1
|
Kusenda P, Caprnda M, Gabrielova Z, Kukova N, Pavlovic S, Stefanickova J. Understanding Loss to Follow-Up in AMD Patients Receiving VEGF Inhibitor Therapy: Associated Factors and Underlying Reasons. Diagnostics (Basel) 2024; 14:400. [PMID: 38396439 PMCID: PMC10887977 DOI: 10.3390/diagnostics14040400] [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: 01/15/2024] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND In patients with wet age-related macular degeneration (AMD), loss to follow-up (LTFU) leads to unplanned interruptions in therapy and the risk of visual loss. METHODS This retrospective and prospective case-control cohort study compared AMD patients with (LTFU YES) and without (LTFU NO) LTFU during anti-VEGF treatment over 12 years. LTFU was defined as missing any treatment or monitoring visits, or not scheduling follow-ups for six months. RESULTS Significant differences between LTFU NO (n = 298) and LTFU YES (n = 174) groups were age, treatment phase, baseline and final best-corrected visual acuity (BCVA), type of anti-VEGF drug, treatment switch, commuting distance, and escort during commuting. A multivariate logistic regression analysis identified the need for an escort during the commuting and treatment phase as the only significant difference. The four most common reasons for LTFU were general health worsening (21.8%), patient-missed appointments (16.7%), COVID-19-related issues (14.9%), and treatment dissatisfaction (8.6%). CONCLUSIONS The factors associated with increased LTFU rates were older age, inactive treatment phase, lower baseline and final BCVA, bevacizumab treatment, monotherapy, longer travelling distance, and commuting with an escort. According to the multivariate logistic regression analysis, only the escort during the commuting and treatment phases was significant. These findings could direct research to explore social support in treatment adherence and highlight the importance of treatment phases in practice.
Collapse
Affiliation(s)
- Pavol Kusenda
- Department of Ophthalmology, University Hospital—St. Michael’s Hospital, 811 08 Bratislava, Slovakia; (P.K.); (Z.G.)
| | - Martin Caprnda
- First Department of Internal Medicine, Faculty of Medicine, Comenius University, University Hospital Bratislava, 811 07 Bratislava, Slovakia;
| | - Zuzana Gabrielova
- Department of Ophthalmology, University Hospital—St. Michael’s Hospital, 811 08 Bratislava, Slovakia; (P.K.); (Z.G.)
| | | | - Samuel Pavlovic
- Department of Ophthalmology, Faculty Hospital Nitra, 950 01 Nitra, Slovakia;
| | - Jana Stefanickova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, 821 01 Bratislava, Slovakia
- Oftalmocentrum Betliarska Euromedix, 851 07 Bratislava, Slovakia
| |
Collapse
|
2
|
McAllister IL, Smithies LA, Chen FK, Mackey DA, Sanfilippo PG. Benefits of a Laser Chorioretinal Anastomosis Plus Ranibizumab vs Ranibizumab Alone for Central Retinal Vein Occlusion: 4-Year Results. Am J Ophthalmol 2023; 252:101-110. [PMID: 37030494 DOI: 10.1016/j.ajo.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE To evaluate what clinical gains can be achieved over conventional treatment with ranibizumab alone for central retinal vein occlusion (CRVO) when causal pathology is additionally addressed successfully with a laser-induced chorio-retinal anastomosis (L-CRA). DESIGN Two-year extension of prospective, randomized controlled clinical trial. METHODS A total of 58 patients with macular edema secondary to CRVO were randomized 1:1 to receive either an L-CRA (n = 29) or sham procedure (n = 29) at baseline and then monthly intravitreal ranibizumab 0.5 mg. Outcomes (best corrected visual acuity [BCVA], central subfield thickness [CST], injection requirements) were monitored in the monthly pro re nata (PRN) ranibizumab phase from months 7 to 48. RESULTS Injection requirements for patients with a functioning L-CRA (24 of 29) during the monthly PRN period from 7 to 24 months were a mean (95% CI) of 2.18 (1.57, 2.78) injections compared to 7.07 (6.08, 8.06) (P < .0001) for control (ranibizumab alone). These decreased further over the next 2 years to 0.29 (0.14, 0.61) compared to 2.20 (1.68, 2.88) (P < .001) for the third year and 0.25 (0.11, 0.56) and 1.84 (1.34, 2.54) for the fourth year (P < .001). Mean BCVA was statistically different at all follow-up time points from month 7 through month 48 for the group with the functioning L-CRA compared to the control monotherapy group. This improved to 14.06 letters at month 48 (P = .009). There was no difference in CST between any of the groups over the 48 months of follow-up. CONCLUSION For CRVO patients, addressing causal pathology in addition to conventional therapy improves BCVA and reduces injection requirements.
Collapse
Affiliation(s)
- Ian L McAllister
- From the Centre for Ophthalmology and Visual Science (I.L.M., L.A.S., F.K.C., D.A.M., P.G.S.), Lions Eye Institute, University of Western Australia, Perth, Australia.
| | - Lynne A Smithies
- From the Centre for Ophthalmology and Visual Science (I.L.M., L.A.S., F.K.C., D.A.M., P.G.S.), Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Fred K Chen
- From the Centre for Ophthalmology and Visual Science (I.L.M., L.A.S., F.K.C., D.A.M., P.G.S.), Lions Eye Institute, University of Western Australia, Perth, Australia
| | - David A Mackey
- From the Centre for Ophthalmology and Visual Science (I.L.M., L.A.S., F.K.C., D.A.M., P.G.S.), Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Paul G Sanfilippo
- From the Centre for Ophthalmology and Visual Science (I.L.M., L.A.S., F.K.C., D.A.M., P.G.S.), Lions Eye Institute, University of Western Australia, Perth, Australia; Centre for Eye Research Australia (P.G.S.), University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| |
Collapse
|
3
|
Hicks PM, Kang L, Armstrong ML, Pongrac JR, Stagg BC, Saylor KM, Newman-Casey PA, Woodward MA. A scoping review of patients' barriers to eye care for glaucoma and keratitis. Surv Ophthalmol 2023; 68:567-577. [PMID: 37004793 PMCID: PMC10875963 DOI: 10.1016/j.survophthal.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
In this scoping review, we examine underlying causes of loss to follow-up for chronic (glaucoma) and acute (corneal ulcers) eye conditions using the Penchansky and Thomas access to care framework. We explore barriers by World Health Organization income levels and by studying geographical location. We identified 6,363 abstracts, with 75 articles retrieved and 16 meeting inclusion criteria. One article discussed barriers to follow-up care for people with corneal ulcers, and the other 15 were for people with glaucoma. The most frequent barriers to care were affordability, awareness, and accessibility. The international studies had a greater percentage of studies report acceptability as a barrier to loss to follow-up. Countries with universal healthcare included affordability as a loss to follow-up barrier, emphasizing that cost goes beyond the ability to pay for direct treatment costs. Understanding and addressing barriers to follow-up care can aid the goal of continued care and decrease the risk of poor outcomes and vision loss.
Collapse
Affiliation(s)
- Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Linda Kang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - Joseph R Pongrac
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Brian C Stagg
- John Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Kate M Saylor
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
4
|
Huang X, Zheng M, Lu J, Wang X, Zheng Z. Analyze of factors and prognosis of eyes lost to follow-up in retinal vein occlusive disease patients receiving anti-vascular endothelial growth factor therapy. BMC Ophthalmol 2023; 23:262. [PMID: 37308854 DOI: 10.1186/s12886-023-03018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Patients with macular edema (ME) secondary to retinal vein occlusion (RVO) who received at least one intravitreal injection of anti-vascular endothelial growth factor therapy (VEGF) and lost to follow-up (LTFU) for more than six months were analyzed to investigate the factors contributing to the LTFU and the prognosis. METHOD This was a retrospective, single-center study to analyze the causes and prognosis of LTFU over six months in RVO-ME patients treated with intravitreal anti-VEGF injections at our institution from January 2019 to August 2022 and to collect patients' baseline characteristics along with the number of injections before LTFU, primary disease, best corrected visual acuity (BCVA) before LTFU and after return visit, central macular thickness (CMT), months before LTFU and after LTFU, reasons for LTFU, and complications, to analyze the factors affecting visual outcome at a return visit. RESULTS This study included 125 patients with LTFU; 103 remained LTFU after six months, and 22 returned after LTFU. The common reason for LTFU was "no improvement in vision" (34.4%), followed by "transport inconvenience" (22.4%), 16 patients (12.8%) were unwilling to visit the clinic, 15 patients (12.0%) had already elected to seek treatment elsewhere, 12 patients (9.6%) were not seen in time due to the 2019-nCov epidemic, and 11 patients (8.8%) cannot do it due to financial reasons. The number of injections before LTFU was a risk factor for LTFU (P < 0.05). LogMAR at the initial visit (P < 0.001), CMT at the initial visit (P < 0.05), CMT before the LTFU (P < 0.001), and CMT after the return visit (P < 0.05) were influential factors for logMAR at the return visit. CONCLUSION Most RVO-ME patients were LTFU after anti-VEGF therapy. Long-term LTFU is greatly detrimental to the visual quality of patients; thus, the management of RVO-ME patients in follow-up should be considered.
Collapse
Affiliation(s)
- Xiaoying Huang
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Minming Zheng
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiatao Lu
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng Zheng
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
5
|
Qin Z, Li X, Ren H, Song W, Su L, Gao X. The Correlation between Obstructive Sleep Apnea and Retinal Vein Obstruction: A Meta-Analysis and Systematic Review. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8065629. [PMID: 35935317 PMCID: PMC9296346 DOI: 10.1155/2022/8065629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
Despite of inadequate evidence, previous studies have demonstrated a potential correlation between obstructive sleep apnea (OSA) and retinal vein occlusion (RVO). In this study, a meta-analysis is conducted to investigate the correlation between OSA and RVO. Databases are searched for relevant literatures up to July 14, 2021, including PubMed, Embase, Cochrane, Web of Science, CNKI, WanFang, VIP, and Chinese Biomedical Literature Database (CBM). The odds ratio (OR) and 95% confidence interval (CI) are estimated to evaluate the correlation between OSA and RVO. Six articles were finally enrolled, including 36,086 subjects from 5 case-controlled studies and 1 cohort study. It is clearly evident that the RVO risk is higher among OSA patients than non-OSA patients (OR = 3.24, 95% CI = 3.24). The results of sensitivity analysis indicate that the present meta-analysis is robust and reliable. Furthermore, Egger's test for publication bias is performed with P = 0.195, and the results reveal no significant publication bias. The findings demonstrate that OSA is significantly correlated with RVO, and OSA is a risk factor for RVO.
Collapse
Affiliation(s)
- Ziwen Qin
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Xiang Li
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Hanyu Ren
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Wei Song
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Longlong Su
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Xiaoling Gao
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| |
Collapse
|
6
|
Drozdova EA. [Long-term outcomes of anti-VEGF therapy for macular edema in retinal vein occlusion]. Vestn Oftalmol 2022; 138:140-148. [PMID: 35801893 DOI: 10.17116/oftalma2022138031140] [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] [Indexed: 06/15/2023]
Abstract
Antiangiogenic therapy (anti-VEGF) is the standard in the treatment of many retinal vascular diseases, including macular edema associated with retinal vein occlusion (RVO). A large evidentiary basis has been collected, consisting of randomized clinical trials in which anti-VEGF therapy demonstrated a significant advantage over laser photocoagulation and placebo in patients with RVO. However, in everyday clinical practice the results are not always comparable to randomized clinical trials. This review presents an analysis of the current studies based on actual clinical practice. Their results helped identify the main aspects of antiangiogenic therapy that could improve the treatment outcomes for patients with RVO. Additionally, the article discusses the predictive factors for therapy outcomes and the effect of anti-VEGF therapy on the development of neovascular complications in patients with ischemic RVO.
Collapse
Affiliation(s)
- E A Drozdova
- South-Ural State Medical University, Chelyabinsk, Russia
| |
Collapse
|