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Subhi Y, Schneider M, Hajari JN, la Cour M. Injection burden and treatment intervals of aflibercept in observe-and-plan regimen for neovascular age-related macular degeneration. Acta Ophthalmol 2024; 102:821-827. [PMID: 38733136 DOI: 10.1111/aos.16709] [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: 01/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE The Observe-and-Plan (O&P) regimen allows for individualised treatment. In this study, we evaluated injection burden and intervals using aflibercept in an O&P regimen for eyes with neovascular age-related macular degeneration (AMD). METHODS This was a retrospective registry-based study of treatment-naïve eyes with neovascular AMD. Treatment data were compiled for 3 years after commencement of intravitreal aflibercept therapy. We evaluated clinical consequences at the first follow-up after loading dose, the proportion of patients who obtained and kept dry macula after loading dose, number of injections and intervals between injections. RESULTS Data were obtained for 1103 eyes. After loading dose, 0.4% were lost to follow-up, 7.5% discontinued, 50.9% booked for further injections and 41.3% booked for monthly observations. After loading dose, the macula remained dry in 49.2% at 3 months, 34.0% at 6 months, 23.7% at 12 months and 15.2% at 24 months. For the entire population, median cumulative total number of injections was 7, 12 and 15, after 1, 2 and 3 years, respectively. After the 3rd year, the proportion of eyes in the short 4-6 weeks treatment interval was 51.1%, 8 weeks interval was kept in 14.4% and the extended treatment intervals of 10 and 12 weeks was possible in 34.4%. CONCLUSION After loading dose, one in two eyes required further injections. A large proportion required therapy with shorter intervals than the label-recommended 8 weeks. The large majority of those who obtained a dry macula after loading dose turned exudative again, mostly within the first 3 months.
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Affiliation(s)
- Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Javad Nouri Hajari
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Munzar R, Roh S, Ramsey DJ. Factors associated with loss to follow-up in patients with advanced age-related macular degeneration: A telehealth recall initiative. Ophthalmic Physiol Opt 2024; 44:626-633. [PMID: 38425149 DOI: 10.1111/opo.13298] [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: 08/10/2023] [Revised: 11/19/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Patients with advanced age-related macular degeneration (AMD) frequently experience loss to follow-up (LTFU), heightening the risk of vision loss from treatment delays. This study aimed to identify factors contributing to LTFU in patients with advanced AMD and assess the effectiveness of telephone-based outreach in reconnecting them with eye care. METHODS A custom reporting tool identified patients with advanced AMD who had not returned for eye care between 31 October 2021 and 1 November 2022. Potentially LTFU patients were enrolled in a telephone outreach programme conducted by a telehealth extender to encourage their return for care. Linear regression analysis identified factors associated with being LTFU and likelihood of accepting care post-outreach. RESULTS Out of 1269 patients with advanced AMD, 105 (8.3%) did not return for recommended eye care. Patients LTFU were generally older (89.2 ± 8.9 years vs. 87.2 ± 8.5 years, p = 0.02) and lived farther from the clinic (25 ± 43 miles vs. 17 ± 30 miles, p = 0.009). They also had a higher rate of advanced dry AMD (26.7% vs. 18.5%, p = 0.04) and experienced worse vision in both their better-seeing (0.683 logMAR vs. 0.566 logMAR, p = 0.03) and worse-seeing (1.388 logMAR vs. 1.235 logMAR, p = 0.04) eyes. Outreach by a telehealth extender reached 62 patients (59%), 43 through family members or healthcare proxies. Half of the cases where a proxy was contacted revealed that the patient in question had died. Among those contacted directly, one third expressed willingness to resume eye care (20 patients), with 11 scheduling appointments (55%). Despite only two patients returning for in-person eye care through the intervention, the LTFU rate halved to 4.4% by accounting for those patients who no longer needed eye care at the practice. CONCLUSIONS There is a substantial risk that older patients with advanced AMD will become LTFU. Targeted telephone outreach can provide a pathway for vulnerable patients to return to care.
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Affiliation(s)
- Rachel Munzar
- Lahey Department of Surgery, Division of Ophthalmology, UMass Chan Medical School, University of Massachusetts, Burlington, Massachusetts, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Shiyoung Roh
- Lahey Department of Surgery, Division of Ophthalmology, UMass Chan Medical School, University of Massachusetts, Burlington, Massachusetts, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - David J Ramsey
- Lahey Department of Surgery, Division of Ophthalmology, UMass Chan Medical School, University of Massachusetts, Burlington, Massachusetts, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
- New England College of Optometry, Boston, Massachusetts, USA
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Huther A, Roh S, Ramsey DJ. Telehealth improves follow-up and monitoring of age-related macular degeneration during the COVID-19 pandemic. Int Ophthalmol 2023; 43:5031-5043. [PMID: 37921948 DOI: 10.1007/s10792-023-02906-9] [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: 04/21/2022] [Accepted: 09/28/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE To prevent vision loss, it is important to monitor patients with age-related macular degeneration (AMD) for the development of choroidal neovascularization. The coronavirus disease 2019 (COVID-19) pandemic caused many patients to miss or delay visits. To offset those gaps in care, providers utilized telehealth (TH) to evaluate patients for symptoms of disease progression and provide health education on the importance of continuous monitoring. METHODS This study evaluates the impact of TH encounters on the rate of return for recommended in-person examinations for 1103 patients with non-neovascular (dry) AMD seen in an outpatient ophthalmology clinic in 2019 and due for return evaluation after the outbreak of COVID-19 in 2020. Logistic regression analysis was used to identify demographic, clinical, and sociomedical factors associated with TH utilization and in-person return. RESULTS 422 patients (38%) utilized TH during the study period. Patients who completed a TH encounter were more likely to return for an in-person examination as compared with those who did not receive TH (OR: 1.8, CI 95%: 1.4-2.3, P < 0.001). Completing a TH visit was associated with the detection of new wet AMD (OR: 3.3, 95% CI 1.04-10.6, P = 0.043), as well as with an earlier return for those patients who were found to have disease progression (62 ± 54 days vs. 100 ± 57 days, P = 0.049). CONCLUSION Completing a TH visit increased the rate at which patients with dry AMD returned for recommended in-person eye examinations. In many cases, this permitted the earlier detection of wet AMD, which is linked with achieving better outcomes.
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Affiliation(s)
- Alexander Huther
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA, 01960, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Shiyoung Roh
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA, 01960, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - David J Ramsey
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA, 01960, USA.
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA.
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Onwuka O, Saddemi JL, Akkan Aydoğmuş FS, Lasalle CC, Ramsey DJ. Consequences of Real-World Surveillance of Fellow Eyes in Neovascular Age-Related Macular Degeneration. Life (Basel) 2023; 13:385. [PMID: 36836742 PMCID: PMC9963142 DOI: 10.3390/life13020385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
This study investigated whether the interval of monitoring at-risk, fellow eyes of patients with unilateral neovascular age-related macular degeneration (nAMD) has any bearing on the severity of the disease at the time of diagnosis. The study comprised a retrospective, cross-sectional comparative case series of treatment-naïve eyes in patients who were diagnosed sequentially with nAMD. We compared the visual acuity (VA) and central macular thickness (CMT) of patients who were actively receiving intravitreal injections (IVIs) of anti-vascular endothelial growth factor (anti-VEGF) agents at the time of second eye diagnosis with the VA and CMT of patients who had ceased treatment in their first eye because of reaching end-stages of disease. Intervals of visits and frequency of monitoring the macula of fellow eyes by means of optical coherence tomography (OCT) were abstracted from the medical record. We found that the at-risk fellow eyes of patients who had stopped treatment for nAMD in their first eye prior to fellow eye conversion were monitored significantly less frequently than the fellow eyes of patients who continued to receive treatment at the time of second eye diagnosis. Despite less frequent monitoring, VA and CMT were similar at the time of fellow eye diagnosis for both groups.
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Affiliation(s)
- Oluchukwu Onwuka
- Department of Surgery, Division of Ophthalmology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA 01805, USA; (O.O.); (J.L.S.); (F.S.A.A.); (C.C.L.)
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Jackson L. Saddemi
- Department of Surgery, Division of Ophthalmology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA 01805, USA; (O.O.); (J.L.S.); (F.S.A.A.); (C.C.L.)
- Cooper Medical School, Rowan University, Camden, NJ 08103, USA
| | - Fatma Sema Akkan Aydoğmuş
- Department of Surgery, Division of Ophthalmology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA 01805, USA; (O.O.); (J.L.S.); (F.S.A.A.); (C.C.L.)
- Ophthalmology Department, Ankara Sehir Hastanesi, Üniversiteler, Çankaya, 06800 Ankara, Turkey
| | - Claudia C. Lasalle
- Department of Surgery, Division of Ophthalmology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA 01805, USA; (O.O.); (J.L.S.); (F.S.A.A.); (C.C.L.)
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA
| | - David J. Ramsey
- Department of Surgery, Division of Ophthalmology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA 01805, USA; (O.O.); (J.L.S.); (F.S.A.A.); (C.C.L.)
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA
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Research Advances in Age-Related Macular Degeneration. J Clin Med 2022; 11:jcm11133627. [PMID: 35806911 PMCID: PMC9267815 DOI: 10.3390/jcm11133627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022] Open
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Kim JG, Kim YC, Kang KT. Impact of Delayed Intravitreal Anti-Vascular Endothelial Growth Factor (VEGF) Therapy Due to the Coronavirus Disease Pandemic on the Prognosis of Patients with Neovascular Age-Related Macular Degeneration. J Clin Med 2022; 11:jcm11092321. [PMID: 35566445 PMCID: PMC9100166 DOI: 10.3390/jcm11092321] [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: 02/24/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
This study estimated the outcome of delayed intravitreal anti-vascular endothelial growth factor (VEGF) therapy due to the coronavirus (COVID-19) disease pandemic on the prognosis of patients with neovascular age-related macular degeneration (nAMD). This study retrospectively enrolled 57 nAMD patients whose intravitreal anti-VEGF injections were delayed for >2 weeks between February and June 2020. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and anatomical characteristics were evaluated before (baseline), on the day, and at 2, 4, and 6 months after the delayed injection, and risk factors were identified. The average injection interval before and after treatment delay was 3.05 ± 1.45 and 2.41 ± 1.46 months, respectively (p = 0.002). The CST at baseline and on the day of delayed injection was 227.82 ± 62.46 and 267.26 ± 77.74 µm, respectively (p < 0.001). The average BCVA decreased from 0.29 ± 0.29 logMAR (baseline) to 0.38 ± 0.31 logMAR (6 months) (p = 0.001). The maximum subretinal fluid (SRF) height increased from 84.32 ± 89.33 µm (baseline) to 121.38 ± 103.36 µm (6 months) (p = 0.027). A higher baseline maximum SRF height was associated with less SRF height deterioration 6 months later (p < 0.001). Delayed intravitreal anti-VEGF therapy caused by the COVID-19 pandemic has worsened BCVA and residual SRF in nAMD patients after a temporary recovery. The baseline SRF reduce the degree of SRF height deterioration.
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Drop in well-being of ARMD patients under treatment with anti-VEGF injections during the COVID-19 pandemic. Int Ophthalmol 2022; 42:2493-2499. [PMID: 35362811 PMCID: PMC8972774 DOI: 10.1007/s10792-022-02296-4] [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: 10/31/2021] [Accepted: 03/10/2022] [Indexed: 11/15/2022]
Abstract
Purpose Patients with age-related macular degeneration (ARMD) are required to follow a treatment protocol that requires regular follow-ups. The COVID-19 pandemic has created an additional burden for patients with ARMD under treatment with anti-vascular endothelial growth factor (anti-VEGF) injections, since patients face a congestion of the health system and closing of the outpatient services. This study examines the impact of the uncertainty regarding patients’ treatment on their sense of well-being.
Methods This is a longitudinal cohort study of eighty patients who were followed during the year following the outbreak of the COVID pandemic. Patients reported their sense of well-being with the WHO-5 questionnaire and their perception and fears for the impact of the pandemic on their ongoing ARMD treatment. Results There was a significant drop in mental well-being during the pandemic that paralleled the self-reported impact of the pandemic on ARMD treatment. Patients who reported a higher impact of COVID-19 on their treatment had experienced a higher drop in mental wellbeing compared to those who hadn’t, with female gender being an additional risk factor. Objective measurements of visual acuity did not factor in the drop of sense of well-being. Conclusions The high initial level of uncertainty regarding ARMD patients’ long-term course was further exacerbated when exposed to additional uncertainties during the pandemic regarding their standard of care. Planning ahead for continuation of services and close contact with patients during similar health emergencies is of paramount importance.
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Telemedicine for the Diagnosis and Management of Age-Related Macular Degeneration: A Review. J Clin Med 2022; 11:jcm11030835. [PMID: 35160286 PMCID: PMC8836711 DOI: 10.3390/jcm11030835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 01/30/2023] Open
Abstract
Use of ophthalmic telemedicine for patients with age-related macular degeneration (AMD) has shown remarkable advances over recent years. The recent COVID pandemic accelerated this transition since in-person evaluation of elderly patients at high risk for advanced AMD and severe vision loss were also at higher risk for complications from COVID infection. To date, ophthalmic telemedicine has been successfully used in remote retinal consultation by general ophthalmologists for AMD management, hybrid testing visits with both in-office testing and remote evaluation, as well as early successes in home-based remote monitoring of patients with high-risk AMD. We therefore review the current literature and evidence base related to ophthalmic telemedicine for AMD.
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Invernizzi A. The impact of COVID-19 on the retina: clinical features and management considerations. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2021877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
- The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Save Sight Institute, Sydney Eye Hospital, The University of Sydney, Sydney, Australia
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Effect of COVID-19 Lockdown in Spain on Structural and Functional Outcomes of Neovascular AMD Patients. J Clin Med 2021; 10:jcm10163551. [PMID: 34441845 PMCID: PMC8397186 DOI: 10.3390/jcm10163551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022] Open
Abstract
This is a retrospective single-center study of patients with neovascular age-related macular degeneration whose follow-up was delayed due to COVID-19 pandemic with at least three months between visits in Madrid, Spain. The purpose of the study was to evaluate best corrected visual acuity (BCVA) changes and try to identify features in optical coherence tomography (OCT) that could be related to more profound visual loss. It included 270 eyes. The two last visits before lockdown were used for comparison with the visit after lockdown. BCVA changed from 60.2 ± 18.2 to 55.9 ± 20.5 ETDRS letters. 29% of the eyes lost more than 5 letters. OCT was active in 67% of eyes before lockdown and in 80.4% after lockdown. Multiple lineal analysis showed that patients whose OCT before lockdown presented with a combination of intra and subretinal fluid were more likely to suffer a greater visual loss (p = 0.002). These patients should be encouraged to not miss any visits in case a new lockdown is imposed.
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