis of whether they had PD at baseline. The association between PD and VI with other variables was compared using the two-sample t-test for continuous variables and chi-squared test for discrete variables. Cox regression analyses were used to calculate the hazard ratio (HR). Cumulative incidence of PD was analyzed using the Kaplan-Meier method, and differences among participants with different severities of VI were analyzed using the two-tailed log-rank test. Subgroup analyses were performed to calculate the HR for PD among participants with different severities of VI. The PD group showed a significantly high percentage of VI. In addition, participants with VI showed a significantly higher HR and seven-year cumulative incidence rate of PD than those without VI. VI was independently and significantly associated with a higher incidence of PD among older Asian people. Therefore, identifying and treating correctible VI is important to prevent PD and improve the overall quality of life.
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Ulhaq ZS, Soraya GV, Dewi NA, Wulandari LR. The prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Ther Adv Ophthalmol 2022; 14:25158414221090100. [PMID: 35464342 PMCID: PMC9021519 DOI: 10.1177/25158414221090100] [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: 01/04/2021] [Accepted: 03/09/2022] [Indexed: 12/26/2022] Open
Abstract
Background: Progressive and irreversible vision loss has been shown to place a patient at risk of mental health problems such as anxiety. However, the reported prevalence of anxiety symptoms and disorders among eye disease patients vary across studies. Thus, this study aims to clarify the estimated prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Methods: Relevant studies on the prevalence of anxiety symptoms and disorders among eye disease patients were collected through international databases, PubMed, Scopus, and Web of Science. A random-effects model was used to determine the pooled prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Results: The 95 included studies yielded a pooled prevalence of 31.2% patients with anxiety symptoms and 19.0% with anxiety disorders among subjects with ophthalmic disease. Pediatric patients were more anxious (58.6%) than adults (29%). Anxiety symptoms were most prevalent in uveitis (53.5%), followed by dry eye disease (DED, 37.2%), retinitis pigmentosa (RP, 36.5%), diabetic retinopathy (DR, 31.3%), glaucoma (30.7%), myopia (24.7%), age-related macular degeneration (AMD, 21.6%), and cataract (21.2%) patients. Anxiety disorders were most prevalent in thyroid eye disease (TED, 28.9%), followed by glaucoma (22.2%) and DED (11.4%). When compared with healthy controls, there was a twofold increase on the prevalence of anxiety symptoms (OR = 1.912, 95% CI 1.463–2.5, p < 0.001) and anxiety disorders (OR = 2.281, 95% CI 1.168–4.454, p = 0.016). Conclusion: Anxiety symptoms and disorders are common problems associated with ophthalmic disease patients. Thus, comprehensive and appropriate treatments are necessary for treating anxiety symptoms and disorders among ophthalmic disease patients.
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Affiliation(s)
- Zulvikar Syambani Ulhaq
- Research Center for Pre-Clinical and Clinical Medicine, National Research and Innovation Agency Republic of Indonesia, Cibinong, Indonesia
| | - Gita Vita Soraya
- Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Nadia Artha Dewi
- Department of Ophthalmology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Lely Retno Wulandari
- Department of Ophthalmology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
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12
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Skelly A, Taylor N, Fasser C, Malkowski JP, Goswami P, Downey L. Patient Preferences in the Management of Wet Age-Related Macular Degeneration: A Conjoint Analysis. Adv Ther 2022; 39:4808-4820. [PMID: 35995894 PMCID: PMC9464751 DOI: 10.1007/s12325-022-02248-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/28/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION To identify patient preference drivers related to the management of wet age-related macular degeneration (wet AMD). METHODS In this cross-sectional study, a self-explicated 'conjoint analysis' survey was administered online to eligible patients with wet AMD (receiving anti-vascular endothelial growth factor [VEGF] treatment for at least 12 months) from the USA, Canada, UK, France, Spain, Germany, Italy, Japan, Taiwan, and Australia. The survey consisted of six domains with 21 attributes, which were selected on the basis of a literature review, social media listening, and tele-interviews/discussions with patients, clinical experts, and patient groups. Utility and relative importance scores were generated for each attribute and utility difference significance testing was performed using 'unequal variances t tests'. The Patient Activation Measure (PAM-13) questionnaire was administered to assess patients' knowledge, skill, and confidence in self-management. RESULTS A total of 466 patients (mean age, 68 years; women, 54%; binocular wet AMD, 28%) with an average anti-VEGF treatment duration of 3.9 years completed the survey. The most important preference domains were 'treatment effects on vision' (non-significant) and 'vision-related symptom burdens' (p < 0.001), followed by 'treatment risk' (p < 0.05), 'impact on daily activities' (p < 0.05), 'burden of clinic/hospital visits' (p < 0.001), and 'impact on psychological well-being'. The five most important attributes in order of importance were clarity of vision, treatment effect on symptoms, quality of vision, time to treatment effect, and time to re-administration. The two most important attributes globally were also in the top three attributes across countries. The majority of participants in the study were level 3 or level 4 of the PAM-13 questionnaire. CONCLUSIONS This study identified the most important disease and treatment attributes to patients using patient-centred methods. The data showed the degree of harmonization of preferences across geographies and that participants actively adopt behaviours required for improved treatment outcomes. The identified preference drivers may inform future clinical development.
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13
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Aninye IO, Digre K, Hartnett ME, Baldonado K, Shriver EM, Periman LM, Grutzmacher J, Clayton JA. The roles of sex and gender in women's eye health disparities in the United States. Biol Sex Differ 2021; 12:57. [PMID: 34670620 PMCID: PMC8527306 DOI: 10.1186/s13293-021-00401-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/08/2021] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND In the United States, women are at a higher risk of developing vision impairment or a serious eye disease (such as age-related macular degeneration, thyroid eye disease, or chronic dry eye disease) than men. Disparities in eye diseases due to biology widen even further when considering factors such as social determinants of health; gaps in research data, literature, and policy; insufficient provider and patient education; and limitations in screening and treatment options. Sex and gender disparities in eye health are clinically under-addressed and burdensome on both patient quality of life and the health care and economic systems, resulting in a pressing population health issue that negatively impacts women. DESIGN The Society for Women's Health Research convened a working group of expert clinicians, researchers, and patient advocates to review the current state of science regarding sex and gender disparities in women's eye health, identify knowledge gaps and unmet needs, and explore better means to advance research, improve patient care, and raise awareness of key issues. DISCUSSION The SWHR Women's Eye Health Working Group identified priority areas in research, clinical care, and education to reduce disparities and improve patient care in women's eye health. The working group recommends using a systems approach that incorporates a comprehensive research framework with a sex and gender lens to guide future work and that increases health care provider and public education, as well as engagement by expanding partnerships among ophthalmologic providers, researchers, and non-vision stakeholders.
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Affiliation(s)
- Irene O Aninye
- Society for Women's Health Research, 1025 Connecticut Avenue, NW, Suite 1104, Washington, DC, 20036, USA.
| | - Kathleen Digre
- Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | | | | | - Erin M Shriver
- Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | | | | | - Janine A Clayton
- Office of Research on Women's Health, National Institute of Health, Bethesda, MD, USA
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14
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Macnamara A, Chen C, Schinazi VR, Saredakis D, Loetscher T. Simulating Macular Degeneration to Investigate Activities of Daily Living: A Systematic Review. Front Neurosci 2021; 15:663062. [PMID: 34483815 PMCID: PMC8414246 DOI: 10.3389/fnins.2021.663062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Investigating difficulties during activities of daily living is a fundamental first step for the development of vision-related intervention and rehabilitation strategies. One way to do this is through visual impairment simulations. The aim of this review is to synthesize and assess the types of simulation methods that have been used to simulate age-related macular degeneration (AMD) in normally sighted participants, during activities of daily living (e.g., reading, cleaning, and cooking). Methods: We conducted a systematic literature search in five databases and a critical analysis of the advantages and disadvantages of various AMD simulation methods (following PRISMA guidelines). The review focuses on the suitability of each method for investigating activities of daily living, an assessment of clinical validation procedures, and an evaluation of the adaptation periods for participants. Results: Nineteen studies met the criteria for inclusion. Contact lenses, computer manipulations, gaze contingent displays, and simulation glasses were the main forms of AMD simulation identified. The use of validation and adaptation procedures were reported in approximately two-thirds and half of studies, respectively. Conclusions: Synthesis of the methodology demonstrated that the choice of simulation has been, and should continue to be, guided by the nature of the study. While simulations may never completely replicate vision loss experienced during AMD, consistency in simulation methodology is critical for generating realistic behavioral responses under vision impairment simulation and limiting the influence of confounding factors. Researchers could also come to a consensus regarding the length and form of adaptation by exploring what is an adequate amount of time and type of training required to acclimatize participants to vision impairment simulations.
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Affiliation(s)
- Anne Macnamara
- Cognitive Ageing and Impairment Neurosciences Laboratory, UniSA Justice & Society, University of South Australia, Adelaide, SA, Australia
| | - Celia Chen
- College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Victor R Schinazi
- Department of Psychology, Faculty of Society & Design, Bond University, Gold Coast, QLD, Australia.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Dimitrios Saredakis
- Cognitive Ageing and Impairment Neurosciences Laboratory, UniSA Justice & Society, University of South Australia, Adelaide, SA, Australia
| | - Tobias Loetscher
- Cognitive Ageing and Impairment Neurosciences Laboratory, UniSA Justice & Society, University of South Australia, Adelaide, SA, Australia
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15
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Lee HC, Nam H, Kang D, Yeom MI. Depression, Anxiety, Somatization Disorder, and Adjustment Disorder in Older Patients with Exudative Age-related Macular Degeneration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.8.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: The aim of this study was to analyze the prevalence of depression, anxiety, somatization disorder, and adjustment disorder in older patients diagnosed with exudative age-related macular degeneration (AMD) and to evaluate the relationship between exudative AMD and psychological disease.Methods: The 2016 Health Insurance Review and Assessment Service-Aged Patient Sample was applied in this study. The subjects were divided into two groups: AMD patients undergoing intravitreal injection treatment and a control group. Comorbidities were evaluated using the Charlson Comorbidity Index.Results: A total of 1,319,052 subjects were selected, of which 3,134 were in the exudative AMD group receiving intravitreal injections. The average age of the subjects was 74.7 ± 6.7 years, and 41.8% were male. In patients with exudative AMD, the prevalence of depression, anxiety, somatization disorder, and adjustment disorder were 16%, 20%, 0.5%, and 0.4%, respectively; in particular, the prevalence of depression and adjustment disorder were significantly higher than in the control group. In multivariate regression analysis, exudative AMD was a significant factor of depression (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.08-1.31, p < 0.001) and adjustment disorder (OR 2.47, 95% CI 1.47-4.18, p < 0.001). However, the association between AMD and anxiety or somatization disorder was not statistically significant.Conclusions: Exudative AMD showed a significant association with psychiatric disease, such as depression, and requires close clinical attention.
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16
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Wettstein M, Wahl HW, Heyl V. Perceived Stress Predicts Subsequent Self-Reported Problems With Vision and Hearing: Longitudinal Findings From the German Ageing Survey. Res Aging 2021; 44:286-300. [PMID: 34169758 PMCID: PMC8948369 DOI: 10.1177/01640275211027304] [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] [Indexed: 11/17/2022]
Abstract
Although stress is a risk factor for various diseases in later life, its role for sensory abilities in the second half of life has rarely been empirically addressed. We examined if perceived stress at baseline predicts self-reported difficulties with vision and hearing 3 years later. We also explored whether chronological age is a moderator of associations between stress and sensory difficulties. Our sample was derived from the German Ageing Survey and consisted of n = 5,085 individuals aged 40-95 years (M = 64.01 years, SD = 10.84 years). Controlling for baseline self-reported sensory functioning, socio-demographic indicators, self-rated health and chronic diseases, greater perceived stress at baseline predicted greater self-reported difficulties with vision and hearing 3 years later. The effect of stress did not vary by age. Our findings suggest that, from middle adulthood to advanced old age, stress is a risk factor for increases in self-perceived problems with vision and hearing.
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Affiliation(s)
- Markus Wettstein
- German Centre of Gerontology, Berlin, Germany.,Heidelberg University, Germany
| | | | - Vera Heyl
- University of Education, Heidelberg, Germany
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17
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Fleckenstein M, Keenan TDL, Guymer RH, Chakravarthy U, Schmitz-Valckenberg S, Klaver CC, Wong WT, Chew EY. Age-related macular degeneration. Nat Rev Dis Primers 2021; 7:31. [PMID: 33958600 DOI: 10.1038/s41572-021-00265-2] [Citation(s) in RCA: 334] [Impact Index Per Article: 111.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
Age-related macular degeneration (AMD) is the leading cause of legal blindness in the industrialized world. AMD is characterized by accumulation of extracellular deposits, namely drusen, along with progressive degeneration of photoreceptors and adjacent tissues. AMD is a multifactorial disease encompassing a complex interplay between ageing, environmental risk factors and genetic susceptibility. Chronic inflammation, lipid deposition, oxidative stress and impaired extracellular matrix maintenance are strongly implicated in AMD pathogenesis. However, the exact interactions of pathophysiological events that culminate in drusen formation and the associated degeneration processes remain to be elucidated. Despite tremendous advances in clinical care and in unravelling pathophysiological mechanisms, the unmet medical need related to AMD remains substantial. Although there have been major breakthroughs in the treatment of exudative AMD, no efficacious treatment is yet available to prevent progressive irreversible photoreceptor degeneration, which leads to central vision loss. Compelling progress in high-resolution retinal imaging has enabled refined phenotyping of AMD in vivo. These insights, in combination with clinicopathological and genetic correlations, have underscored the heterogeneity of AMD. Hence, our current understanding promotes the view that AMD represents a disease spectrum comprising distinct phenotypes with different mechanisms of pathogenesis. Hence, tailoring therapeutics to specific phenotypes and stages may, in the future, be the key to preventing irreversible vision loss.
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Affiliation(s)
- Monika Fleckenstein
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.
| | - Tiarnán D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, VIC, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - Usha Chakravarthy
- Department of Ophthalmology, Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Caroline C Klaver
- Department of Ophthalmology, Erasmus MC, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands.,Department of Ophthalmology, Radboud Medical Center, Nijmegen, Netherlands.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Wai T Wong
- Section on Neuron-Glia Interactions in Retinal Disease, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
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18
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Naufal F, Gajwani P, Medina R, Dutson M, Mariotti SP, West SK. Knowledge of patient emotional health status: impact on clinical care in glaucoma and retinal services. BMJ Open Ophthalmol 2021; 6:e000640. [PMID: 33981855 PMCID: PMC8061815 DOI: 10.1136/bmjophth-2020-000640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/08/2021] [Accepted: 03/31/2021] [Indexed: 11/04/2022] Open
Abstract
Objective Knowledge of a patient’s emotional health status and using patient-centred communication may be key to providing early intervention and referral to appropriate treatment/support services for ophthalmology patients. This study aims to determine if and how ophthalmologists use anxiety and depression scores to determine clinical care of patients with chronic eye disease. Methods and analysis This cross-sectional study included 10 ophthalmologists and a convenience sample of 100 of their patients (>18 years). The Patient Health Questionnaire (PHQ-9) for depression and the Generalised Anxiety Disorder (GAD-7) tool were administered to patients. Scores from these instruments were provided to ophthalmologists just prior to the clinic visit. After the visit, ophthalmologists were given a questionnaire to assess self-reported change in clinical practice and whether knowledge of scores impacted their communication style, treatment plan and follow-up protocol. Results Of these patients (mean age=63), 27% reported mild-moderate anxiety or depression as their worst score, while 2% reported suicidal thoughts; 20% reported neither anxiety nor depression. Ophthalmologists’ response to patients with mild or worse anxiety or depression was to change clinical approach (28%) and communication style (31%), both metrics increasing with severity of symptoms (Fisher’s exact p<0.05). None reported changing their choice of treatment or modifying follow-up protocols; referral to social work/psychiatry services was 60%, 3.7% and 0% for patients with moderately severe or worse, mild-to-moderate, or minimal scores, respectively. Conclusion Providing ophthalmologists with knowledge of the emotional health of their patients may change the clinical approach and referral pattern.
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Affiliation(s)
- Fahd Naufal
- Dana Center for Preventive Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Prateek Gajwani
- Dana Center for Preventive Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Robert Medina
- Dana Center for Preventive Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Madison Dutson
- Dana Center for Preventive Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | | | - Sheila K West
- Dana Center for Preventive Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
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Mitchell W, Resnick H, Zebardast N. Age-Related Macular Degeneration and Visual and Physical Disability in a Nationally Representative Sample from the United States. Transl Vis Sci Technol 2021; 9:42. [PMID: 33442496 PMCID: PMC7774103 DOI: 10.1167/tvst.9.13.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/21/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose Outline the association between age-related macular degeneration (AMD) and functional difficulty using novel item response theory (IRT) psychometric techniques, and highlight populations particularly at risk of functional impairment. Methods This cross-sectional study included 5604 US adults. Primary outcomes were item response theory–adjusted visual and physical difficulty scores. Secondary analyses of AMD populations at highest risk of reporting greater functional difficulty were undertaken. Results In total, there were 386 participants with early AMD (mean presenting visual acuity [pVA], 0.12) and 55 with late AMD (mean pVA, 0.35). Those with late AMD reported substantially higher item visual difficulty, whereas those with both early/late AMD reported significantly higher item physical difficulty versus those with no AMD (P < .05). In univariate regression, only those with late AMD reported significantly higher visual difficulty versus those with no AMD (10.1 points [95% confidence interval (CI), 8.2–12.1 points] vs 7.1 points [95% CI, 7.0–7.2 points]; P = .003). Both early/late AMD reported higher physical difficulty versus those with no AMD (11.6 points [95% CI, 11.1–12.1 points; P = .005]; 13.4 points [95% CI, 11.8–15.0 points; P = .03], respectively, versus 11.0 points [95% CI, 10.9–11.1 points]. After adjustment for sociodemographic and medical variables (excluding pVA), only those with late AMD reported significantly greater visual and physical difficulty versus those with no AMD (10.0 points [95% CI, 8.2–11.9 points] vs 7.1 [95% CI, 7.0–7.2 points; P = .002]; and 12.7 points [95% CI, 11.3–14.0 points] vs 11.0 [95% CI, 10.9–11.1 points; P = .02], respectively); greater visual difficulty in those with late AMD persisted after additionally adjusting for pVA versus those with no AMD (9.1 points [95% CI, 7.6–10.6 points] vs 7.1 points [95% CI, 7.0–7.2 points; P = .01]). Among individuals with AMD, lower income, higher medical comorbidities, depression, and pVA predicted greater visual and physical difficulties. Conclusions AMD confers significant functional difficulty among US adults with sociodemographic characteristics influencing dysfunction; highlighting the value of alternatives to Snellen visual acuity in assessing visual characteristics. With aging populations and the increasing prevalence of AMD, health care professionals should be aware of the functional burden of AMD and recognize those at higher risk of functional difficulty. Translational Relevance Contemporary psychometric validation techniques can be effective in accurately describing the level of functional impairment for those with visual impairment.
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Affiliation(s)
- William Mitchell
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Nazlee Zebardast
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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20
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Sörensen S, Missell RL, Eustice-Corwin A, Otieno DA. Perspectives on Aging-Related Preparation. JOURNAL OF ELDER POLICY 2021; 1:10.18278/jep.1.2.7. [PMID: 35169787 PMCID: PMC8841953 DOI: 10.18278/jep.1.2.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
When older adults face age-related life challenges, anticipating what to expect and how to access potential coping strategies can both prevent and provide the possibility of easier recovery from crises. Aging-Related Preparation (ARP) is defined as the continuum of thoughts and activities about how to age well, often beginning with the awareness of age-related changes, or the anticipation of retirement, and concluding with specifying end-of-life wishes. In the current paper, we introduce the concept of ARP and related formulations regarding plans for aging well, describe both predictors and outcomes of ARP for several the domains of ARP, and consider the elements of ARP within the context of existing social policy. We conclude that ARP is determined by a variety of influences both intrinsic to the older person (e.g., personality, cognitive ability, beliefs about planning, problem-solving skills), linked to social class and education, as well as dependent on family structures, access to and knowledge of options, services, and local community resources, and social policy. We further provide evidence that ARP has positive effects in the domain of pre-retirement planning (for retirement adjustment), of preparation for future care (for emotional well-being), and of ACP (for a good death). However, other domains of ARP, including planning for leisure, housing, and social planning are under-researched. Finally, we discuss policy implications of the existing research.
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Affiliation(s)
- Silvia Sörensen
- Corresponding Author: Silvia Sörensen, PhD, Associate Professor, Counseling and Human Development, Warner School of Education and Human Development:
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21
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Age-Related Macular Degeneration: Epidemiology and Clinical Aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1256:1-31. [PMID: 33847996 DOI: 10.1007/978-3-030-66014-7_1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Age-related macular degeneration (AMD) is a degenerative disease of the human retina affecting individuals over the age of 55 years. This heterogeneous condition arises from a complex interplay between age, genetics, and environmental factors including smoking and diet. It is the leading cause of blindness in industrialized countries. Worldwide, the number of people with AMD is predicted to increase from 196 million in 2020 to 288 million by 2040. By this time, Asia is predicted to have the largest number of people with the disease. Distinct patterns of AMD prevalence and phenotype are seen between geographical areas that are not explained fully by disparities in population structures. AMD is classified into early, intermediate, and late stages. The early and intermediate stages, when visual symptoms are typically absent or mild, are characterized by macular deposits (drusen) and pigmentary abnormalities. Through risk prediction calculators, grading these features helps predict the risk of progression to late AMD. Late AMD is divided into neovascular and atrophic forms, though these can coexist. The defining lesions are macular neovascularization and geographic atrophy, respectively. At this stage, visual symptoms are often severe and irreversible, and can comprise profoundly decreased central vision in both eyes. For these reasons, the condition has major implications for individuals and society, as affected individuals may experience substantially decreased quality of life and independence. Recent advances in retinal imaging have led to the recognition of an expanded set of AMD phenotypes, including reticular pseudodrusen, nonexudative macular neovascularization, and subtypes of atrophy. These developments may lead to refinements in current classification systems.
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22
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Marakis TP, Koutsandrea C, Poulou MS. The impact of vision impairment on vision-related quality of life of patients with neovascular age-related macular degeneration. Eur J Ophthalmol 2020; 32:481-490. [PMID: 33213182 DOI: 10.1177/1120672120972625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the validity and reliability of the Greek Impact of Vision Impairment Questionnaire (IVI) and to explore the predictors of vision-related quality of life (VRQoL) in individuals with neovascular age-related macular degeneration (nAMD). METHODS About 191 patients completed the IVI and the SF-12 Health Survey, and were assessed on visual exams. A random group of 20 participants completed the IVI twice with a 2 weeks interval, to assess test-retest reliability. About 102 patients completed the IVI 1 year later in a follow-up examination. Rasch analysis was used to evaluate response category functioning, scale precision, unidimensionality, scale targeting and differential item functioning. Stepwise multiple linear regression analyses identified predictors of VRQoL. RESULTS Test-retest reliability of IVI items was calculated from 0.86 to 0.98. The six response categories were merged into four to figure out disordered thresholds. Rasch analysis concluded in three scales: Mobility and Independence, Reading and Accessing Information, and Emotional Wellbeing. Regarding convergent validity, the IVI scores had significant associations with SF-12 components (ρ = 0.28-0.47) and measurements of visual acuity (ρ = 0.39-0.66). Worse VRQoL at 1 year follow-up was correlated with decline in distance and near VA. Distance VA and the SF-12 components were common predictors for all three subscales. The duration of disease was a significant predictor for the emotional subscale. CONCLUSION The Greek IVI was found to assess AMD patients' perceptions of VRQoL in a valid, reliable and responsive to eyesight manner. VRQoL was mainly established by patients' distance VA and mental health.
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Affiliation(s)
- Theodoros P Marakis
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas," Athens, Attica, Greece
| | - Chrysanthi Koutsandrea
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas," Athens, Attica, Greece
| | - Maria S Poulou
- Department of Educational Sciences and Early Childhood Education, University of Patras, Patras, Western Greece, Greece
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Tang D, Mitchell P, Liew G, Burlutsky G, Flood VM, Gopinath B. Telephone-Delivered Dietary Intervention in Patients with Age-Related Macular Degeneration: 3-Month Post-Intervention Findings of a Randomised Controlled Trial. Nutrients 2020; 12:E3083. [PMID: 33050401 PMCID: PMC7650817 DOI: 10.3390/nu12103083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
There is an evidence-practice gap between the dietary recommendations for age-related macular degeneration (AMD) presented in the literature and those practiced by patients. This study reports on the 3-month post-intervention results of a randomised controlled trial (RCT) evaluating telephone-delivered counselling to improve dietary behaviours among AMD patients. A total of 155 AMD patients (57% female, aged 78 ± 8 years; control: 78, intervention: 77), primarily residing in New South Wales, Australia, were recruited. Participants completed a baseline questionnaire and a short dietary questionnaire (SDQ-AMD). The intervention included an evidence-based nutrition resource and four monthly calls with a dietitian. Immediately post-intervention, intervention participants repeated the SDQ-AMD and completed a feedback form. At 3 months post-intervention, both study arms repeated the SDQ-AMD. Statistical analyses included t-tests and McNemar's test. Intervention participants reported satisfaction with the tailored phone calls, nutrition resource and nutrition education provided. At 3 months post-intervention, there was no statistically significant difference between study arms in the proportion of participants meeting the dietary goals nor in intake (mean servings ± SE) of total vegetables (primary outcome) and other key food groups; however, there was a significantly higher intake of nuts (secondary outcome) (3.96 ± 0.51 vs. 2.71 ± 0.32; p = 0.04) among participants in the intervention versus control group. Within the intervention arm, there were also significant improvements in intakes of the following secondary outcomes: dark green leafy vegetables (0.99 ± 0.17 vs. 1.71 ± 0.22; p = 0.003) and legumes (0.69 ± 0.10 vs. 1.12 ± 0.16; p = 0.02) and intake of sweets and processed/prepared foods (8.31 ± 0.76 vs. 6.54 ± 0.58, p = 0.01). In summary, although there were few dietary differences between study arms at 3 months post-intervention, the intervention involving four monthly calls was acceptable and helpful to the participants. This type of intervention therefore has the potential to provide people with AMD the needed support for improving their nutrition knowledge and dietary practices, especially if continued over a longer period.
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Affiliation(s)
- Diana Tang
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Victoria M. Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Western Sydney Local Health District, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
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24
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Maaswinkel IM, van der Aa HPA, van Rens GHMB, Beekman ATF, Twisk JWR, van Nispen RMA. Mastery and self-esteem mediate the association between visual acuity and mental health: a population-based longitudinal cohort study. BMC Psychiatry 2020; 20:461. [PMID: 32972387 PMCID: PMC7513319 DOI: 10.1186/s12888-020-02853-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/03/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND With deteriorating eyesight, people often become dependent on others for many aspects of their daily lives. As a result, they feel less 'in control' and experience lower self-esteem. Lower sense of mastery and self-esteem are known to predict depression, but their roles in people with visual impairment have only marginally been investigated. Therefore, this study aimed to determine the influence of mastery and self-esteem on the relationship between visual acuity and mental health. METHODS A longitudinal cohort study was performed using data from the Longitudinal Aging Study Amsterdam (LASA), collected between 2001 and 2012. A community-based population of 2599 older adults were included, who were randomly selected from population registers. Outcomes of interest were the Pearlin Mastery Scale, Rosenberg Self-Esteem Scale, Center for Epidemiologic Studies - Depression scale and the Hospital Anxiety Depression Scale - Anxiety subscale. Linear mixed models were used to establish the association between visual acuity and mental health over time. RESULTS Mean age was 72 years, 56% was female and 1.2% qualified as having low vision. Visual impairment was associated with a lower sense of mastery (β = - 0.477, p < 0.001), lower self-esteem (β = - 0.166, p = 0.008) and more depression (β = 0.235, p < 0.001). No significant association between visual acuity and anxiety was found. The relationship between visual acuity and depression was mediated by self-esteem (25%) and sense of mastery (79%). CONCLUSIONS Vision loss was associated with depression. This association was mediated by self-esteem and sense of mastery. This provides us with new possibilities to identify, support and treat those at risk for developing depression by aiming to increase their self-esteem and sense of mastery.
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Affiliation(s)
- I. M. Maaswinkel
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - H. P. A. van der Aa
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - G. H. M. B. van Rens
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.414480.d0000 0004 0409 6003Elkerliek Hospital, Ophthalmology, Helmond, The Netherlands
| | - A. T. F. Beekman
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Specialized Mental Health Care, Research and Innovation, Amsterdam, The Netherlands
| | - J. W. R. Twisk
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - R. M. A. van Nispen
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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25
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Curcio CA, McGwin G, Sadda SR, Hu Z, Clark ME, Sloan KR, Swain T, Crosson JN, Owsley C. Functionally validated imaging endpoints in the Alabama study on early age-related macular degeneration 2 (ALSTAR2): design and methods. BMC Ophthalmol 2020; 20:196. [PMID: 32429847 PMCID: PMC7236516 DOI: 10.1186/s12886-020-01467-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/08/2020] [Indexed: 12/29/2022] Open
Abstract
Background Age-related macular degeneration (AMD), a leading cause of irreversible vision impairment in the United States and globally, is a disease of the photoreceptor support system involving the retinal pigment epithelium (RPE), Bruch’s membrane, and the choriocapillaris in the setting of characteristic extracellular deposits between outer retinal cells and their blood supply. Research has clearly documented the selective vulnerability of rod photoreceptors and rod-mediated (scotopic) vision in early AMD, including delayed rod-mediated dark adaptation (RMDA) and impaired rod-mediated light and pattern sensitivity. The unifying hypothesis of the Alabama Study on Early Macular Degeneration (ALSTAR2) is that early AMD is a disease of micronutrient deficiency and vascular insufficiency, due to detectable structural changes in the retinoid re-supply route from the choriocapillaris to the photoreceptors. Functionally this is manifest as delayed rod-mediated dark adaptation and eventually as rod-mediated visual dysfunction in general. Methods A cohort of 480 older adults either in normal macular health or with early AMD will be enrolled and followed for 3 years to examine cross-sectional and longitudinal associations between structural and functional characteristics of AMD. Using spectral domain optical coherence tomography, the association between (1) subretinal drusenoid deposits and drusen, (2) RPE cell bodies, and (3) the choriocapillaris’ vascular density and rod- and cone-mediated vision will be examined. An accurate map and timeline of structure-function relationships in aging and early AMD gained from ALSTAR2, especially the critical transition from aging to disease, will identify major characteristics relevant to future treatments and preventative measures. Discussion A major barrier to developing treatments and prevention strategies for early AMD is a limited understanding of the temporal interrelationships among structural and functional characteristics while transitioning from aging to early AMD. ALSTAR2 will enable the development of functionally valid, structural biomarkers for early AMD, suitable for use in forthcoming clinical trials as endpoint/outcome measures. The comprehensive dataset will also allow hypothesis-testing for mechanisms that underlie the transition from aging to AMD, one of which is a newly developed Center-Surround model of cone resilience and rod vulnerability. Trial registration ClinicalTrials.gov Identifier NCT04112667, October 7, 2019.
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Affiliation(s)
- Christine A Curcio
- Department of Ophthalmology and Visual Sciences, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, 1720 University Blvd., Suite 609, Birmingham, AL, 35294-0009, USA
| | - Gerald McGwin
- Department of Ophthalmology and Visual Sciences, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, 1720 University Blvd., Suite 609, Birmingham, AL, 35294-0009, USA.,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Srinivas R Sadda
- Doheny Eye Institute, P.O. Box 86228, Los Angeles, CA, 90033, USA
| | - Zhihong Hu
- Doheny Eye Institute, P.O. Box 86228, Los Angeles, CA, 90033, USA
| | - Mark E Clark
- Department of Ophthalmology and Visual Sciences, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, 1720 University Blvd., Suite 609, Birmingham, AL, 35294-0009, USA
| | - Kenneth R Sloan
- Department of Ophthalmology and Visual Sciences, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, 1720 University Blvd., Suite 609, Birmingham, AL, 35294-0009, USA.,Department of Computer Science, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Thomas Swain
- Department of Ophthalmology and Visual Sciences, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, 1720 University Blvd., Suite 609, Birmingham, AL, 35294-0009, USA
| | - Jason N Crosson
- Department of Ophthalmology and Visual Sciences, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, 1720 University Blvd., Suite 609, Birmingham, AL, 35294-0009, USA.,Retina Consultants of Alabama, Birmingham, AL, 35233, USA
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, 1720 University Blvd., Suite 609, Birmingham, AL, 35294-0009, USA.
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26
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Owsley C, McGwin G. Cautionary Remarks on Linking Cognitive Impairment to Glaucoma and Age-Related Macular Degeneration. Ophthalmology 2020; 127:667. [PMID: 32327133 DOI: 10.1016/j.ophtha.2020.01.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 11/29/2022] Open
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27
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Mayro EL, Murchison AP, Hark LA, Silverstein M, Wang OY, Gilligan JP, Leiby BE, Pizzi LT, Casten RJ, Rovner BW, Haller JA. Prevalence of depressive symptoms and associated factors in an urban, ophthalmic population. Eur J Ophthalmol 2020; 31:740-747. [PMID: 31983234 DOI: 10.1177/1120672120901701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence of depressive symptoms in an adult ophthalmic patient population and to delineate correlates. DESIGN Cross-sectional study. PARTICIPANTS Adult patients (⩾18 years) were approached in general and sub-specialty cornea, retina, and glaucoma ophthalmic clinics. A total of 367 patients from the four clinics were enrolled. METHODS Depressive symptoms were assessed using the Patient Health Questionnaire-9. A cut-off score of ⩾10 was used to indicate clinically significant depressive symptoms. Patient Health Questionnaire-9 scores were used to evaluate bivariate relationships between depressive symptoms and distance visual acuity, ocular diagnosis, diabetes status, smoking status, demographic information, and medications. RESULTS The majority of patients were female (52.9%) and Caucasian (48.6%). The mean age was 52.0 years (standard deviation: 16.7). Clinically significant depressive symptoms were present in 19.9% of patients overall; this rate varied slightly by clinic. Patients with low vision and blindness (visual acuity worse than 20/60) were more likely to have depressive symptoms (odds ratio = 2.82; 95% confidence interval: 1.90-4.21). Smoking and diabetes were also associated with depressive symptoms (odds ratio = 3.11 (2.66-3.64) and 3.42 (1.90-6.16), respectively). CONCLUSION In a sample of urban ophthalmic adult patients, depressive symptoms were highly associated with low vision, smoking, and diabetes. This information can be used to target interventions to those at greatest risk of depressive symptoms.
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Affiliation(s)
- Eileen L Mayro
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ann P Murchison
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Wills Eye Hospital, Philadelphia, PA, USA
| | - Lisa A Hark
- Wills Eye Hospital, Philadelphia, PA, USA.,Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA.,Vagelos College of Physicians and Surgeons and Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Marlee Silverstein
- Department of Ophthalmology, The Ohio State University, Columbus, OH, USA
| | - Olivia Y Wang
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - John P Gilligan
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ, USA
| | - Robin J Casten
- Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry W Rovner
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Neurology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Wills Eye Hospital, Philadelphia, PA, USA
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28
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Flt3 Regulation in the Mononuclear Phagocyte System Promotes Ocular Neovascularization. J Ophthalmol 2018; 2018:2518568. [PMID: 29854425 PMCID: PMC5960574 DOI: 10.1155/2018/2518568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/06/2018] [Indexed: 12/20/2022] Open
Abstract
Fms-like tyrosine kinase 3 (Flt3), a tyrosine kinase receptor expressed in CD34+ hematopoietic stem/progenitor cells, is important for both normal myeloid and lymphoid differentiation. It has been implicated in mice and humans for potential multilineage differentiation. We found that mice deficient in Flt3 or mice that received an Flt3 inhibitor (AC220) showed significantly reduced areas of ischemia-induced retinal neovascularization (RNV) and laser-induced choroidal NV (CNV) (P < 0.05). Increased Flt3 expression at the protein level was detected in retinas of oxygen-induced retinopathy (OIR) mice at P15 and P18 during retinal NV (RNV) progression. We subsequently found that macrophages (Mphi) polarization was regulated at the site of CNV in Flt3-deficient mice. Flow cytometry analysis demonstrated that Flt3 deficiency shifted Mphi polarization towards an M2 phenotype during RNV with significant reduction in M1 cytokine expression when compared to the wild-type controls (P < 0.05). Based on the above findings, we concluded that Flt3 inhibition alleviated ocular NV by promoting a Mphi polarization shift towards the M2 phenotype. Therapies targeting Flt3 may provide a new approach for the treatment of ocular NV.
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29
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Péntek M, Brodszky V, Biró Z, Kölkedi Z, Dunai Á, Németh J, Baji P, Rencz F, Gulácsi L, Resch MD. Subjective health expectations of patients with age-related macular degeneration treated with antiVEGF drugs. BMC Geriatr 2017; 17:233. [PMID: 29017463 PMCID: PMC5635533 DOI: 10.1186/s12877-017-0619-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/02/2017] [Indexed: 12/04/2022] Open
Abstract
Background Subjective expectations regarding future health may influence patients’ judgement of current health and treatment effects, as well as adherence to therapies in chronic diseases. We aimed to explore subjective expectations on longevity and future health-related quality of life (HRQOL) of patients with age-related macular degeneration (AMD) treated with antiVEGF injections and analyse the influencing factors. Methods Consecutive AMD patients in two ophthalmology centres were included. Demographics, clinical characteristics and informal care utilisation were recorded. Current health was evaluated by the EQ-5D generic health status questionnaire and time trade-off (TTO) methods. Happiness was measured on a visual analogue scale (VAS). Subjective life-expectancy and expected EQ-5D status at ages 70, 80 and 90 were surveyed. T-test was applied to compare subgroups and Pearson correlations were performed to analyse relationships between variables. Results One hundred twenty two patients were involved (females 62%) with a mean (SD) age of 75.2 (7.9) years and disease duration of 2.9 (2.5) years. The majority were in AREDS-4 state, the better eye’s ETDRS was 64.7 (15.4). EQ-5D and TTO revealed moderate deterioration of health (0.66 vs. 0.72, p = 0.131), happiness VAS was 6.3 (2.2). Correlation between EQ-5D and ETDRS was moderate (R = 0.242, p < 0.05) and having both versus one eye in AREDS-4 resulted lower TTO (0.68 vs. 0.83; p = 0.013). Subjective life-expectancy did not differ significantly from statistical life-expectancy and had no significant impact on TTO. The self-estimated mean EQ-5D score was 0.60, 0.40 and 0.24 for ages 70, 80 and 90 which is lower than the population norm of age-groups 65–74, 75–84 and 85+ (0.77, 0.63 and 0.63, respectively). Age, gender, current EQ-5D, need for informal care and happiness were deterministic factors of subjective health expectations. Conclusion AMD patients with antiVEGF treatment have comparable HRQOL as the age-matched general public but expect a more severe deterioration of health with age. Older patients with worse HRQOL have worse subjective expectations. Exploring patients’ health expectations provides an opportunity for ophthalmologists to correct misperceptions and improve the quality of AMD care. Further studies should provide evidences on the relationship between subjective expectations and actual health outcomes, and on its impact on patients’ AMD-specific health behaviour. Electronic supplementary material The online version of this article (10.1186/s12877-017-0619-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Zsolt Biró
- Department of Ophthalmology, Pécs University of Sciences, Nyár u. 8, Pécs, 7624, Hungary
| | - Zsófia Kölkedi
- Department of Ophthalmology, Pécs University of Sciences, Nyár u. 8, Pécs, 7624, Hungary
| | - Árpád Dunai
- Department of Ophthalmology, Semmelweis University Budapest, Mária u. 39, Budapest, 1085, Hungary
| | - János Németh
- Department of Ophthalmology, Semmelweis University Budapest, Mária u. 39, Budapest, 1085, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.,Clinical Medicine Doctoral School, Semmelweis University Budapest, Ulloi u. 26, Budapest, 1085, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Miklós D Resch
- Department of Ophthalmology, Semmelweis University Budapest, Mária u. 39, Budapest, 1085, Hungary
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30
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Aberrant brain grey matter volume patterns differ among Chinese Han drug-naïve depression patients with acute and chronic stress. Oncotarget 2017; 8:91958-91964. [PMID: 29190889 PMCID: PMC5696155 DOI: 10.18632/oncotarget.20954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/26/2017] [Indexed: 01/18/2023] Open
Abstract
Chronic or acute stress can induce structural changes and brain alterations associated with the neural mechanisms of depression. Aimed to investigate the GMV alterations in the drug-naïve depression patients with chronic and acute stress experience,we enrolled fifty depression patients with acute stress experience, fifty five depression patients with chronic stress experience and forty seven healthy controls(HC) to participant in the present study. We used voxel-based morphometry to analyze the brain grey matter volume (GMV) alterations. Compared with the HC, the patients with acute stress and those with chronic stress exhibited a distinct GMV impairment pattern. Widespread, decreased GMV was detected in most of the cerebral cortex in all the depression patients. Importantly, the greatest finding in our study is that the decreased GMV in the depression patients with chronic stress was more widespread than that in the patients with acute stress. All brain regions with decreased GMV participated in the regulation of emotions, memory, and executive function processing, which is consistent with previous findings. There was no significant difference between the major depression disorder patients with acute stressful life events and those with chronic stressful life events, and this finding largely weakens the support of our current conclusion. Thus, we cannot confirm this postulation. However, our findings probably indicate that GMV may be more sensitive to major depression disorder patients when compared to healthy controls, it did not sensitive when in the comparison of patient's group. Overall, our findings provide important information for the use of appropriate treatment methods to address acute stress and alleviate chronic stress in patients with depression, and such treatments can delay the deterioration of the affected brain regions and improve remission rates. More importantly, all the inexplicable findings in the present study encourage us to conduct a follow-up study to describe the developmental trajectory of the pathological brain features of depression patients and explore therapeutic targets for future personalized treatment.
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31
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Madsen H, Dam H, Hageman I. Eye disorder differentiates seasonality outcomes in persons with severe visual impairment. J Affect Disord 2017; 217:233-236. [PMID: 28432995 DOI: 10.1016/j.jad.2017.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/28/2017] [Accepted: 04/02/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Light plays a crucial role in both the pathogenesis and treatment of seasonal affective disorder (SAD). Consequently decreased retinal sensitivity to light has been suggested to be a risk factor for SAD. In a population of persons with severe visual impairment we recently found a highly increased prevalence of SAD. We now aimed to identify eye disorders or anatomical locations with specific association to seasonality. METHODS In 912 cases (33%) from our prior seasonal pattern assessment questionnaire (SPAQ) screening study, we retrieved eye diagnoses from the Danish National Patient Registry and analyzed for specific eye disorders or anatomical locations that significantly differentiated SPAQ outcomes (global seasonality score, (GSS) and SPAQ-SAD prevalence). RESULTS Persons with early life eye disorders (congenital conditions or retinopathy of prematurity) reported less symptoms of SAD (median GSS 4.5) than persons with acquired eye disorders (median GSS 5.0, p=0.005). Persons with macular degenerative disorders (MD) had highly increased seasonality outcomes (hazard ratio 2.23, p=0.002, median GSS 5 vs. 8, p=0.01). LIMITATIONS the study is a cross-sectional study based on a self-report questionnaire. Register data may be incomplete. CONCLUSIONS MD is significantly associated to high-level seasonality and SAD prevalence. Early life eye disorder is associated to slightly lower seasonality compared to acquired eye disorder. Longitudinal studies are needed to assess causality.
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Affiliation(s)
- Heller Madsen
- Mental Health Center Copenhagen, University of Copenhagen, Denmark.
| | - Henrik Dam
- Mental Health Center Copenhagen, University of Copenhagen, Denmark
| | - Ida Hageman
- Mental Health Center Copenhagen, University of Copenhagen, Denmark
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32
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Neely DC, Bray KJ, Huisingh CE, Clark ME, McGwin G, Owsley C. Prevalence of Undiagnosed Age-Related Macular Degeneration in Primary Eye Care. JAMA Ophthalmol 2017; 135:570-575. [PMID: 28448669 DOI: 10.1001/jamaophthalmol.2017.0830] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Age-related macular degeneration (AMD) is the leading cause of irreversible vision impairment in older adults in the United States, yet little is known about whether AMD is appropriately diagnosed in primary eye care. Objectives To examine the prevalence of eyes with AMD in patients seen in primary eye care clinics who purportedly have normal macular health per their medical record and the association of AMD with patient and physician characteristics. Design, Setting, and Participants In this cross-sectional study of primary eye care practices in Birmingham, Alabama, 644 persons 60 years or older with normal macular health per medical record based on their most recent dilated comprehensive eye examination by a primary eye care ophthalmologist or optometrist were enrolled from May 1, 2009, through December 31, 2011. Data analysis was performed from May 1, 2016, through December 20, 2016. Main Outcomes and Measures Presence of AMD as defined by the Clinical Age-Related Maculopathy Staging system based on color fundus photography and a masked grader. Types of AMD-associated lesions were noted. Patient health and physician characteristics were collected. Results The sample consisted of 1288 eyes from 644 participants (231 [35.9%] male and 413 [64.1%] female; mean [SD] age, 69.4 [6.1] years; 611 white [94.9%]) seen by 31 primary eye care ophthalmologists or optometrists. A total of 968 eyes (75.2%) had no AMD, in agreement with their medical record; 320 (24.8%) had AMD despite no diagnosis of AMD in the medical record. Among eyes with undiagnosed AMD, 32 (10.0%) had hyperpigmentation, 43 (13.4%) had hypopigmentation, 249 (77.8%) had small drusen, 250 (78.1%) had intermediate drusen, and 96 (30.0%) had large drusen. Undiagnosed AMD was associated with older patient age (odds ratio [OR], 1.06; 95% CI, 1.04-1.09; P < .001), male sex (age-adjusted OR, 1.39; 95% CI, 1.02-1.91; P = .04), and less than a high school education (age-adjusted OR, 2.40; 95% CI, 1.03-5.62; P = .04). Prevalence of undiagnosed AMD was not different for ophthalmologists and optometrists (age adjusted OR, 0.99; 95% CI, 0.71-1.36; P = .94). Conclusions and Relevance Approximately 25.0% of eyes deemed to be normal based on dilated eye examination by primary eye care physicians had macular characteristics that indicated AMD revealed by fundus photography and trained raters. A total of 30.0% of eyes with undiagnosed AMD had AMD with large drusen that would have been treatable with nutritional supplements had it been diagnosed. Improved AMD detection strategies may be needed in primary eye care as more effective treatment strategies for early AMD become available in the coming years.
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Affiliation(s)
- David C Neely
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
| | - Kevin J Bray
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
| | - Carrie E Huisingh
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
| | - Mark E Clark
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
| | - Gerald McGwin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Cynthia Owsley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
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Marakis TP, Koutsandrea C, Chatzistefanou KI, Tountas Y. Treatment satisfaction of patients with neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents. Int Ophthalmol 2017; 38:565-576. [PMID: 28285389 DOI: 10.1007/s10792-017-0492-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the psychometric properties of the Greek Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) and evaluate the factors that influence treatment satisfaction of patients with neovascular age-related macular degeneration (nAMD). METHODS The MacTSQ was translated into Greek and administered to 176 patients. All patients completed the SF-12 Health Survey and the Macular disease Dependent Quality of Life Questionnaire (MacDQoL) and underwent vision measurements. For test-retest reliability, a subset of 19 participants completed the MacTSQ twice, two weeks apart. Stepwise multiple linear regression analyses were performed to identify predictors of treatment satisfaction. Change in MacTSQ scores over time was assessed on 83 patients who completed the MacTSQ at a follow-up visit, one year later. RESULTS The intraclass correlation coefficients between the first and second test-retest administration ranged from 0.88 to 0.98 for the items and total score. Internal reliability of the total score was adequate (Cronbach's a = 0.837). Principal component analysis revealed three subscales (effectiveness, information provision and convenience, impact). The MacTSQ score showed significant correlations with SF-12 summary scales and MacDQoL scores (ρ = 0.16-0.27). The most important factor that determined the satisfaction was mental health. Distance visual acuity (VA) in better eye was the best predictor of the effectiveness subscale, and the total number of injections was a negative predictor for the convenience subscale. Treatment satisfaction increased at one-year follow-up, despite the deterioration in distance VA. CONCLUSIONS The Greek MacTSQ is a reliable and valid instrument for assessing nAMD patients' perceptions of treatment satisfaction, especially using its three new subscales. Treatment satisfaction is multifactorial and was primarily determined by patients' mental health status.
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Affiliation(s)
- Theodoros P Marakis
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece.
| | - Chrysanthi Koutsandrea
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Klio I Chatzistefanou
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Yannis Tountas
- Department of Hygiene and Epidemiology, Center for Health Services Research, University of Athens Medical School, Athens, Greece
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Garcia GA, Khoshnevis M, Gale J, Frousiakis SE, Hwang TJ, Poincenot L, Karanjia R, Baron D, Sadun AA. Profound vision loss impairs psychological well-being in young and middle-aged individuals. Clin Ophthalmol 2017; 11:417-427. [PMID: 28260855 PMCID: PMC5328297 DOI: 10.2147/opth.s113414] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to evaluate the effects of profound vision loss on psychological well-being in adolescents, young adults, and middle-aged adults with regard to mood, interpersonal interactions, and career-related goals. In addition, we assessed the significance of the resources that may be used to enhance psychological well-being in cases of profound vision loss, and in particular, examined the utility of low vision aids and the role of the ophthalmologist as a provider of emotional support. Methods A questionnaire was issued to individuals aged 13–65 years with profound vision loss resulting from Leber’s hereditary optic neuropathy (LHON). Depression prevalence was evaluated with questions regarding major depressive disorder symptomatology. Participants appraised the effects of vision loss on their interpersonal interactions and career goals by providing an impact rating (IR) on a 21-point psychometric scale from −10 to +10. Social well-being index was defined as the average of interpersonal IR and career IR. Subjects were additionally asked about the use of low vision aids and sources of emotional support. Results A total of 103 participants (mean age =26.4±11.2 years at LHON diagnosis; mean ± standard deviation) completed the questionnaire. Nearly half (49.5%) met the depression criteria after vision loss. Negative impacts on interpersonal interactions (median IR = −5) and career goals (median IR = −6) were observed; both ratings were worse (P<0.001) for depressed versus nondepressed subjects. Older age at diagnosis corresponded to higher depression prevalence and increased incidence of negative interpersonal IR and career IR. Sixty-eight percent of subjects used electronic vision aids; controlling for age, social well-being index was higher among these individuals than for those who did not use electronic aids (P=0.03). Over half of the participants (52.4%) asserted that they derived emotional support from their ophthalmologist. Conclusion Profound vision loss in adolescents, young adults, and middle-aged adults is associated with significant negative psychological and psychosocial effects, which are influenced by age and use of electronic vision aids. Ophthalmologists, in addition to managing vision loss, may serve an important role in the emotional adaptation of these patients.
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Affiliation(s)
- Giancarlo A Garcia
- Doheny Eye Institute, Los Angeles, CA, USA; University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Matin Khoshnevis
- Doheny Eye Institute, Los Angeles, CA, USA; Department of Ophthalmology, Temple University, Philadelphia, PA, USA
| | - Jesse Gale
- Doheny Eye Institute, Los Angeles, CA, USA; Wellington School of Medicine and Health Sciences, University of Otago, Wellington, NZ
| | - Starleen E Frousiakis
- Doheny Eye Institute, Los Angeles, CA, USA; Department of Ophthalmology, New York Medical College, Valhalla, NY, USA
| | - Tiffany J Hwang
- Doheny Eye Institute, Los Angeles, CA, USA; Department of Psychiatry & The Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Rustum Karanjia
- Doheny Eye Institute, Los Angeles, CA, USA; Doheny Eye Centers, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles California, CA, USA; Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Health Research Institute, Ottawa, ON, Canada
| | - David Baron
- Department of Psychiatry & The Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alfredo A Sadun
- Doheny Eye Institute, Los Angeles, CA, USA; Doheny Eye Centers, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles California, CA, USA
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Berber P, Grassmann F, Kiel C, Weber BHF. An Eye on Age-Related Macular Degeneration: The Role of MicroRNAs in Disease Pathology. Mol Diagn Ther 2017; 21:31-43. [PMID: 27658786 PMCID: PMC5250647 DOI: 10.1007/s40291-016-0234-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Age-related macular degeneration (AMD) is the primary cause of blindness in developed countries, and is the third leading cause worldwide. Emerging evidence suggests that beside environmental and genetic factors, epigenetic mechanisms, such as microRNA (miRNA) regulation of gene expression, are relevant to AMD providing an exciting new avenue for research and therapy. MiRNAs are short, non-coding RNAs thought to be imperative for coping with cellular stress. Numerous studies have analyzed miRNA dysregulation in AMD patients, although with varying outcomes. Four studies which profiled dysregulated circulating miRNAs in AMD yielded unique sets, and there is only minimal overlap in ocular miRNA profiling of AMD. Mouse models of AMD, including oxygen-induced retinopathy and laser-induced choroidal neovascularization, showed similarities to some extent with miRNA patterns in AMD. For example, miR-146a is an extensively researched miRNA thought to modulate inflammation, and was found to be upregulated in AMD mice and cellular systems, but also in human AMD retinae and vitreous humor. Similarly, mir-17, miR-125b and miR-155 were dysregulated in multiple AMD mouse models as well as in human AMD plasma or retinae. These miRNAs are thought to regulate angiogenesis, apoptosis, phagocytosis, and inflammation. A promising avenue of research is the modulation of such miRNAs, as the phenotype of AMD mice could be ameliorated with antagomirs or miRNA-mimic treatment. However, before meaningful strides can be made to develop miRNAs as a diagnostic or therapeutic tool, reproducible miRNA profiles need to be established for the various clinical outcomes of AMD.
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Affiliation(s)
- Patricia Berber
- Institute of Human Genetics, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Felix Grassmann
- Institute of Human Genetics, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christina Kiel
- Institute of Human Genetics, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Bernhard H F Weber
- Institute of Human Genetics, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Eclectic Ocular Comorbidities and Systemic Diseases with Eye Involvement: A Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6215745. [PMID: 27051666 PMCID: PMC4808667 DOI: 10.1155/2016/6215745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/01/2016] [Accepted: 02/01/2016] [Indexed: 02/07/2023]
Abstract
Coexistence of several ocular diseases is more frequent than suspected. In spite of the refractive errors, one or more of the following can be detected simultaneously: glaucoma, cataracts, uveitis, age-related macular degeneration, and dry eyes. In addition, as people age, ocular comorbidities are much more usually seen. Specific diseases are openly acknowledged to affect the eyes and vision, such as diabetes mellitus, hypertension blood pressure, arthritis, hyperthyroidism, neurodegenerative disorders, hematologic malignancies, and/or systemic infections. Recent advances in early diagnosis and therapy of the ophthalmic pathologies have reinforced patient options to prevent visual impairment and blindness. Because of this, it is essential not to overlook sight-threatening conditions such as the ocular comorbidities and/or the eye involvement in the context of systemic disorders. Moreover, the important role of the multidisciplinary cooperation to improve and sustain management of patients affected with eclectic ocular comorbidities and/or systemic disorders with eye repercussion is specifically addressed. This review intends to shed light on these topics to help in making opportune diagnosis and appropriately managing the affected patients.
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