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Tan TE, Jampol LM, Ferris FL, Tadayoni R, Sadda SR, Chong V, Domalpally A, Blodi BL, Duh EJ, Curcio CA, Antonetti DA, Dutta S, Levine SR, Sun JK, Gardner TW, Wong TY. Imaging Modalities for Assessing the Vascular Component of Diabetic Retinal Disease: Review and Consensus for an Updated Staging System. Ophthalmol Sci 2024; 4:100449. [PMID: 38313399 PMCID: PMC10837643 DOI: 10.1016/j.xops.2023.100449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 02/06/2024]
Abstract
Purpose To review the evidence for imaging modalities in assessing the vascular component of diabetic retinal disease (DRD), to inform updates to the DRD staging system. Design Standardized narrative review of the literature by an international expert workgroup, as part of the DRD Staging System Update Effort, a project of the Mary Tyler Moore Vision Initiative. Overall, there were 6 workgroups: Vascular Retina, Neural Retina, Systemic Health, Basic and Cellular Mechanisms, Visual Function, and Quality of Life. Participants The Vascular Retina workgroup, including 16 participants from 4 countries. Methods Literature review was conducted using standardized evidence grids for 5 modalities: standard color fundus photography (CFP), widefield color photography (WFCP), standard fluorescein angiography (FA), widefield FA (WFFA), and OCT angiography (OCTA). Summary levels of evidence were determined on a validated scale from I (highest) to V (lowest). Five virtual workshops were held for discussion and consensus. Main Outcome Measures Level of evidence for each modality. Results Levels of evidence for standard CFP, WFCP, standard FA, WFFA, and OCTA were I, II, I, I, and II respectively. Traditional vascular lesions on standard CFP should continue to be included in an updated staging system, but more studies are required before they can be used in posttreatment eyes. Widefield color photographs can be used for severity grading within the area covered by standard CFPs, although these gradings may not be directly interchangeable with each other. Evaluation of the peripheral retina on WFCP can be considered, but the method of grading needs to be clarified and validated. Standard FA and WFFA provide independent prognostic value, but the need for dye administration should be considered. OCT angiography has significant potential for inclusion in the DRD staging system, but various barriers need to be addressed first. Conclusions This study provides evidence-based recommendations on the utility of various imaging modalities for assessment of the vascular component of DRD, which can inform future updates to the DRD staging system. Although new imaging modalities offer a wealth of information, there are still major gaps and unmet research needs that need to be addressed before this potential can be realized. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Tien-En Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Programme (EYE ACP), Duke-National University of Singapore Medical School, Singapore
| | - Lee M. Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Ramin Tadayoni
- Ophthalmology Department, Lariboisière, AP-HP, Saint Louis and Fondation Adolphe de Rothschild Hospitals, Université Paris Cité, Paris, France
| | - Srinivas R. Sadda
- Doheny Eye Institute, Pasadena, California
- Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Victor Chong
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, Wisconsin Reading Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Barbara L. Blodi
- Department of Ophthalmology and Visual Sciences, Wisconsin Reading Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Elia J. Duh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - David A. Antonetti
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - S. Robert Levine
- The Mary Tyler Moore & S. Robert Levine, MD Charitable Foundation, Greenwich, Connecticut
| | - Jennifer K. Sun
- Joslin Diabetes Center, Beetham Eye Institute, Harvard Medical School, Boston, Massachusetts
| | - Thomas W. Gardner
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Programme (EYE ACP), Duke-National University of Singapore Medical School, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
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Olvera-Barrios A, Rudnicka AR, Anderson J, Bolter L, Chambers R, Warwick AN, Welikala R, Fajtl J, Barman S, Remgnino P, Wu Y, Lee AY, Chew EY, Ferris FL, Hingorani A, Sofat R, A Egan C, Tufail A, Owen CG. Two-year recall for people with no diabetic retinopathy: a multi-ethnic population-based retrospective cohort study using real-world data to quantify the effect. Br J Ophthalmol 2023; 107:1839-1845. [PMID: 37875374 DOI: 10.1136/bjo-2023-324097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/19/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND/AIMS The English Diabetic Eye Screening Programme (DESP) offers people living with diabetes (PLD) annual screening. Less frequent screening has been advocated among PLD without diabetic retinopathy (DR), but evidence for each ethnic group is limited. We examined the potential effect of biennial versus annual screening on the detection of sight-threatening diabetic retinopathy (STDR) and proliferative diabetic retinopathy (PDR) among PLD without DR from a large urban multi-ethnic English DESP. METHODS PLD in North-East London DESP (January 2012 to December 2021) with no DR on two prior consecutive screening visits with up to 8 years of follow-up were examined. Annual STDR and PDR incidence rates, overall and by ethnicity, were quantified. Delays in identification of STDR and PDR events had 2-year screening intervals been used were determined. FINDINGS Among 82 782 PLD (37% white, 36% South Asian, and 16% black people), there were 1788 incident STDR cases over mean (SD) 4.3 (2.4) years (STDR rate 0.51, 95% CI 0.47 to 0.55 per 100-person-years). STDR incidence rates per 100-person-years by ethnicity were 0.55 (95% CI 0.48 to 0.62) for South Asian, 0.34 (95% CI 0.29 to 0.40) for white, and 0.77 (95% CI 0.65 to 0.90) for black people. Biennial screening would have delayed diagnosis by 1 year for 56.3% (1007/1788) with STDR and 43.6% (45/103) with PDR. Standardised cumulative rates of delayed STDR per 100 000 persons for each ethnic group were 1904 (95% CI 1683 to 2154) for black people, 1276 (95% CI 1153 to 1412) for South Asian people, and 844 (95% CI 745 to 955) for white people. INTERPRETATION Biennial screening would have delayed detection of some STDR and PDR by 1 year, especially among those of black ethnic origin, leading to healthcare inequalities.
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Affiliation(s)
- Abraham Olvera-Barrios
- Institute of Ophthalmology, University College London, London, UK, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St George's, University of London, London, UK
| | - John Anderson
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Louis Bolter
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Ryan Chambers
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Alasdair N Warwick
- Institute of Cardiovascular Science, University College London, London, UK
| | - Roshan Welikala
- Department of Computer Science, Kingston University, Kingston-Upon-Thames, UK
| | - Jiri Fajtl
- Department of Computer Science, Kingston University, Kingston-Upon-Thames, UK
| | - Sarah Barman
- Department of Computer Science, Kingston University, Kingston-Upon-Thames, UK
| | - Paolo Remgnino
- Department of Computer Science, University of Durham, Durham, UK
| | - Yue Wu
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Aroon Hingorani
- Institute of Cardiovascular Science, University College London, London, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Catherine A Egan
- Institute of Ophthalmology, University College London, London, UK, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adnan Tufail
- Institute of Ophthalmology, University College London, London, UK, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's, University of London, London, UK
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Olvera-Barrios A, Owen CG, Anderson J, Warwick AN, Chambers R, Bolter L, Wu Y, Welikala R, Fajtl J, Barman SA, Remagnino P, Chew EY, Ferris FL, Hingorani AD, Sofat R, Lee AY, Egan C, Tufail A, Rudnicka AR. Ethnic disparities in progression rates for sight-threatening diabetic retinopathy in diabetic eye screening: a population-based retrospective cohort study. BMJ Open Diabetes Res Care 2023; 11:e003683. [PMID: 37949472 PMCID: PMC10649497 DOI: 10.1136/bmjdrc-2023-003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/08/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The English Diabetic Eye Screening Programme (DESP) offers people living with diabetes (PLD) annual eye screening. We examined incidence and determinants of sight-threatening diabetic retinopathy (STDR) in a sociodemographically diverse multi-ethnic population. RESEARCH DESIGN AND METHODS North East London DESP cohort data (January 2012 to December 2021) with 137 591 PLD with no retinopathy, or non-STDR at baseline in one/both eyes, were used to calculate STDR incidence rates by sociodemographic factors, diabetes type, and duration. HR from Cox models examined associations with STDR. RESULTS There were 16 388 incident STDR cases over a median of 5.4 years (IQR 2.8-8.2; STDR rate 2.214, 95% CI 2.214 to 2.215 per 100 person-years). People with no retinopathy at baseline had a lower risk of sight-threatening diabetic retinopathy (STDR) compared with those with non-STDR in one eye (HR 3.03, 95% CI 2.91 to 3.15, p<0.001) and both eyes (HR 7.88, 95% CI 7.59 to 8.18, p<0.001). Black and South Asian individuals had higher STDR hazards than white individuals (HR 1.57, 95% CI 1.50 to 1.64 and HR 1.36, 95% CI 1.31 to 1.42, respectively). Additionally, every 5-year increase in age at inclusion was associated with an 8% reduction in STDR hazards (p<0.001). CONCLUSIONS Ethnic disparities exist in a health system limited by capacity rather than patient economic circumstances. Diabetic retinopathy at first screen is a strong determinant of STDR development. By using basic demographic characteristics, screening programmes or clinical practices can stratify risk for sight-threatening diabetic retinopathy development.
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Affiliation(s)
- Abraham Olvera-Barrios
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St. George's University of London, London, UK
| | - John Anderson
- Diabetes, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Alasdair N Warwick
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ryan Chambers
- Diabetes, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Louis Bolter
- Diabetes, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Yue Wu
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
- Roger and Angie Keralis Johnson Retina Center, Seattle, Washington, USA
| | - Roshan Welikala
- School of Computer Science and Mathematics, Kingston University, London, UK
| | - Jiri Fajtl
- School of Computer Science and Mathematics, Kingston University, London, UK
| | - Sarah A Barman
- School of Computer Science and Mathematics, Kingston University, London, UK
| | - Paolo Remagnino
- Department of Computer Science, Durham University, Durham, UK
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, NEI/NIH, Bethesda, Maryland, USA
| | | | - Aroon D Hingorani
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
- Roger and Angie Keralis Johnson Retina Center, Seattle, Washington, USA
| | - Catherine Egan
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St. George's University of London, London, UK
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Sun JK, Beaulieu WT, Melia M, Ferris FL, Maturi RK, Nielsen JS, Solomon SD, Jampol LM. DEFINING "STRONG" VERSUS "WEAK" RESPONSE TO ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT FOR CENTER-INVOLVED DIABETIC MACULAR EDEMA. Retina 2023; 43:616-623. [PMID: 36728692 PMCID: PMC11040570 DOI: 10.1097/iae.0000000000003730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/PURPOSE To define "strong" versus "weak" antivascular endothelial growth factor (anti-VEGF) treatment response in eyes with center-involved diabetic macular edema (CI-DME). METHODS Exploratory analyses of three DRCR Retina Network randomized trials of eyes with CI-DME treated with aflibercept, bevacizumab, or ranibizumab. Thresholds of 5-, 10-, and 15-letter gain defined strong visual acuity (VA) response when baseline VA was 20/25-20/32, 20/40-20/63, or 20/80-20/320, respectively. Thresholds of 50, 100, or 200- µ m reduction defined strong anatomical response when baseline central subfield thickness (CST) was <75, ≥75 to <175, or ≥175- µ m above standard thresholds. Additional thresholds from regression equations were calculated. RESULTS At 24 weeks, outcomes for strong response were achieved by 476 of 958 eyes (50%) for VA and 505 eyes (53%) for CST. At 104 weeks among the 32% of eyes with strong VA and CST response at 24 weeks, 195 of 281 (69%) maintained strong VA and CST response, whereas 20 (7%) had neither strong VA nor strong CST response. Outcomes rates were similar across protocols and when defined using regression equations. CONCLUSION These phenotypes are suitable for efforts to identify predictive biomarkers for response to anti-VEGF therapy for DME and might facilitate comparison of treatment response among diverse cohorts with DME.
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Affiliation(s)
- Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology, Boston, Massachusetts
| | | | | | | | - Raj K Maturi
- Midwest Eye Institute, Indianapolis, Indiana
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Sharon D Solomon
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University Medical School, Chicago, Illinois
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Jhaveri CD, Glassman AR, Ferris FL, Liu D, Maguire MG, Allen JB, Baker CW, Browning D, Cunningham MA, Friedman SM, Jampol LM, Marcus DM, Martin DF, Preston CM, Stockdale CR, Sun JK. Aflibercept Monotherapy or Bevacizumab First for Diabetic Macular Edema. N Engl J Med 2022; 387:692-703. [PMID: 35833805 PMCID: PMC9714135 DOI: 10.1056/nejmoa2204225] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In eyes with diabetic macular edema, the relative efficacy of administering aflibercept monotherapy as compared with bevacizumab first with a switch to aflibercept if the eye condition does not improve sufficiently (a form of step therapy) is unclear. METHODS At 54 clinical sites, we randomly assigned eyes in adults who had diabetic macular edema involving the macular center and a visual-acuity letter score of 24 to 69 (on a scale from 0 to 100, with higher scores indicating better visual acuity; Snellen equivalent, 20/320 to 20/50) to receive either 2.0 mg of intravitreous aflibercept or 1.25 mg of intravitreous bevacizumab. The drug was administered at randomization and thereafter according to the prespecified retreatment protocol. Beginning at 12 weeks, eyes in the bevacizumab-first group were switched to aflibercept therapy if protocol-specified criteria were met. The primary outcome was the mean change in visual acuity over the 2-year trial period. Retinal central subfield thickness and visual acuity at 2 years and safety were also assessed. RESULTS A total of 312 eyes (in 270 adults) underwent randomization; 158 eyes were assigned to receive aflibercept monotherapy and 154 to receive bevacizumab first. Over the 2-year period, 70% of the eyes in the bevacizumab-first group were switched to aflibercept therapy. The mean improvement in visual acuity was 15.0 letters in the aflibercept-monotherapy group and 14.0 letters in the bevacizumab-first group (adjusted difference, 0.8 letters; 95% confidence interval, -0.9 to 2.5; P = 0.37). At 2 years, the mean changes in visual acuity and retinal central subfield thickness were similar in the two groups. Serious adverse events (in 52% of the patients in the aflibercept-monotherapy group and in 36% of those in the bevacizumab-first group) and hospitalizations for adverse events (in 48% and 32%, respectively) were more common in the aflibercept-monotherapy group. CONCLUSIONS In this trial of treatment of moderate vision loss due to diabetic macular edema involving the center of the macula, we found no evidence of a significant difference in visual outcomes over a 2-year period between aflibercept monotherapy and treatment with bevacizumab first with a switch to aflibercept in the case of suboptimal response. (Funded by the National Institutes of Health; Protocol AC ClinicalTrials.gov number, NCT03321513.).
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Affiliation(s)
- Chirag D Jhaveri
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Adam R Glassman
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Frederick L Ferris
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Danni Liu
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Maureen G Maguire
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - John B Allen
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Carl W Baker
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - David Browning
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Matthew A Cunningham
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Scott M Friedman
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Lee M Jampol
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Dennis M Marcus
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Daniel F Martin
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Carin M Preston
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Cynthia R Stockdale
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Jennifer K Sun
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
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6
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Liu J, Laiginhas R, Corvi F, Ferris FL, Lim TH, Sadda SR, Waheed NK, Iyer PG, Shen M, Shi Y, Trivizki O, Wang L, Vanner EA, Feuer WJ, Gregori G, Rosenfeld PJ. Diagnosing Persistent Hyper-Transmission Defects on En Face OCT Imaging of Age-Related Macular Degeneration. Ophthalmol Retina 2022; 6:387-397. [PMID: 35093585 PMCID: PMC9152950 DOI: 10.1016/j.oret.2022.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE A training exercise was performed to study the ability of graders to reliably identify precursor lesions to geographic atrophy (GA), known as persistent choroidal hyper-transmission defects (hyperTDs), using en face optical coherence tomography (OCT) images from eyes with non-exudative age-related macular degeneration (AMD). DESIGN Intergrader agreement study PARTICIPANTS: Eleven graders participated in this exercise. METHODS Formal training on how to identify persistent hyperTDs on en face OCT images was provided to the graders. Persistent hyperTDs were defined as bright lesions having a greatest linear dimension (GLD) of at least 250 μm. Training consisted of a tutorial session followed by the grading of three pretest exercises, each consisting of three cases. After all the graders scored 100% on the pretest exercises, they performed a final exercise consisting of 30 en face OCT images from 29 eyes with non-exudative AMD containing 107 hyperTDs that each grader needed to evaluate. The cases contained a variety of AMD-related atrophic lesions. MAIN OUTCOME MEASURES The sensitivity, positive predictive value (PPV), and modified accuracy were assessed for each grader. RESULTS A total of 1177 hyperTDs from 30 en face OCT images were reviewed by the graders. The mean sensitivity, PPV, and modified accuracy for all the graders were calculated to be 99.0%, 99.2%, and 98.2%, respectively. There was a 97% agreement observed between all the graders (AC1 = 0.97). Internal graders from the Bascom Palmer Eye Institute (BPEI) had a slightly higher agreement compared with the external graders (AC1 = 0.98 vs. 0.96). The hyperTDs most often incorrectly identified included the following features: (1) hyperTDs containing a hypo-transmission defect (hypoTD) core, (2) single hyperTDs that were incorrectly graded as two separate lesions, and (3) hyperTDs with a borderline GLD that was close to 250 μm. CONCLUSION The accurate detection of persistent hyperTDs on en face OCT images by graders demonstrates the feasibility of using this OCT biomarker to identify disease progression in eyes with non-exudative AMD, especially when used as a clinical trial endpoint in studies designed to test new therapies that may slow disease progression from intermediate AMD (iAMD) to GA.
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Affiliation(s)
- Jeremy Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rita Laiginhas
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
| | | | - Tock Han Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen, School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Prashanth G Iyer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Liang Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth A Vanner
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - William J Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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7
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Sun JK, Josic K, Melia M, Glassman AR, Bailey C, Chalam KV, Chew EY, Cukras C, Grover S, Jaffe GJ, Lee R, Nielsen JS, Thompson DJS, Wiley HE, Ferris FL. Conversion of Central Subfield Thickness Measurements of Diabetic Macular Edema Across Cirrus and Spectralis Optical Coherence Tomography Instruments. Transl Vis Sci Technol 2021; 10:34. [PMID: 34967834 PMCID: PMC8727314 DOI: 10.1167/tvst.10.14.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Develop equations to convert Cirrus central subfield thickness (CST) to Spectralis CST equivalents and vice versa in eyes with diabetic macular edema (DME). Methods The DRCR Retina Network Protocol O data were split randomly to train (70% sample) and validate (30% sample) conversion equations. Data from an independent study (CADME) also validated the equations. Bland–Altman 95% limits of agreement between predicted and observed values evaluated the equations. Results Protocol O included 374 CST scan pairs from 187 eyes (107 participants). The CADME study included 150 scan pairs of 37 eyes (37 participants). Proposed conversion equations are Spectralis = 40.78 + 0.95 × Cirrus and Cirrus = 1.82 + 0.94 × Spectralis regardless of age, sex, or CST. Predicted values were within 10% of observed values in 101 (90%) of Spectralis and 99 (88%) of Cirrus scans in the validation data; and in 136 (91%) of the Spectralis and 148 (99%) of the Cirrus scans in the CADME data. Adjusting for within-eye correlations, 95% of conversions are estimated to be within 17% (95% confidence interval, 14%–21%) of CST on Spectralis and within 22% (95% confidence interval, 18%–28%) of CST on Cirrus. Conclusions Conversion equations developed in this study allow the harmonization of CST measurements for eyes with DME using a mix of current Cirrus and Spectralis device images. Translational Relevance The CSTs measured on Cirrus and Spectralis devices are not directly comparable owing to outer boundary segmentation differences. Converting CST values across spectral domain optical coherence tomography instruments should benefit both clinical research and standard care efforts.
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Affiliation(s)
- Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology, Boston, Massachusetts, USA
| | - Kristin Josic
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Michele Melia
- Jaeb Center for Health Research, Tampa, Florida, USA
| | | | - Clare Bailey
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kakarla V Chalam
- Department of Ophthalmology, Loma Linda University Health Care, Loma Linda, California, USA
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Catherine Cukras
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Grover
- Department of Ophthalmology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Richard Lee
- Bristol Eye Hospital, Bristol Royal Infirmary NHS Trust, Department of Medical Retina and Uveitis, Bristol, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital, University College London Institute of Ophthalmology, London, UK
| | | | | | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
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8
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Durham TA, Duncan JL, Ayala AR, Birch DG, Cheetham JK, Ferris FL, Hoyng CB, Pennesi ME, Sahel JA. Tackling the Challenges of Product Development Through a Collaborative Rare Disease Network: The Foundation Fighting Blindness Consortium. Transl Vis Sci Technol 2021; 10:23. [PMID: 34004001 PMCID: PMC8083110 DOI: 10.1167/tvst.10.4.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The Foundation Fighting Blindness, a 501(c)(3) nonprofit organization, established an international consortium of inherited retinal disease specialists in 2016, with a mission to accelerate the development of treatments for rare, inherited retinal degenerations, such as retinitis pigmentosa, Stargardt disease, Leber congenital amaurosis, Usher syndrome, choroideremia, and achromatopsia. The Consortium accomplishes its mission by evaluating novel outcome measures, sharing standardized study protocols and datasets, and disseminating findings. Having established research infrastructure in the first 3 years, including 39 global research sites, the network is now poised to expand its infrastructure for trials of new therapies in partnership with industry. This model represents an innovative approach to overcome challenges of therapeutic development for rare diseases.
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Affiliation(s)
| | - Jacque L Duncan
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Carel B Hoyng
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark E Pennesi
- Casey Eye Institute - Oregon Health & Science University, Portland, OR, USA
| | - José-Alain Sahel
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, Paris, France.,Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DGOS CIC1423, Paris, France.,Department of Ophthalmology, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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9
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Pietraszkiewicz AA, Payne D, Abraham M, Garced A, Devarasetty KC, Wall M, Menezes SM, Ugarte S, Pirsl F, Goklemez S, Ferris FL, Barrett J, Battiwalla M, Childs RW, Pavletic SZ, Bishop RJ. Correction: Ocular surface indicators and biomarkers in chronic ocular graft-versus-host disease: a prospective cohort study. Bone Marrow Transplant 2021; 56:2040-2041. [PMID: 33972701 DOI: 10.1038/s41409-021-01315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Debbie Payne
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Angel Garced
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Megan Wall
- The Emmes Company, LLC, Rockville, MD, USA
| | | | | | - Filip Pirsl
- National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Sencer Goklemez
- National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - John Barrett
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Minoo Battiwalla
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Richard W Childs
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Steven Z Pavletic
- National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Rachel J Bishop
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
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10
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Martin DF, Maguire MG, Fine SL, Ying GS, Jaffe GJ, Grunwald JE, Toth C, Redford M, Ferris FL. Ranibizumab and Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration: Two-Year Results. Ophthalmology 2020; 127:S135-S145. [PMID: 32200813 DOI: 10.1016/j.ophtha.2020.01.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 03/29/2012] [Accepted: 03/29/2012] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To describe effects of ranibizumab and bevacizumab when administered monthly or as needed for 2 years and to describe the impact of switching to as-needed treatment after 1 year of monthly treatment. DESIGN Multicenter, randomized clinical trial. PARTICIPANTS Patients (n = 1107) who were followed up during year 2 among 1185 patients with neovascular age-related macular degeneration who were enrolled in the clinical trial. INTERVENTIONS At enrollment, patients were assigned to 4 treatment groups defined by drug (ranibizumab or bevacizumab) and dosing regimen (monthly or as needed). At 1 year, patients initially assigned to monthly treatment were reassigned randomly to monthly or as-needed treatment, without changing the drug assignment. MAIN OUTCOME MEASURES Mean change in visual acuity. RESULTS Among patients following the same regimen for 2 years, mean gain in visual acuity was similar for both drugs (bevacizumab-ranibizumab difference, -1.4 letters; 95% confidence interval [CI], -3.7 to 0.8; P = 0.21). Mean gain was greater for monthly than for as-needed treatment (difference, -2.4 letters; 95% CI, -4.8 to -0.1; P = 0.046). The proportion without fluid ranged from 13.9% in the bevacizumab-as-needed group to 45.5% in the ranibizumab monthly group (drug, P = 0.0003; regimen, P < 0.0001). Switching from monthly to as-needed treatment resulted in greater mean decrease in vision during year 2 (-2.2 letters; P = 0.03) and a lower proportion without fluid (-19%; P < 0.0001). Rates of death and arteriothrombotic events were similar for both drugs (P > 0.60). The proportion of patients with 1 or more systemic serious adverse events was higher with bevacizumab than ranibizumab (39.9% vs. 31.7%; adjusted risk ratio, 1.30; 95% CI, 1.07-1.57; P = 0.009). Most of the excess events have not been associated previously with systemic therapy targeting vascular endothelial growth factor (VEGF). CONCLUSIONS Ranibizumab and bevacizumab had similar effects on visual acuity over a 2-year period. Treatment as needed resulted in less gain in visual acuity, whether instituted at enrollment or after 1 year of monthly treatment. There were no differences between drugs in rates of death or arteriothrombotic events. The interpretation of the persistence of higher rates of serious adverse events with bevacizumab is uncertain because of the lack of specificity to conditions associated with inhibition of VEGF. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
| | | | | | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stuart L Fine
- Department of Ophthalmology, University of Colorado, Denver, Colorado
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Juan E Grunwald
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cynthia Toth
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Maryann Redford
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
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11
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Duncan JL, Liang W, Maguire MG, Audo I, Ayala AR, Birch DG, Carroll J, Cheetham JK, Esposti SD, Durham TA, Erker L, Farsiu S, Ferris FL, Heon E, Hufnagel RB, Iannaccone A, Jaffe GJ, Kay CN, Michaelides M, Pennesi ME, Sahel JA. Baseline Visual Field Findings in the RUSH2A Study: Associated Factors and Correlation With Other Measures of Disease Severity. Am J Ophthalmol 2020; 219:87-100. [PMID: 32446738 DOI: 10.1016/j.ajo.2020.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To report baseline visual fields in the Rate of Progression in USH2A-related Retinal Degeneration (RUSH2A) study. DESIGN Cross-sectional study within a natural history study. METHODS Setting: multicenter, international. STUDY POPULATION Usher syndrome type 2 (USH2) (n = 80) or autosomal recessive nonsyndromic retinitis pigmentosa (ARRP) (n = 47) associated with biallelic disease-causing sequence variants in USH2A. OBSERVATION PROCEDURES Repeatability of full-field static perimetry (SP) and between-eye symmetry of kinetic perimetry (KP) were evaluated with intraclass correlation coefficients (ICCs). The association of demographic and clinical characteristics with total hill of vision (VTOT) was assessed with general linear models. Associations between VTOT and other functional and morphologic measures were assessed using Spearman correlation coefficients and t tests. MAIN OUTCOME MEASURES VTOT (SP) and III4e isopter area (KP). RESULTS USH2 participants had more severe visual field loss than ARRP participants (P < .001, adjusting for disease duration, age of enrollment). Mean VTOT measures among 3 repeat tests were 32.7 ± 24.1, 31.2 ± 23.4, and 31.7 ± 23.9 decibel-steradians (intraclass correlation coefficient [ICC] = 0.96). Better VA, greater photopic ERG 30-Hz flicker amplitudes, higher mean microperimetry sensitivity, higher central subfield thickness, absence of macular cysts, and higher III4e seeing area were associated with higher VTOT (all r > .48; P < .05). Mean III4e isopter areas for left (4561 ± 4426 squared degrees) and right eyes (4215 ± 4300 squared degrees) were concordant (ICC = 0.94). CONCLUSIONS USH2 participants had more visual field loss than participants with USH2A-related ARRP, adjusting for duration of disease and age of enrollment. VTOT was repeatable and correlated with other functional and structural metrics, suggesting it may be a good summary measure of disease severity in patients with USH2A-related retinal degeneration.
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12
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Birch DG, Cheng P, Duncan JL, Ayala AR, Maguire MG, Audo I, Cheetham JK, Durham TA, Fahim AT, Ferris FL, Heon E, Huckfeldt RM, Iannaccone A, Khan NW, Lad EM, Michaelides M, Pennesi ME, Stingl K, Vincent A, Weng CY. The RUSH2A Study: Best-Corrected Visual Acuity, Full-Field Electroretinography Amplitudes, and Full-Field Stimulus Thresholds at Baseline. Transl Vis Sci Technol 2020; 9:9. [PMID: 33133772 PMCID: PMC7552938 DOI: 10.1167/tvst.9.11.9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/06/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose The purpose of this study was to evaluate baseline best corrected visual acuity (BCVA), full-field electroretinography (ERG), full-field stimulus thresholds (FST), and their relationship with baseline demographic and clinical characteristics in the Rate of Progression in Usher syndrome type 2 (USH2A)-related Retinal Degeneration (RUSH2A) multicenter study. Methods Participants had Usher syndrome type 2 (USH2, N = 80) or autosomal recessive nonsyndromic retinitis pigmentosa (ARRP, N = 47) associated with biallelic variants in the USH2A gene. Associations of demographic and clinical characteristics with BCVA, ERG, and FST were assessed with regression models. Results In comparison to ARRP, USH2 had worse BCVA (median 79 vs. 82 letters; P < 0.001 adjusted for age), lower rod-mediated ERG b-wave amplitudes (median 0.0 vs. 6.6 µV; P < 0.001) and 30 Hz flicker cone-mediated ERG amplitudes (median 1.5 vs. 3.1 µV; P = 0.001), and higher (white, blue, and red) FST thresholds (means [−26, −31, −23 dB] vs. [−39, −45, −28 dB]; P < 0.001 for all stimuli). After adjusting for age, gender, and duration of vision loss, the difference in BCVA between diagnosis groups was attenuated (P = 0.09). Only diagnosis was associated with rod- and cone-mediated ERG parameters, whereas both genders (P = 0.04) and duration of visual loss (P < 0.001) also were associated with FST white stimulus. Conclusions USH2 participants had worse BCVA, ERG, and FST than ARRP participants. FST was strongly associated with duration of disease; it remains to be determined whether it will be a sensitive measure of progression. Translational Relevance Using standardized research protocols in RUSH2A, measures have been identified to monitor disease progression and treatment response and differentiate features of prognostic relevance between USH2 and ARRP participants with USH2A mutations.
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Affiliation(s)
| | | | - Jacque L Duncan
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Isabelle Audo
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, Paris, France.,Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DGOS CIC1423, Paris, France
| | | | | | - Abigail T Fahim
- University of Michigan, Kellogg Eye Center, Ann Arbor, MI, USA
| | | | - Elise Heon
- Departments of Ophthalmology and Vision Sciences, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
| | | | | | - Naheed W Khan
- University of Michigan, Kellogg Eye Center, Ann Arbor, MI, USA
| | - Eleonora M Lad
- Duke University Medical Center, Department of Ophthalmology, Durham, NC, USA
| | | | - Mark E Pennesi
- Casey Eye Institute - Oregon Health & Science University, Portland, OR, USA
| | - Katarina Stingl
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,Center for Rare Eye Diseases, University of Tuebingen, Tuebingen, Germany
| | - Ajoy Vincent
- Departments of Ophthalmology and Vision Sciences, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
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13
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Tisdale AK, Agrón E, Sunshine SB, Clemons TE, Ferris FL, Chew EY. Association of Dietary and Supplementary Calcium Intake With Age-Related Macular Degeneration: Age-Related Eye Disease Study Report 39. JAMA Ophthalmol 2020; 137:543-550. [PMID: 30896764 DOI: 10.1001/jamaophthalmol.2019.0292] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Previous studies of the role of dietary and supplementary calcium in age-related macular degeneration (AMD) have produced mixed results, suggesting that supplementation and decreased dietary intake are both harmful. Objective To evaluate the association of baseline dietary and supplementary calcium intake with progression of AMD. Design, Setting, and Participants This study involved secondary analyses of participants enrolled in the Age-Related Eye Disease Study (AREDS). The AREDS study (1992-2001) enrolled patients from academic and community-based retinal practices in the United States. Men and women with varying severity of AMD were included. Data analysis for this article occurred from September 2015 to December 2018. Exposures Baseline self-reported dietary or supplementary calcium intake. Main Outcomes and Measures Development of late AMD, geographic atrophy (central or noncentral), or neovascular AMD detected on centrally graded baseline and annual fundus photographs. Results A total of 4751 participants were included (mean [SD] age, 69.4 [5.1] years); 4543 (95.6%) were white, and 2655 (55.9%) were female. Compared with those who were in the lowest quintile, the participants in the highest quintile of dietary calcium intake had a lower risk of developing late AMD (hazard ratio [HR], 0.73 [95% CI, 0.59-0.90]), central geographic atrophy (HR, 0.64 [95% CI, 0.48-0.86]), and any geographic atrophy (HR, 0.80 [95% CI, 0.64-1.00]). The participants in the highest tertile of supplementary calcium intake had a lower risk of developing neovascular AMD (HR, 0.70 [95% CI, 0.50-0.97]) compared with those who did not take calcium supplements. When stratified by sex, women in the highest quintile of dietary calcium intake had a lower risk of developing late AMD (HR, 0.73 [95% CI, 0.56-0.97]) compared with those in the lowest quintile. Women in the highest tertile of calcium supplementation had a lower risk of progression to neovascular AMD (HR, 0.67 [95% CI, 0.48-0.94]) compared with those who did not take calcium supplements. Similar findings were found in men for dietary calcium. Too few men took calcium supplements to allow for analyses. Conclusions and Relevance In this secondary analysis, higher levels of dietary and supplementary calcium intake were associated with lower incidence of progression to late AMD in AREDS participants. The results may be owing to uncontrolled confounding or chance and should be considered hypothesis development requiring additional study.
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Affiliation(s)
- Alanna K Tisdale
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Sarah B Sunshine
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Frederick L Ferris
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
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14
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Christakis PG, Agrón E, Klein ML, Clemons TE, Campbell JP, Ferris FL, Chew EY, Keenan TD. Incidence of Macular Atrophy after Untreated Neovascular Age-Related Macular Degeneration: Age-Related Eye Disease Study Report 40. Ophthalmology 2019; 127:784-792. [PMID: 31899035 DOI: 10.1016/j.ophtha.2019.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/29/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To report the natural history of untreated neovascular age-related macular degeneration (nAMD) regarding subsequent macular atrophy. DESIGN Prospective cohort within a randomized, controlled trial of oral micronutrient supplements. PARTICIPANTS Age-Related Eye Disease Study (AREDS) participants (55-80 years) who demonstrated nAMD during follow-up (1992-2005), prior to anti-vascular endothelial growth factor (VEGF) therapy. METHODS Color fundus photographs were collected at annual study visits and graded centrally for late age-related macular degeneration (AMD). Incident macular atrophy after nAMD was examined by Kaplan-Meier analysis and proportional hazards regression. MAIN OUTCOME MEASURES Incident macular atrophy after nAMD. RESULTS Of the 4757 AREDS participants, 708 eyes (627 participants) demonstrated nAMD during follow-up and were eligible. The cumulative risks of incident macular atrophy after untreated nAMD were 9.6% (standard error, 1.2%), 31.4% (standard error, 2.2%), 43.1% (standard error, 2.6%), and 61.5% (standard error, 4.3%) at 2, 5, 7, and 10 years, respectively. This corresponded to a linear risk of 6.5% per year. The cumulative risk of central involvement was 30.4% (standard error, 3.2%), 43.4% (standard error, 3.8%), and 57.0% (standard error, 4.8%) at first appearance of atrophy, 2 years, and 5 years, respectively. Geographic atrophy (GA) in the fellow eye was associated with increased risk of macular atrophy (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.17-2.49; P = 0.006). However, higher 52-single nucleotide polymorphism AMD genetic risk score was not associated with increased risk of macular atrophy (HR, 1.03; 95% CI, 0.90-1.17; P = 0.67). Similarly, no significant differences were observed according to SNPs at CFH, ARMS2, or C3. CONCLUSIONS The rate of incident macular atrophy after untreated nAMD is relatively high, increasing linearly over time and affecting half of eyes by 8 years. Hence, factors other than anti-VEGF therapy are involved in atrophy development, including natural progression to GA. Comparison with studies of treated nAMD suggests it may not be necessary to invoke a large effect of anti-VEGF therapy on inciting macular atrophy, although a contribution remains possible. Central involvement is present in one third of eyes at the outset (similar to pure GA) and increases linearly to half at 3 years.
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Affiliation(s)
- Panos G Christakis
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael L Klein
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | | | - J Peter Campbell
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Tiarnan D Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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15
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Gross JG, Glassman AR, Liu D, Sun JK, Antoszyk AN, Baker CW, Bressler NM, Elman MJ, Ferris FL, Gardner TW, Jampol LM, Martin DF, Melia M, Stockdale CR, Beck RW. Five-Year Outcomes of Panretinal Photocoagulation vs Intravitreous Ranibizumab for Proliferative Diabetic Retinopathy: A Randomized Clinical Trial. JAMA Ophthalmol 2019; 136:1138-1148. [PMID: 30043039 DOI: 10.1001/jamaophthalmol.2018.3255] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Ranibizumab is a viable treatment option for eyes with proliferative diabetic retinopathy (PDR) through 2 years. However, longer-term results are needed. Objective To evaluate efficacy and safety of 0.5-mg intravitreous ranibizumab vs panretinal photocoagulation (PRP) over 5 years for PDR. Design, Setting, and Participants Diabetic Retinopathy Clinical Research Network multicenter randomized clinical trial evaluated 394 study eyes with PDR enrolled February through December 2012. Analysis began in January 2018. Interventions Eyes were randomly assigned to receive intravitreous ranibizumab (n = 191) or PRP (n = 203). Frequency of ranibizumab was based on a protocol-specified retreatment algorithm. Diabetic macular edema could be managed with ranibizumab in either group. Main Outcomes and Measures Mean change in visual acuity (intention-to-treat analysis) was the main outcome. Secondary outcomes included peripheral visual field loss, development of vision-impairing diabetic macular edema, and ocular and systemic safety. Results The 5-year visit was completed by 184 of 277 participants (66% excluding deaths). Of 305 enrolled participants, the mean (SD) age was 52 (12) years, 135 (44%) were women, and 160 (52%) were white. For the ranibizumab and PRP groups, the mean (SD) number of injections over 5 years was 19.2 (10.9) and 5.4 (7.9), respectively; the mean (SD) change in visual acuity letter score was 3.1 (14.3) and 3.0 (10.5) letters, respectively (adjusted difference, 0.6; 95% CI, -2.3 to 3.5; P = .68); the mean visual acuity was 20/25 (approximate Snellen equivalent) in both groups at 5 years. The mean (SD) change in cumulative visual field total point score was -330 (645) vs -527 (635) dB in the ranibizumab (n = 41) and PRP (n = 38) groups, respectively (adjusted difference, 208 dB; 95% CI, 9-408). Vision-impairing diabetic macular edema developed in 27 and 53 eyes in the ranibizumab and PRP groups, respectively (cumulative probabilities: 22% vs 38%; hazard ratio, 0.4; 95% CI, 0.3-0.7). No statistically significant differences between groups in major systemic adverse event rates were identified. Conclusions and Relevance Although loss to follow-up was relatively high, visual acuity in most study eyes that completed follow-up was very good at 5 years and was similar in both groups. Severe vision loss or serious PDR complications were uncommon with PRP or ranibizumab; however, the ranibizumab group had lower rates of developing vision-impairing diabetic macular edema and less visual field loss. Patient-specific factors, including anticipated visit compliance, cost, and frequency of visits, should be considered when choosing treatment for patients with PDR. These findings support either anti-vascular endothelial growth factor therapy or PRP as viable treatments for patients with PDR. Trial Registration ClinicalTrials.gov Identifier: NCT01489189.
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Affiliation(s)
| | | | - Danni Liu
- Jaeb Center for Health Research, Tampa, Florida
| | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology, Boston, Massachusetts.,CME Editor
| | - Andrew N Antoszyk
- Charlotte Eye, Ear, Nose and Throat Associates, PA, Charlotte, North Carolina
| | | | - Neil M Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Editor
| | | | - Frederick L Ferris
- Ophthalmic Research Consultants, LLC, Waxhaw, North Carolina.,Deputy Editor, Opinion
| | | | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida.,Deputy Editor
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16
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Ervin AM, Strauss RW, Ahmed MI, Birch D, Cheetham J, Ferris FL, Ip MS, Jaffe GJ, Maguire MG, Schönbach EM, Sadda SR, West SK, Scholl HP. A Workshop on Measuring the Progression of Atrophy Secondary to Stargardt Disease in the ProgStar Studies: Findings and Lessons Learned. Transl Vis Sci Technol 2019; 8:16. [PMID: 31019847 PMCID: PMC6469878 DOI: 10.1167/tvst.8.2.16] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 11/24/2022] Open
Abstract
The Progression of Atrophy Secondary to Stargardt Disease (ProgStar) studies were designed to measure the progression of Stargardt disease through the use of fundus autofluorescence imaging, optical coherence tomography, and microperimetry. The overarching objectives of the studies were to document the natural course of Stargardt disease and identify the most appropriate clinical outcome measures for clinical trials assessing the efficacy and safety of upcoming treatments for Stargardt disease. A workshop organized by the Foundation Fighting Blindness Clinical Research Institute was held on June 11, 2018, in Baltimore, MD, USA. Invited speakers discussed spectral-domain optical coherence tomography, fundus autofluorescence, and microperimetry methods and findings in the ProgStar prospective study. The workshop concluded with a panel discussion of optimal endpoints for measuring treatment efficacy in Stargardt disease. We summarize the workshop presentations in light of the most current literature on Stargardt disease and discuss potential clinical outcome measures and endpoints for future treatment trials.
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Affiliation(s)
- Ann-Margret Ervin
- Wilmer Eye Institute, The Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rupert W. Strauss
- Wilmer Eye Institute, The Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Moorfields Eye Hospital NHS Foundation Trust, and UCL Institute of Ophthalmology, University College London, London, UK
- Department of Ophthalmology, Kepler University Clinic, Linz, Austria
- Department of Ophthalmology, Medical University Graz, Graz, Austria
| | - Mohamed I. Ahmed
- Wilmer Eye Institute, The Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - David Birch
- Retina Foundation of the Southwest, Dallas, TX, USA
| | - Janet Cheetham
- Foundation Fighting Blindness Clinical Research Institute, Columbia, MD, USA
| | | | - Michael S. Ip
- Doheny Imaging Reading Center, Doheny Eye Institute, David Geffen School of Medicine at University of California Los Angeles, CA, USA
| | - Glenn J. Jaffe
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Maureen G. Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Etienne M. Schönbach
- Wilmer Eye Institute, The Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - SriniVas R. Sadda
- Doheny Imaging Reading Center, Doheny Eye Institute, David Geffen School of Medicine at University of California Los Angeles, CA, USA
| | - Sheila K. West
- Wilmer Eye Institute, The Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hendrik P.N. Scholl
- Wilmer Eye Institute, The Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Ophthalmology, University of Basel, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - for the ProgStar Study Group
- Wilmer Eye Institute, The Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Moorfields Eye Hospital NHS Foundation Trust, and UCL Institute of Ophthalmology, University College London, London, UK
- Department of Ophthalmology, Kepler University Clinic, Linz, Austria
- Department of Ophthalmology, Medical University Graz, Graz, Austria
- Retina Foundation of the Southwest, Dallas, TX, USA
- Foundation Fighting Blindness Clinical Research Institute, Columbia, MD, USA
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
- Doheny Imaging Reading Center, Doheny Eye Institute, David Geffen School of Medicine at University of California Los Angeles, CA, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Case Western Reserve University, Cleveland, OH, USA
- Department of Ophthalmology, University of Basel, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
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17
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Gross JG, Glassman AR, Klein MJ, Jampol LM, Ferris FL, Bressler NM, Beck RW. Interim Safety Data Comparing Ranibizumab With Panretinal Photocoagulation Among Participants With Proliferative Diabetic Retinopathy. JAMA Ophthalmol 2018; 135:672-673. [PMID: 28492921 DOI: 10.1001/jamaophthalmol.2017.0969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | | | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Neil M Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
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18
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Chen KG, Alvarez JA, Yazdanie M, Papudesu C, Wong WT, Wiley HE, Keenan TD, Chew EY, Ferris FL, Cukras CA. Longitudinal Study of Dark Adaptation as a Functional Outcome Measure for Age-Related Macular Degeneration. Ophthalmology 2018; 126:856-865. [PMID: 30278196 DOI: 10.1016/j.ophtha.2018.09.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/25/2018] [Accepted: 09/25/2018] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To investigate the natural history of dark adaptation (DA) function as measured by the change in rod intercept time (RIT) over 4 years and to correlate RIT change with age-related macular degeneration (AMD) severity. DESIGN Longitudinal, single-center, observational study. PARTICIPANTS A total of 77 participants aged ≥50 years with a range of AMD severities. METHODS Participants each contributing a single study eye to the analysis were assigned into person-based AMD severity groups based on fundus characteristics (drusen, pigmentary changes, late AMD, and subretinal drusenoid deposits [SDDs]). The DA function was assessed in study eyes at baseline and 3, 6, 12, 18, 24, 36, and 48 months. Mean change in DA function over time was calculated using the slope of linear regression fits of longitudinal RIT data. Patient-reported responses on a Low Luminance Questionnaire (LLQ) were obtained at baseline and yearly. Nonparametric statistical testing was performed on all comparisons. MAIN OUTCOME MEASURE The RIT, defined as the time taken after a photobleach for visual sensitivity to recover detection of a 5×10-3 cd/m2 stimulus (a decrease of 3 log units), was monitored in study eyes over 4 years, and the mean rate of change was computed. RESULTS Longitudinal analysis of 65 study eyes followed on the standard testing protocol (mean age, 71±9.3 years; 49% were female) revealed that higher rates of RIT prolongation were correlated with AMD severity group assignment at baseline (P = 0.026) and with severity group assignments at year 4 (P = 0.0011). Study eyes that developed SDD during follow-up demonstrated higher rates of RIT prolongation relative to those that did not (P < 0.0001). Overall, higher rates of RIT prolongation were significantly correlated with greater 4-year decreases in LLQ scores (total mean score, P = 0.0032). CONCLUSIONS Longitudinal decline in DA function, which correlated with patient-reported functional deficits, was accelerated in eyes with greater AMD severity and especially in eyes with SDD both at baseline and at 4 years. The RIT prolongation as a measure of changing DA function may be a functional outcome measure in AMD clinical studies.
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Affiliation(s)
- Katherine G Chen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Jason A Alvarez
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Mohammad Yazdanie
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Chandana Papudesu
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Wai T Wong
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Tiarnan D Keenan
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Catherine A Cukras
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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19
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Keenan TD, Agrón E, Domalpally A, Clemons TE, van Asten F, Wong WT, Danis RG, Sadda S, Rosenfeld PJ, Klein ML, Ratnapriya R, Swaroop A, Ferris FL, Chew EY. Progression of Geographic Atrophy in Age-related Macular Degeneration: AREDS2 Report Number 16. Ophthalmology 2018; 125:1913-1928. [PMID: 30060980 DOI: 10.1016/j.ophtha.2018.05.028] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To analyze the prevalence, incidence, and clinical characteristics of eyes with geographic atrophy (GA) in age-related macular degeneration (AMD), including clinical and genetic factors affecting enlargement. DESIGN Prospective cohort study within a controlled clinical trial. PARTICIPANTS Age-Related Eye Disease Study 2 (AREDS2) participants, aged 50-85 years. METHODS Baseline and annual stereoscopic color fundus photographs were evaluated for GA presence and area. Analyses included GA prevalence and incidence rates, Kaplan-Meier rates, mixed-model regression, and multivariable analysis of the square root of GA, area adjusted for covariates, including clinical/imaging characteristics and genotype. MAIN OUTCOME MEASURES (1) Presence or development of GA; (2) change in the square root of GA area over time. RESULTS At baseline, 517 eyes (6.2%) of 411 participants (9.8%) had pre-existing GA (without neovascular AMD), with the following characteristics: 33% central, 67% noncentral; and the following configurations: 36% small, 26% solid/unifocal, 24% multifocal, 9% horseshoe/ring, and 6% indeterminate. Of the remaining 6530 eyes at risk, 1099 eyes (17.3%) of 883 participants developed incident GA without prior neovascular disease during mean follow-up of 4.4 years. The Kaplan-Meier rate of incident GA was 19% of eyes at 5 years. In eyes with incident GA, 4-year risk of subsequent neovascular AMD was 29%. In eyes with incident noncentral GA, 4-year risk of central involvement was 57%. GA enlargement rate (following square root transformation) was similar in eyes with pre-existing GA (0.29 mm/year; 95% confidence interval 0.27-0.30) and incident GA (0.28 mm/year; 0.27-0.30). In the combined group, GA enlargement was significantly faster with noncentrality, multifocality, intermediate baseline size, and bilateral GA (P < 0.0001 for interaction in each case) but not with AREDS2 treatment assignment (P = 0.33) or smoking status (P = 0.05). Enlargement was significantly faster with ARMS2 risk (P < 0.0001), C3 non-risk (P = 0.0002), and APOE non-risk (P = 0.001) genotypes. CONCLUSIONS Analyses of AREDS2 data on natural history of GA provide representative data on GA evolution and enlargement. GA enlargement, which was influenced by lesion features, was relentless, resulting in rapid central vision loss. The genetic variants associated with faster enlargement were partially distinct from those associated with risk of incident GA. These findings are relevant to further investigations of GA pathogenesis and clinical trial planning.
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Affiliation(s)
- Tiarnan D Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Amitha Domalpally
- Fundus Photographic Reading Center, The University of Wisconsin, Madison, Wisconsin
| | | | - Freekje van Asten
- Neurobiology-Neurodegeneration & Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Wai T Wong
- Unit on Microglia, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Ronald G Danis
- Fundus Photographic Reading Center, The University of Wisconsin, Madison, Wisconsin
| | | | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael L Klein
- Casey Eye Institute, Portland, Oregon; Devers Eye Clinic, Portland, Oregon
| | - Rinki Ratnapriya
- Neurobiology-Neurodegeneration & Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Anand Swaroop
- Neurobiology-Neurodegeneration & Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Frederick L Ferris
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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20
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Modjtahedi BS, Ferris FL, Hunter DG, Fong DS. Public Health Burden and Potential Interventions for Myopia. Ophthalmology 2018; 125:628-630. [DOI: 10.1016/j.ophtha.2018.01.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 01/21/2018] [Accepted: 01/24/2018] [Indexed: 11/28/2022] Open
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21
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Ferris FL, Nathan DM. Preventing Diabetic Retinopathy Progression. Ophthalmology 2018; 123:1840-2. [PMID: 27549874 DOI: 10.1016/j.ophtha.2016.05.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 01/08/2023] Open
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22
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Vitale S, Clemons TE, Agrón E, Ferris FL, Domalpally A, Danis RP, Chew EY. Evaluating the Validity of the Age-Related Eye Disease Study Grading Scale for Age-Related Macular Degeneration: AREDS2 Report 10. JAMA Ophthalmol 2017; 134:1041-7. [PMID: 27442263 DOI: 10.1001/jamaophthalmol.2016.2383] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To test potential treatments for age-related macular degeneration (AMD), clinical trials need standardized outcome measures that are valid for predicting AMD progression in different study populations. OBJECTIVE To evaluate the validity of the Age-Related Eye Disease Study (AREDS) detailed and simple AMD severity scales by comparing rates of development of late AMD (neovascular AMD and/or central geographic atrophy) between AREDS and AREDS2 participants. DESIGN, SETTING, AND PARTICIPANTS Both AREDS (1992-2001) and AREDS2 (2006-2012) enrolled patients from academic and community-based retinal practices across the United States. In AREDS (n = 4519), participants with varying severity of AMD-from no AMD to late AMD in 1 eye-were enrolled. In AREDS2 (n = 4203), participants with bilateral large drusen or large drusen in the study eye and late AMD in the fellow eye were enrolled. MAIN OUTCOMES AND MEASURES Five-year incidence of late AMD, assessed by annual masked centralized fundus photograph grading. RESULTS In AREDS, the mean (SD) age of the patients was 69.3 (5.7) years, and 2519 (55.7%) were female. In AREDS2, the mean (SD) age of the patients was 73.1 (7.7) years, and 2388 (56.8%) were female. The 5-year rates of late AMD did not differ between AREDS2 and AREDS participants within nearly all baseline AMD detailed severity scale levels: levels 1 to 3: 2.4% vs 0.5% (difference, 1.9%; 95% CI, -0.2% to 4.0%; P < .001); level 4: 6.5% vs 4.9% (difference, 1.6%; 95% CI, -1.7% to 4.8%; P = .34); level 5: 8.0% vs 5.6% (difference, 2.4%; 95% CI, -1.2% to 5.9%; P = .22); level 6: 12.8% vs 13.7% (difference, -0.9%; 95% CI, -4.8% to 3.1%; P = .66); level 7: 26.2% vs 27.8% (difference, -1.5%; 95% CI, -6.6% to 3.5%; P = .54); and level 8: 46.4% vs 44.7% (difference, 1.7%; 95% CI, -7.5% to 10.9%; P = .72). Within simple scale levels, AREDS2 and AREDS 5-year rates did not differ significantly except for level 1 (9.4% vs 3.1%, P = .02; level 2: 12.8% vs 11.8%, P = .65; level 3: 26.3% vs 25.9%, P = .90; and level 4: 45.6% vs 47.3%, P = .57). CONCLUSIONS AND RELEVANCE The AREDS detailed and simple AMD severity scales were useful measures for assessing the risk of developing late AMD in the AREDS2 population; these data suggest that they should be useful tools for clinical trials of AMD treatments.
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Affiliation(s)
- Susan Vitale
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Frederick L Ferris
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Ronald P Danis
- Fundus Photograph Reading Center, University of Wisconsin, Madison
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
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Hariri AH, Zhang HY, Ho A, Francis P, Weleber RG, Birch DG, Ferris FL, Sadda SR. Quantification of Ellipsoid Zone Changes in Retinitis Pigmentosa Using en Face Spectral Domain-Optical Coherence Tomography. JAMA Ophthalmol 2017; 134:628-35. [PMID: 27031504 DOI: 10.1001/jamaophthalmol.2016.0502] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
IMPORTANCE New methods are needed to quantify the change in the outer retinal structures in retinitis pigmentosa (RP). OBJECTIVE To implement an alternate method for tracking ellipsoid zone (EZ) changes in RP by quantifying the EZ area on en face spectral domain-optical coherence tomographic (SD-OCT) images. DESIGN, SETTING, AND PARTICIPANTS Data for this observational case study were collected at the Department of Ophthalmology, University of California, Los Angeles, from May 1 to July 30, 2015, and included SD-OCT images of a subset of patients from the Trial of Oral Valproic Acid for Retinitis Pigmentosa. To be eligible for the en face OCT subanalysis, the preserved EZ area was required to be limited to the SD-OCT scanning field. Cases in which the EZ band extended to the margins of any B-scan or the most superior or inferior B-scan were excluded. The SD-OCT images of all included cases were imported into the manufacturer's software to generate en face images at the level of the EZ. Two certified SD-OCT graders independently delineated the boundaries of the preserved EZ on the en face images. MAIN OUTCOMES AND MEASURES Comparison of the 2 masked gradings of the generated en face images of patients with RP for agreement between the graders and the validity of the method. RESULTS Of the 43 available patients with volume SD-OCT data, 45 eyes of 24 patients met the eligibility criteria and were included in this subanalysis. Every patient had 2 visits that were 1 year apart, which included a total of 90 en face OCT images that were graded. The mean (SD) absolute difference and percentage difference between the 2 independent graders for each visit were 0.08 (0.10) mm2 and 4.5% (5.9%), respectively. The EZ area determined by the 2 graders showed excellent agreement with an intraclass correlation coefficient of 0.996 (95% CI, 0.995-0.997; P < .001). CONCLUSIONS AND RELEVANCE Quantification of the preserved EZ area on en face SD-OCT images of patients with RP is a valid and reproducible method. En face SD-OCT quantification may be a useful tool for monitoring the EZ changes of patients with advanced RP and a useful outcome measurement variable in therapeutic trials.
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Affiliation(s)
- Amir H Hariri
- Doheny Eye Institute, Los Angeles, California2Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles
| | - Hong Yang Zhang
- Doheny Eye Institute, Los Angeles, California2Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles
| | | | | | | | | | - Frederick L Ferris
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, California2Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles
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24
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Willoughby AS, Chiu SJ, Silverman RK, Farsiu S, Bailey C, Wiley HE, Ferris FL, Jaffe GJ. Platform-Independent Cirrus and Spectralis Thickness Measurements in Eyes with Diabetic Macular Edema Using Fully Automated Software. Transl Vis Sci Technol 2017; 6:9. [PMID: 28180033 PMCID: PMC5295813 DOI: 10.1167/tvst.6.1.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE We determine whether the automated segmentation software, Duke Optical Coherence Tomography Retinal Analysis Program (DOCTRAP), can measure, in a platform-independent manner, retinal thickness on Cirrus and Spectralis spectral domain optical coherence tomography (SD-OCT) images in eyes with diabetic macular edema (DME) under treatment in a clinical trial. METHODS Automatic segmentation software was used to segment the internal limiting membrane (ILM), inner retinal pigment epithelium (RPE), and Bruch's membrane (BM) in SD-OCT images acquired by Cirrus and Spectralis commercial systems, from the same eye, on the same day during a clinical interventional DME trial. Mean retinal thickness differences were compared across commercial and DOCTRAP platforms using intraclass correlation (ICC) and Bland-Altman plots. RESULTS The mean 1 mm central subfield thickness difference (standard error [SE]) comparing segmentation of Spectralis images with DOCTRAP versus HEYEX was 0.7 (0.3) μm (0.2 pixels). The corresponding values comparing segmentation of Cirrus images with DOCTRAP versus Cirrus software was 2.2 (0.7) μm. The mean 1 mm central subfield thickness difference (SE) comparing segmentation of Cirrus and Spectralis scan pairs with DOCTRAP using BM as the outer retinal boundary was -2.3 (0.9) μm compared to 2.8 (0.9) μm with inner RPE as the outer boundary. CONCLUSIONS DOCTRAP segmentation of Cirrus and Spectralis images produces validated thickness measurements that are very similar to each other, and very similar to the values generated by the corresponding commercial software in eyes with treated DME. TRANSLATIONAL RELEVANCE This software enables automatic total retinal thickness measurements across two OCT platforms, a process that is impractical to perform manually.
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Affiliation(s)
| | | | | | - Sina Farsiu
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Clare Bailey
- University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, NC, USA
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Ferris FL, Maguire MG, Glassman AR, Ying GS, Martin DF. Evaluating Effects of Switching Anti–Vascular Endothelial Growth Factor Drugs for Age-Related Macular Degeneration and Diabetic Macular Edema. JAMA Ophthalmol 2017; 135:145-149. [DOI: 10.1001/jamaophthalmol.2016.4820] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | | | - Gui-shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia
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26
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Daniel E, Grunwald JE, Kim BJ, Maguire MG, Jaffe GJ, Toth CA, Ferris FL, Martin DF, Shaffer J, Ying GS. Visual and Morphologic Outcomes in Eyes with Hard Exudate in the Comparison of Age-Related Macular Degeneration Treatments Trials. Ophthalmol Retina 2017; 1:25-33. [PMID: 28620652 DOI: 10.1016/j.oret.2016.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare baseline characteristics, visual acuity (VA) and morphological outcomes between eyes with baseline hard exudates (HE) and all other eyes among patients with neovascular age-related macular degeneration (NVAMD) treated with anti-vascular endothelial growth factors (anti-VEGF). DESIGN Prospective cohort study within the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). PARTICIPANTS Patients with NVAMD. METHODS Readers evaluated baseline and follow-up morphology on digital color images, fluorescein angiography (FA), and optical coherence tomography (OCT) in eyes with NVAMD that were randomly assigned to treatment with either ranibizumab or bevacizumab. Ophthalmologists identified HE on color images in the study eye. MAIN OUTCOME MEASURES VA; scar; geographic atrophy; retinal thickness, fluid; and number of anti-VEGF injections. RESULTS HE was present in 128 of 1185 (11%) study eyes at baseline, 77% within 1 disc diameter of the foveal center. Patients with study eye HE were more likely female (81% vs 60%; p<0.001) and non-smokers (53% vs 42%; p=0.004). Both groups had similar proportions of hypercholesterolemia and hypertriglyceridemia. At baseline, eyes with HE had worse VA (mean 57 vs 61 letters; p=0.003), larger total lesion size (3.3 vs 2.4 DA; p <0.001), greater total foveal thickness (522µm vs 452µm; p<0.001), more retinal angiomatous proliferation (18% vs 10%; p=0.009) and sub-RPE fluid (65% vs 47%; p<0.001). At 1 year, VA was similar in both groups; more eyes with baseline HE had no fluid (45% vs 29%; p<0.001) and greater reduction in total foveal thickness (-266µm vs -158u; p<0.001). VA at year 2 was similar but retinas of eyes with baseline HE were thinner (267µm vs 299µm; p=0.03) and fewer eyes had sub-retinal fluid (23% vs 36%; p=0.008). HE was present in 19% of eyes at 1 year and 5% of eyes at 2 years. LIPC promoter SNP rs10468017 was not associated with NVAMD HE. CONCLUSION Eyes with HE have larger CNV lesions and more RAP. Their initially thicker retina rapidly becomes thinner on anti-VEGF treatment. HE is not significantly associated with hyperlipidemia. HE at baseline does not significantly influence VA, scar and GA outcomes in eyes with NVAMD treated with anti-VEGF. Few eyes have HE at year 2.
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Affiliation(s)
- Ebenezer Daniel
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Juan E Grunwald
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Benjamin J Kim
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Glenn J Jaffe
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Cynthia A Toth
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Frederick L Ferris
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Daniel F Martin
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - James Shaffer
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
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Nair P, Aiello LP, Gardner TW, Jampol LM, Ferris FL. Report From the NEI/FDA Diabetic Retinopathy Clinical Trial Design and Endpoints Workshop. Invest Ophthalmol Vis Sci 2016; 57:5127-5142. [PMID: 27699406 PMCID: PMC6016432 DOI: 10.1167/iovs.16-20356] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | | | - Lee M. Jampol
- Northwestern University, Chicago, Illinois, United States
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28
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Bressler SB, Ayala AR, Bressler NM, Melia M, Qin H, Ferris FL, Flaxel CJ, Friedman SM, Glassman AR, Jampol LM, Rauser ME. Persistent Macular Thickening After Ranibizumab Treatment for Diabetic Macular Edema With Vision Impairment. JAMA Ophthalmol 2016; 134:278-85. [PMID: 26746868 DOI: 10.1001/jamaophthalmol.2015.5346] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The prevalence of persistent diabetic macular edema (DME) after months of anti-vascular endothelial growth factor therapy and its effect on visual acuity are unknown. OBJECTIVE To assess subsequent outcomes of eyes with DME persisting for 24 weeks after initiating treatment with 0.5 mg of ranibizumab. DESIGN, SETTING, AND PARTICIPANTS We performed post hoc, exploratory analyses of a randomized clinical trial from March 20, 2007, through January 29, 2014, from 117 of 296 eyes (39.5%) randomly assigned to receive ranibizumab with persistent DME (central subfield thickness ≥250 μm on time domain optical coherence tomography) through the 24-week visit. INTERVENTIONS Four monthly intravitreous injections of ranibizumab and then as needed per protocol. MAIN OUTCOMES AND MEASURES Cumulative 3-year probabilities of chronic persistent DME (failure to achieve a central subfield thickness <250 μm and at least a 10% reduction from the 24-week visit on at least 2 consecutive study visits) determined by life-table analyses, and at least 10 letter (≥2 line) gain or loss of visual acuity among those eyes. RESULTS The probability of chronic persistent DME among eyes with persistent DME at the 24-week visit decreased from 100% at the 32-week visit to 81.1% (99% CI, 69.6%-88.6%), 55.8% (99% CI, 42.9%-66.9%), and 40.1% (99% CI, 27.4%-52.4%) at the 1-, 2-, and 3-year visits, respectively. At 3 years, visual acuity improved in eyes with and without chronic persistent DME through the follow-up period, respectively, by a mean of 7 letters and 13 letters from baseline. Among 40 eyes with chronic persistent edema through 3 years, 17 (42.5%) (99% CI, 23.1%-63.7%) gained 10 letters or more from baseline, whereas 5 (12.5%) (99% CI, 2.8%-31.5%) lost 10 letters or more from baseline. CONCLUSIONS AND RELEVANCE These data suggest less than half of eyes treated for DME with intravitreous ranibizumab have persistent central-involved DME through 24 weeks after initiating treatment. Among the 40% that then have chronic persistent central-involved DME through 3 years, longer-term visual acuity outcomes appear to be slightly worse than in the 60% in which DME does not persist. Nevertheless, when following the treatment protocol used in this trial among eyes with vision impairment from DME, long-term improvement in visual acuity from baseline is typical and substantial (≥2-line) loss of visual acuity is likely uncommon through 3 years, even when central-involved DME chronically persists.
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Affiliation(s)
- Susan B Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Neil M Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland3Editor, JAMA Ophthalmology
| | | | - Haijing Qin
- Jaeb Center for Health Research, Tampa, Florida
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland5Viewpoint Editor, JAMA Ophthalmology
| | | | | | | | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University Medical School, Chicago, Illinois
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29
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Maguire MG, Martin DF, Ying GS, Jaffe GJ, Daniel E, Grunwald JE, Toth CA, Ferris FL, Fine SL. Five-Year Outcomes with Anti-Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration: The Comparison of Age-Related Macular Degeneration Treatments Trials. Ophthalmology 2016; 123:1751-1761. [PMID: 27156698 PMCID: PMC4958614 DOI: 10.1016/j.ophtha.2016.03.045] [Citation(s) in RCA: 487] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe outcomes 5 years after initiating treatment with bevacizumab or ranibizumab for neovascular age-related macular degeneration (AMD). DESIGN Cohort study. PARTICIPANTS Patients enrolled in the Comparison of AMD Treatments Trials. METHODS Patients were assigned randomly to ranibizumab or bevacizumab and to 1 of 3 dosing regimens. After 2 years, patients were released from the clinical trial protocol. At 5 years, patients were recalled for examination. MAIN OUTCOME MEASURES Visual acuity (VA) and morphologic retinal features. RESULTS Visual acuity was obtained for 647 of 914 (71%) living patients with average follow-up of 5.5 years. The mean number of examinations for AMD care after the clinical trial ended was 25.3, and the mean number of treatments was 15.4. Most patients (60%) were treated 1 time or more with a drug other than their assigned drug. At the 5-year visit, 50% of eyes had VA of 20/40 or better and 20% had VA of 20/200 or worse. Mean change in VA was -3 letters from baseline and -11 letters from 2 years. Among 467 eyes with fluorescein angiography, mean total lesion area was 12.9 mm(2), a mean of 4.8 mm(2) larger than at 2 years. Geographic atrophy was present in 213 of 515 (41%) gradable eyes and was subfoveal in 85 eyes (17%). Among 555 eyes with spectral-domain optical coherence tomography, 83% had fluid (61% intraretinal, 38% subretinal, and 36% sub-retinal pigment epithelium). Mean foveal total thickness was 278 μm, a decrease of 182 μm from baseline and 20 μm from 2 years. The retina was abnormally thin (<120 μm) in 36% of eyes. Between 2 and 5 years, the group originally assigned to ranibizumab for 2 years lost more VA than the bevacizumab group (-4 letters; P = 0.008). Otherwise, there were no statistically significant differences in VA or morphologic outcomes between drug or regimen groups. CONCLUSIONS Vision gains during the first 2 years were not maintained at 5 years. However, 50% of eyes had VA of 20/40 or better, confirming anti-vascular endothelial growth factor therapy as a major long-term therapeutic advance for neovascular AMD.
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Affiliation(s)
- Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Daniel F Martin
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Ebenezer Daniel
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juan E Grunwald
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Stuart L Fine
- Department of Ophthalmology, University of Colorado, Denver, Colorado
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30
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Wells JA, Glassman AR, Jampol LM, Aiello LP, Antoszyk AN, Baker CW, Bressler NM, Browning DJ, Connor CG, Elman MJ, Ferris FL, Friedman SM, Melia M, Pieramici DJ, Sun JK, Beck RW. Association of Baseline Visual Acuity and Retinal Thickness With 1-Year Efficacy of Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema. JAMA Ophthalmol 2016; 134:127-34. [PMID: 26605836 DOI: 10.1001/jamaophthalmol.2015.4599] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Comparisons of the relative effect of 3 anti-vascular endothelial growth factor agents to treat diabetic macular edema warrant further assessment. OBJECTIVE To provide additional outcomes from a randomized trial evaluating 3 anti-vascular endothelial growth factor agents for diabetic macular edema within subgroups based on baseline visual acuity (VA) and central subfield thickness (CST) as evaluated on optical coherence tomography. DESIGN, SETTING, AND PARTICIPANTS Post hoc exploratory analyses were conducted of randomized trial data on 660 adults with diabetic macular edema and decreased VA (Snellen equivalent, approximately 20/32 to 20/320). The original study was conducted between August 22, 2012, and August 28, 2013. Analysis was conducted from January 7 to June 2, 2015. INTERVENTIONS Repeated 0.05-mL intravitreous injections of 2.0 mg of aflibercept (224 eyes), 1.25 mg of bevacizumab (218 eyes), or 0.3 mg of ranibizumab (218 eyes) as needed per protocol. MAIN OUTCOMES AND MEASURES One-year VA and CST outcomes within prespecified subgroups based on both baseline VA and CST thresholds, defined as worse (20/50 or worse) or better (20/32 to 20/40) VA and thicker (≥400 µm) or thinner (250 to 399 µm) CST. RESULTS In the subgroup with worse baseline VA (n = 305), irrespective of baseline CST, aflibercept showed greater improvement than bevacizumab or ranibizumab for several VA outcomes. In the subgroup with better VA and thinner CST at baseline (61-73 eyes across 3 treatment groups), VA outcomes showed little difference between groups; mean change was +7.2, +8.4, and +7.6 letters in the aflibercept, bevacizumab, and ranibizumab groups, respectively. However, in the subgroup with better VA and thicker CST at baseline (31-43 eyes), there was a suggestion of worse VA outcomes in the bevacizumab group; mean change from baseline to 1 year was +9.5, +5.4, and +9.5 letters in the aflibercept, bevacizumab, and ranibizumab groups, respectively, and VA letter score was greater than 84 (approximately 20/20) in 21 of 33 (64%), 7 of 31 (23%), and 21 of 43 (49%) eyes, respectively. The adjusted differences and 95% CIs were 39% (17% to 60%) for aflibercept vs bevacizumab, 25% (5% to 46%) for ranibizumab vs bevacizumab, and 13% (-8% to 35%) for aflibercept vs ranibizumab. CONCLUSIONS AND RELEVANCE These post hoc secondary findings suggest that for eyes with better initial VA and thicker CST, some VA outcomes may be worse in the bevacizumab group than in the aflibercept and ranibizumab groups. Given the exploratory nature of these analyses and the small sample size within subgroups, caution is suggested when using the data to guide treatment considerations for patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01627249.
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Affiliation(s)
- John A Wells
- Palmetto Retina Center, West Columbia, South Carolina
| | | | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Andrew N Antoszyk
- Charlotte Eye, Ear, Nose and Throat Associates, PA, Charlotte, North Carolina
| | | | - Neil M Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland8Editor, JAMA Ophthalmology
| | - David J Browning
- Charlotte Eye, Ear, Nose and Throat Associates, PA, Charlotte, North Carolina
| | | | | | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | | | - Jennifer K Sun
- Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
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31
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Fox AR, Chew EY, Meyerle C, Vitale S, Ferris FL, Nussenblatt RB, Sen HN. Age-related macular degeneration in patients with uveitis. Br J Ophthalmol 2016; 101:342-347. [PMID: 27154918 DOI: 10.1136/bjophthalmol-2016-308587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/09/2016] [Accepted: 04/14/2016] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the prevalence of large drusen in a uveitis clinic population. DESIGN Retrospective, cohort study. METHODS Patients with primary, non-infectious uveitis 55 years or older who were seen at the National Eye Institute of the National Institutes of Health from 2004 through August 2013 were reviewed using electronic medical records and photographic databases. Patients were classified as having age-related macular degeneration (AMD) if either eye had large drusen, geographic atrophy or neovascular AMD according to definitions used by the Eye Diseases Prevalence Research Group (EDPRG). The expected number of cases and standardised mortality ratio (SMR) for large drusen were estimated based on EDPRG estimates. RESULTS We identified 177 patients aged ≥55 years as having primary non-infectious uveitis; 170 (96.0%) had gradable fundus photos. Average age was 65.0±7.5 years (range 55-87), and 87 were non-Hispanic white, 66 non-Hispanic black, 6 Hispanic white and 11 of other race/ethnicity. Large drusen were identified in four patients (2.4%; 95% CI 0.6 to 6.0). No patients were identified to have late AMD. In the uveitis cohort, the SMR for cases of large drusen, which was adjusted for age, was calculated to be 0.32 (95% CI 0.12 to 0.70) for the whole cohort, 0.28 (95% CI 0.09 to 0.79) for non-Hispanic whites and 0.46 (95% CI 0.14 to 1.29) for non-Hispanic blacks. CONCLUSIONS Large drusen prevalence among patients with uveitis ≥55 years of age appears less than the prevalence in the general US population after accounting for differences in age distribution, especially for non-Hispanic whites. Although the racial and gender distribution in this study population is not directly representative of the general US population, results of this study suggest possible sparing of patients with uveitis from AMD. A larger systematic study with greater power would be needed to confirm these findings.
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Affiliation(s)
- Austin R Fox
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Catherine Meyerle
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Vitale
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
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Bressler SB, Glassman AR, Almukhtar T, Bressler NM, Ferris FL, Googe JM, Gupta SK, Jampol LM, Melia M, Wells JA. Five-Year Outcomes of Ranibizumab With Prompt or Deferred Laser Versus Laser or Triamcinolone Plus Deferred Ranibizumab for Diabetic Macular Edema. Am J Ophthalmol 2016; 164:57-68. [PMID: 26802783 DOI: 10.1016/j.ajo.2015.12.025] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare long-term vision and anatomic effects of ranibizumab with prompt or deferred laser vs laser or triamcinolone + laser with very deferred ranibizumab in diabetic macular edema (DME). DESIGN Randomized clinical trial. METHODS Eight hundred and twenty-eight study eyes (558 [67%] completed the 5-year visit), at 52 sites, with visual acuity 20/32 to 20/320 and DME involving the central macula were randomly assigned to intravitreous ranibizumab (0.5 mg) with either (1) prompt or (2) deferred laser; (3) sham injection + prompt laser; or (4) intravitreous triamcinolone (4 mg) + prompt laser. The latter 2 groups could initiate ranibizumab as early as 74 weeks from baseline, for persistent DME with vision impairment. The main outcome measures were visual acuity, optical coherence central subfield thickness, and number of injections through 5 years. RESULTS At 5 years mean (± standard deviation) change in Early Treatment Diabetic Retinopathy Study visual acuity letter scores from baseline in the ranibizumab + deferred laser (N = 111), ranibizumab + prompt laser (N = 124), laser/very deferred ranibizumab (N = 198), and triamcinolone + laser/very deferred ranibizumab (N = 125) groups were 10 ± 13, 8 ± 13, 5 ± 14, and 7 ± 14, respectively. The difference (95% confidence interval) in mean change between ranibizumab + deferred laser and laser/very deferred ranibizumab and triamcinolone + laser/very deferred ranibizumab was 4.4 (1.2-7.6, P = .001) and 2.8 (-0.9 to 6.5, P = .067), respectively, at 5 years. CONCLUSIONS Recognizing limitations of follow-up available at 5 years, eyes receiving initial ranibizumab therapy for center-involving DME likely have better long-term vision improvements than eyes managed with laser or triamcinolone + laser followed by very deferred ranibizumab for persistent thickening and vision impairment.
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Affiliation(s)
- Susan B Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Neil M Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Joseph M Googe
- Southeastern Retina Associates, PC, Knoxville, Tennessee
| | - Shailesh K Gupta
- Department of Ophthalmology, University of Florida College of Medicine, Jacksonville, Florida
| | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michele Melia
- Jaeb Center for Health Research, Inc, Tampa, Florida
| | - John A Wells
- Palmetto Retina Center, Columbia, South Carolina
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Wells JA, Glassman AR, Ayala AR, Jampol LM, Bressler NM, Bressler SB, Brucker AJ, Ferris FL, Hampton GR, Jhaveri C, Melia M, Beck RW. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema: Two-Year Results from a Comparative Effectiveness Randomized Clinical Trial. Ophthalmology 2016; 123:1351-9. [PMID: 26935357 DOI: 10.1016/j.ophtha.2016.02.022] [Citation(s) in RCA: 616] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To provide 2-year results comparing anti-vascular endothelial growth factor (VEGF) agents for center-involved diabetic macular edema (DME) using a standardized follow-up and retreatment regimen. DESIGN Randomized clinical trial. PARTICIPANTS Six hundred sixty participants with visual acuity (VA) impairment from DME. METHODS Randomization to 2.0-mg aflibercept, 1.25-mg repackaged (compounded) bevacizumab, or 0.3-mg ranibizumab intravitreous injections performed up to monthly using a protocol-specific follow-up and retreatment regimen. Focal/grid laser photocoagulation was added after 6 months if DME persisted. Visits occurred every 4 weeks during year 1 and were extended up to every 4 months thereafter when VA and macular thickness were stable. MAIN OUTCOME MEASURES Change in VA, adverse events, and retreatment frequency. RESULTS Median numbers of injections were 5, 6, and 6 in year 2 and 15, 16, and 15 over 2 years in the aflibercept, bevacizumab, and ranibizumab groups, respectively (global P = 0.08). Focal/grid laser photocoagulation was administered in 41%, 64%, and 52%, respectively (aflibercept vs. bevacizumab, P < 0.001; aflibercept vs. ranibizumab, P = 0.04; bevacizumab vs. ranibizumab, P = 0.01). At 2 years, mean VA improved by 12.8, 10.0, and 12.3 letters, respectively. Treatment group differences varied by baseline VA (P = 0.02 for interaction). With worse baseline VA (20/50 to 20/320), mean improvement was 18.1, 13.3, and 16.1 letters, respectively (aflibercept vs. bevacizumab, P = 0.02; aflibercept vs. ranibizumab, P = 0.18; ranibizumab vs. bevacizumab, P = 0.18). With better baseline VA (20/32 to 20/40), mean improvement was 7.8, 6.8, and 8.6 letters, respectively (P > 0.10, for pairwise comparisons). Anti-Platelet Trialists' Collaboration (APTC) events occurred in 5% with aflibercept, 8% with bevacizumab, and 12% with ranibizumab (global P = 0.047; aflibercept vs. bevacizumab, P = 0.34; aflibercept vs. ranibizumab, P = 0.047; ranibizumab vs. bevacizumab, P = 0.20; global P = 0.09 adjusted for potential confounders). CONCLUSIONS All 3 anti-VEGF groups showed VA improvement from baseline to 2 years with a decreased number of injections in year 2. Visual acuity outcomes were similar for eyes with better baseline VA. Among eyes with worse baseline VA, aflibercept had superior 2-year VA outcomes compared with bevacizumab, but superiority of aflibercept over ranibizumab, noted at 1 year, was no longer identified. Higher APTC event rates with ranibizumab over 2 years warrants continued evaluation in future trials.
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Affiliation(s)
- John A Wells
- Palmetto Retina Center, Columbia, South Carolina
| | | | | | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Neil M Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan B Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander J Brucker
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frederick L Ferris
- National Eye Institutes, National Institutes of Health, Bethesda, Maryland
| | - G Robert Hampton
- Retina-Vitreous Surgeons of Central New York, PC, Syracuse, New York
| | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
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Wiley HE, Thompson DJS, Bailey C, Chew EY, Cukras CA, Jaffe GJ, Lee RWJ, Loken EK, Meyerle CB, Wong W, Ferris FL. A Crossover Design for Comparative Efficacy: A 36-Week Randomized Trial of Bevacizumab and Ranibizumab for Diabetic Macular Edema. Ophthalmology 2016; 123:841-9. [PMID: 26875003 DOI: 10.1016/j.ophtha.2015.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To investigate the comparative efficacy of bevacizumab (Avastin) and ranibizumab (Lucentis; both Genentech, Inc, South San Francisco, CA) for diabetic macular edema (DME) using a crossover study design. DESIGN Randomized, double-masked, 36-week, 3-period crossover clinical trial. PARTICIPANTS Fifty-six subjects with DME involving the center of the macula in one or both eyes. METHODS Monthly intravitreous injections of bevacizumab (1.25 mg) or ranibizumab (0.3 mg). MAIN OUTCOME MEASURES Comparison of mean changes in visual acuity and central retinal thickness, tested using a linear mixed-effects model. RESULTS Based on the linear mixed-effects model, the 3-month estimated mean improvement in visual acuity was 5.3 letters for bevacizumab and 6.6 letters for ranibizumab (difference, 1.3 letters; P = 0.039). Estimated change in optical coherence tomography (OCT) central subfield mean thickness (CSMT) was -89 μm for bevacizumab and -137 μm for ranibizumab (difference, 48 μm; P < 0.001). Incorporating cumulative treatment benefit, the model yielded a predicted 36-week (9-month) average improvement in visual acuity of 7.1 letters (95% confidence interval [CI], 5.0-9.2) for bevacizumab and 8.4 letters (95% CI, 6.3-10.5) for ranibizumab, and a change in OCT CSMT of -128 μm (95% CI, -155 to -100) for bevacizumab and -176 μm (95% CI, -202 to -149) for ranibizumab. There was no significant treatment-by-period interaction (i.e., treatment difference was constant in all 3 periods), nor was there a significant differential carryover effect from one period to the next. CONCLUSIONS This trial demonstrated a statistically significant but small relative clinical benefit of ranibizumab compared with bevacizumab for treatment of DME, using a markedly reduced sample size relative to a full comparative efficacy study. The effects on visual acuity and central retinal thickness for the 2 drugs are consistent with those reported at 1 year for the concurrent parallel-group trial by the Diabetic Retinopathy Clinical Research Network testing bevacizumab, ranibizumab, and aflibercept for DME. The 3-period crossover design allowed for meaningful and efficient comparison, suggesting that this approach may be useful for future comparative efficacy studies of anti-vascular endothelial growth factor drugs for DME.
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Affiliation(s)
- Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
| | | | - Clare Bailey
- University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Catherine A Cukras
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Richard W J Lee
- University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, University of Bristol, Bristol, United Kingdom; National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital, National Health Service Foundation Trust, and University College London Institute of Ophthalmology, London, United Kingdom
| | | | | | - Wai Wong
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
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Datiles MB, Ansari RR, Yoshida J, Brown H, Zambrano AI, Tian J, Vitale S, Zigler JS, Ferris FL, West SK, Stark WJ. Longitudinal Study of Age-Related Cataract Using Dynamic Light Scattering: Loss of α-Crystallin Leads to Nuclear Cataract Development. Ophthalmology 2016; 123:248-254. [PMID: 26545319 PMCID: PMC4724511 DOI: 10.1016/j.ophtha.2015.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/04/2015] [Accepted: 10/06/2015] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To conduct a longitudinal study on age-related nuclear cataracts using dynamic light scattering (DLS) to determine if cataract progression is associated with loss of the unbound form of the lens molecular chaperone protein, α-crystallin. DESIGN Natural history and cohort study. PARTICIPANTS Patients 30 years of age or older of either gender seeking treatment at the Wilmer Eye Institute Cornea-Cataract Department. METHODS All patients underwent a comprehensive dilated eye examination every 6 months, including slit-lamp grading of their lenses using the Age-Related Eye Disease Study (AREDS) clinical lens grading system and obtaining an estimate of unbound α-crystallin level in the nucleus, the α-crystallin index (ACI), using the National Aeronautics and Space Administration-National Eye Institute DLS device. We used a random effects statistical model to examine the relationship of lens opacity changes over time with ACI changes. MAIN OUTCOME MEASURES α-Crystallin Index (ACI) and AREDS nuclear cataract grade. RESULTS Forty-five patients (66 eyes) 34 to 79 years of age with AREDS nuclear lens grades of 0 to 3.0 were followed up every 6 months for a mean of 19 months (range, 6-36 months). We found that lenses with the lowest baseline levels of ACI had the most rapid progression of cataracts, whereas lenses with higher ACI at baseline had no or slower cataract progression. Lenses that lost α-crystallin at the highest rates during the study also had faster progression of nuclear cataracts than lenses with a slower rate of ACI loss. Kaplan-Meier survival curves showed that lenses with the lowest initial ACI had the highest risk of undergoing cataract surgery. CONCLUSIONS This longitudinal study corroborates our previous cross-sectional study finding that higher levels of unbound α-crystallin as assessed by ACI are associated with lower risk of cataract formation and that loss of ACI over time is associated with cataract formation and progression. This study suggested that assessment of ACI with the DLS device could be used as a surrogate for lens opacity risk in clinical studies, and for assessing nuclear cataract events in studies where cataract development may be a side effect of a drug or device.
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Affiliation(s)
- Manuel B Datiles
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
| | - Rafat R Ansari
- National Aeronautics and Space Administration-John H. Glenn Research Center, Cleveland, Ohio
| | - Junko Yoshida
- The Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, Maryland; Department of Ophthalmology, University of Tokyo, Tokyo, Japan
| | - Holly Brown
- The Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, Maryland
| | - Andrea I Zambrano
- The Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, Maryland
| | - Jing Tian
- The Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, Maryland
| | - Susan Vitale
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - J Samuel Zigler
- The Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, Maryland
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Sheila K West
- The Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, Maryland
| | - Walter J Stark
- The Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, Maryland
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Affiliation(s)
- Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Rachel J Bishop
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
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Gross JG, Glassman AR, Jampol LM, Inusah S, Aiello LP, Antoszyk AN, Baker CW, Berger BB, Bressler NM, Browning D, Elman MJ, Ferris FL, Friedman SM, Marcus DM, Melia M, Stockdale CR, Sun JK, Beck RW. Panretinal Photocoagulation vs Intravitreous Ranibizumab for Proliferative Diabetic Retinopathy: A Randomized Clinical Trial. JAMA 2015; 314:2137-2146. [PMID: 26565927 PMCID: PMC5567801 DOI: 10.1001/jama.2015.15217] [Citation(s) in RCA: 492] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE Panretinal photocoagulation (PRP) is the standard treatment for reducing severe visual loss from proliferative diabetic retinopathy. However, PRP can damage the retina, resulting in peripheral vision loss or worsening diabetic macular edema (DME). OBJECTIVE To evaluate the noninferiority of intravitreous ranibizumab compared with PRP for visual acuity outcomes in patients with proliferative diabetic retinopathy. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at 55 US sites among 305 adults with proliferative diabetic retinopathy enrolled between February and December 2012 (mean age, 52 years; 44% female; 52% white). Both eyes were enrolled for 89 participants (1 eye to each study group), with a total of 394 study eyes. The final 2-year visit was completed in January 2015. INTERVENTIONS Individual eyes were randomly assigned to receive PRP treatment, completed in 1 to 3 visits (n = 203 eyes), or ranibizumab, 0.5 mg, by intravitreous injection at baseline and as frequently as every 4 weeks based on a structured re-treatment protocol (n = 191 eyes). Eyes in both treatment groups could receive ranibizumab for DME. MAIN OUTCOMES AND MEASURES The primary outcome was mean visual acuity change at 2 years (5-letter noninferiority margin; intention-to-treat analysis). Secondary outcomes included visual acuity area under the curve, peripheral visual field loss, vitrectomy, DME development, and retinal neovascularization. RESULTS Mean visual acuity letter improvement at 2 years was +2.8 in the ranibizumab group vs +0.2 in the PRP group (difference, +2.2; 95% CI, -0.5 to +5.0; P < .001 for noninferiority). The mean treatment group difference in visual acuity area under the curve over 2 years was +4.2 (95% CI, +3.0 to +5.4; P < .001). Mean peripheral visual field sensitivity loss was worse (-23 dB vs -422 dB; difference, 372 dB; 95% CI, 213-531 dB; P < .001), vitrectomy was more frequent (15% vs 4%; difference, 9%; 95% CI, 4%-15%; P < .001), and DME development was more frequent (28% vs 9%; difference, 19%; 95% CI, 10%-28%; P < .001) in the PRP group vs the ranibizumab group, respectively. Eyes without active or regressed neovascularization at 2 years were not significantly different (35% in the ranibizumab group vs 30% in the PRP group; difference, 3%; 95% CI, -7% to 12%; P = .58). One eye in the ranibizumab group developed endophthalmitis. No significant differences between groups in rates of major cardiovascular events were identified. CONCLUSIONS AND RELEVANCE Among eyes with proliferative diabetic retinopathy, treatment with ranibizumab resulted in visual acuity that was noninferior to (not worse than) PRP treatment at 2 years. Although longer-term follow-up is needed, ranibizumab may be a reasonable treatment alternative, at least through 2 years, for patients with proliferative diabetic retinopathy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01489189.
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Affiliation(s)
| | | | | | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Lloyd Paul Aiello
- Joslin Diabetes Center, Beetham Eye Institute, Department of Ophthalmology, Harvard University, Boston, Massachusetts
| | - Andrew N Antoszyk
- Charlotte Eye, Ear, Nose, and Throat Associates PA, Charlotte, North Carolina
| | | | | | - Neil M Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Browning
- Charlotte Eye, Ear, Nose, and Throat Associates PA, Charlotte, North Carolina
| | | | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Department of Ophthalmology, Harvard University, Boston, Massachusetts
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
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Rand LI, Ferris FL. Long-term Contributions From the Diabetes Control and Complications Trial Cohort. JAMA Ophthalmol 2015; 133:1107-8. [DOI: 10.1001/jamaophthalmol.2015.2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ying GS, Maguire MG, Daniel E, Ferris FL, Jaffe GJ, Grunwald JE, Toth CA, Huang J, Martin DF. Association of Baseline Characteristics and Early Vision Response with 2-Year Vision Outcomes in the Comparison of AMD Treatments Trials (CATT). Ophthalmology 2015; 122:2523-31.e1. [PMID: 26383996 DOI: 10.1016/j.ophtha.2015.08.015] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/07/2015] [Accepted: 08/10/2015] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To evaluate the association of baseline characteristics and early visual acuity (VA) response with visual outcomes at years 1 or 2 in the Comparison of Age-Related Macular Degeneration (AMD) Treatments Trials (CATT). DESIGN Secondary analysis of CATT. PARTICIPANTS The 1185 CATT participants with baseline VA of 20/25 to 20/320. METHODS Participants were assigned to ranibizumab or bevacizumab and to 1 of 3 dosing regimens. Associations of baseline characteristics and early VA response (week 4 or 12) with VA response at years 1 or 2 were assessed by R(2) from linear regression analyses. Patients who had a poor initial response (VA 20/40 or worse with persistent fluid and without ≥1-line VA gain) were defined as candidates for changing treatment. MAIN OUTCOME MEASURES Visual acuity change from baseline. RESULTS Statistically significant (P < 0.05) baseline predictors for less VA gain at year 2 were older age, VA of 20/40 or better, larger choroidal neovascularization area, presence of geographic atrophy, total foveal thickness ≤325 μm or ≥425 μm, and elevation of retinal pigment epithelium. Among 176 eyes gaining ≥3 lines at week 12, 78% had a ≥3-line gain at year 2, whereas among 113 eyes losing ≥1 line at week 12, 27% improved to a ≥1-line gain at year 2. Visual acuity response at week 12 was more predictive of VA response at year 2 (R(2) = 0.30) than VA response at week 4 (R(2) = 0.17) and baseline predictors (R(2) = 0.13; P < 0.0001). Among 126 candidates for changing treatment drug at week 12, mean VA improved by 2.8 letters (P = 0.050), mean total retinal thickness decreased 53 μm (P < 0.0001), and fluid resolved in 33% (P < 0.0001) between week 12 and year 1 with continued use of the same drug and regimen. Similar improvements were observed among 83 candidates for changing drugs at week 24. CONCLUSIONS Visual acuity response at week 12 is more predictive of 2-year vision outcomes than either several baseline characteristics or week 4 response. Eyes with poor initial response may benefit from continued treatment without switching to another drug.
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Affiliation(s)
- Gui-shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ebenezer Daniel
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Juan E Grunwald
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Jiayan Huang
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
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Nittala MG, Hariri A, Wong WT, Chew EY, Ferris FL, Sadda SR. Image Scaling Difference Between a Confocal Scanning Laser Ophthalmoscope and a Flash Fundus Camera. Ophthalmic Surg Lasers Imaging Retina 2015; 46:872-9. [DOI: 10.3928/23258160-20150909-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/24/2015] [Indexed: 01/28/2023]
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Flamendorf J, Agrón E, Wong WT, Thompson D, Wiley HE, Doss EL, Al-Holou S, Ferris FL, Chew EY, Cukras C. Impairments in Dark Adaptation Are Associated with Age-Related Macular Degeneration Severity and Reticular Pseudodrusen. Ophthalmology 2015; 122:2053-62. [PMID: 26253372 DOI: 10.1016/j.ophtha.2015.06.023] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 11/16/2022] Open
Abstract
PURPOSE We investigate whether ocular and person-based characteristics were associated with dark adaptation (DA). DESIGN Cross-sectional, single-center, observational study. PARTICIPANTS One hundred sixteen participants older than 50 years of age with a range of age-related macular degeneration (AMD) severity. METHODS Participants underwent best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, and multimodal imaging. Presence of reticular pseudodrusen (RPD) was assessed by masked grading of fundus images and was confirmed with optical coherence tomography. Eyes also were graded for AMD features (drusen, pigmentary changes, late AMD) to generate person-based AMD severity groups. One eye was designated the study eye for DA testing. Nonparametric statistical testing was performed on all comparisons. MAIN OUTCOME MEASURES The primary outcome of this study was the rod intercept time (RIT), which is defined as the time for a participant's visual sensitivity to recover to a stimulus intensity of 5×10(-3) cd/m(2) (a decrease of 3 log units), or until a maximum test duration of 40 minutes was reached. RESULTS A total of 116 study eyes from 116 participants (mean age, 75.4±9.4 years; 58% female) were analyzed. Increased RIT was associated significantly with increasing AMD severity, increasing age (r = 0.34; P = 0.0002), decreasing BCVA (r = -0.54; P < 0.0001), pseudophakia (P = 0.03), and decreasing subfoveal choroidal thickness (r = -0.27; P = 0.003). Study eyes with RPD (15/116 [13%]) had a significantly greater mean RIT compared with eyes without RPD in any AMD severity group (P < 0.02 for all comparisons), with 80% reaching the DA test ceiling. CONCLUSIONS Impairments in DA increased with age, worse visual acuity, presence of RPD, AMD severity, and decreased subfoveal choroidal thickness. Analysis of covariance found the multivariate model that best fit the data included age, AMD group, and presence of RPD (R(2) = 0.56), with the presence of RPD conferring the largest parameter estimate.
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Affiliation(s)
- Jason Flamendorf
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Wai T Wong
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Darby Thompson
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - E Lauren Doss
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Shaza Al-Holou
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Catherine Cukras
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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Glaser TS, Doss LE, Shih G, Nigam D, Sperduto RD, Ferris FL, Agrón E, Clemons TE, Chew EY. The Association of Dietary Lutein plus Zeaxanthin and B Vitamins with Cataracts in the Age-Related Eye Disease Study: AREDS Report No. 37. Ophthalmology 2015; 122:1471-9. [PMID: 25972257 DOI: 10.1016/j.ophtha.2015.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/27/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate whether dietary intake of luteiin/zeaxanthin and B vitamins is associated with cataract prevalence and incidence. DESIGN Clinic-based, baseline cross-sectional and prospective cohort study designs. PARTICIPANTS Three thousand one hundred fifteen patients (6129 eyes) enrolled in the Age-Related Eye Disease Study 55 to 80 years of age followed up for mean of 9.6 years. METHODS Participants completed baseline food frequency questionnaires. Baseline and annual lens photographs were graded centrally. Multivariate models controlling for previously identified risk factors for cataracts tested for the association of cataracts with reported dietary intake, using the lowest quintile as reference. MAIN OUTCOME MEASURES Cataract surgery, cataract status (type and severity) at baseline, and development of cataracts. RESULTS At baseline, increased dietary riboflavin and B12 were associated inversely with nuclear and cortical lens opacities. In comparisons of persons with and without cataract, persons with the highest riboflavin intake versus those with the lowest intake had the following associations: mild nuclear cataract: odds ratio (OR), 0.78; 95% confidence interval (CI), 0.63-0.97; moderate nuclear cataract: OR, 0.62; 95% CI, 0.43-0.90; and mild cortical cataract: OR, 0.80; 95% CI, 0.65-0.99. For B12, the results were: mild nuclear cataract: OR, 0.78; 95% CI, 0.63-0.96; moderate nuclear cataract: OR, 0.62; 95% CI, 0.43-0.88; and mild cortical cataract: OR, 0.77; 95% CI, 0.63-0.95. Highest dietary B6 intake was associated with a decreased risk of moderate nuclear lens opacity developing compared with the lowest quintile (OR, 0.67; 95% CI, 0.45-0.99). Highest dietary intake levels of niacin and B12 were associated with a decreased risk of development of mild nuclear or mild cortical cataracts in participants not taking Centrum (Pfizer, New York, NY) multivitamins. For participants taking multivitamins during the study, the highest intake of dietary folate was associated with an increased risk of mild posterior subcapsular lens opacity development. No statistically significant associations were found between lutein plus zeaxanthin intake and presence at baseline or development of nuclear or cortical lens opacity outcomes. CONCLUSIONS These findings are consistent with earlier studies suggesting that dietary intake of B vitamins may affect the occurrence of age-related lens opacities. Further investigations are warranted.
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Affiliation(s)
- Tanya S Glaser
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Lauren E Doss
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Grace Shih
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Divya Nigam
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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Ferris FL. The importance of peripheral diabetic retinopathy. Ophthalmology 2015; 122:869-70. [PMID: 25919777 DOI: 10.1016/j.ophtha.2015.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 02/12/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022] Open
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Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, Antoszyk AN, Arnold-Bush B, Baker CW, Bressler NM, Browning DJ, Elman MJ, Ferris FL, Friedman SM, Melia M, Pieramici DJ, Sun JK, Beck RW. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med 2015; 372:1193-203. [PMID: 25692915 PMCID: PMC4422053 DOI: 10.1056/nejmoa1414264] [Citation(s) in RCA: 1037] [Impact Index Per Article: 115.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The relative efficacy and safety of intravitreous aflibercept, bevacizumab, and ranibizumab in the treatment of diabetic macular edema are unknown. METHODS At 89 clinical sites, we randomly assigned 660 adults (mean age, 61±10 years) with diabetic macular edema involving the macular center to receive intravitreous aflibercept at a dose of 2.0 mg (224 participants), bevacizumab at a dose of 1.25 mg (218 participants), or ranibizumab at a dose of 0.3 mg (218 participants). The study drugs were administered as often as every 4 weeks, according to a protocol-specified algorithm. The primary outcome was the mean change in visual acuity at 1 year. RESULTS From baseline to 1 year, the mean visual-acuity letter score (range, 0 to 100, with higher scores indicating better visual acuity; a score of 85 is approximately 20/20) improved by 13.3 with aflibercept, by 9.7 with bevacizumab, and by 11.2 with ranibizumab. Although the improvement was greater with aflibercept than with the other two drugs (P<0.001 for aflibercept vs. bevacizumab and P=0.03 for aflibercept vs. ranibizumab), it was not clinically meaningful, because the difference was driven by the eyes with worse visual acuity at baseline (P<0.001 for interaction). When the initial visual-acuity letter score was 78 to 69 (equivalent to approximately 20/32 to 20/40) (51% of participants), the mean improvement was 8.0 with aflibercept, 7.5 with bevacizumab, and 8.3 with ranibizumab (P>0.50 for each pairwise comparison). When the initial letter score was less than 69 (approximately 20/50 or worse), the mean improvement was 18.9 with aflibercept, 11.8 with bevacizumab, and 14.2 with ranibizumab (P<0.001 for aflibercept vs. bevacizumab, P=0.003 for aflibercept vs. ranibizumab, and P=0.21 for ranibizumab vs. bevacizumab). There were no significant differences among the study groups in the rates of serious adverse events (P=0.40), hospitalization (P=0.51), death (P=0.72), or major cardiovascular events (P=0.56). CONCLUSIONS Intravitreous aflibercept, bevacizumab, or ranibizumab improved vision in eyes with center-involved diabetic macular edema, but the relative effect depended on baseline visual acuity. When the initial visual-acuity loss was mild, there were no apparent differences, on average, among study groups. At worse levels of initial visual acuity, aflibercept was more effective at improving vision. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01627249.).
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Petrou PA, Cunningham D, Shimel K, Harrington M, Hammel K, Cukras CA, Ferris FL, Chew EY, Wong WT. Intravitreal sirolimus for the treatment of geographic atrophy: results of a phase I/II clinical trial. Invest Ophthalmol Vis Sci 2014; 56:330-8. [PMID: 25525171 DOI: 10.1167/iovs.14-15877] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To investigate the safety and effects of intravitreal sirolimus for the potential treatment of geographic atrophy (GA). METHODS The study was a single-center, open-label, phase I/II trial enrolling six participants with bilateral GA treated with intravitreal sirolimus in only one randomly assigned eye, with the fellow eye as control. The primary efficacy outcome measure was the change in total GA area from baseline on color fundus photography (CFP); secondary outcomes included changes in GA area on fundus autofluorescence (FAF), visual acuity, central retinal thickness (CRT), and macular sensitivity from baseline. RESULTS Although no systemic adverse events were attributed to treatment, two of six participants had ocular adverse events that were possibly associated. The treated eye of one participant developed abnormal paralesional changes on FAF that were associated with accelerated retinal thinning. This accelerated retinal thinning was also seen in the treated eye of a second participant. Because of concern that these events were associated with treatment, treatment was suspended. Comparisons of treated and fellow eyes for change in visual acuity, change in GA area, and change in CRT showed no evidence of treatment benefit and generally favored the untreated fellow eye. CONCLUSIONS While paralesional FAF changes and rapid retinal thinning observed are potentially part of the natural course of GA, they may possibly be related to treatment. No general evidence of anatomical or functional benefit was detected in treated eyes. Further data on intravitreal sirolimus for GA treatment will be available from a larger phase II trial. (ClinicalTrials.gov number, NCT01445548.).
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Affiliation(s)
- Philip A Petrou
- Unit on Neuron-Glia Interactions in Retinal Diseases, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Denise Cunningham
- Office of the Clinical Director, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Katherine Shimel
- Office of the Clinical Director, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | | | - Keri Hammel
- The EMMES Corporation, Rockville, Maryland, United States
| | - Catherine A Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Frederick L Ferris
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Wai T Wong
- Unit on Neuron-Glia Interactions in Retinal Diseases, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
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Adamus G, Chew EY, Ferris FL, Klein ML. Prevalence of anti-retinal autoantibodies in different stages of Age-related macular degeneration. BMC Ophthalmol 2014; 14:154. [PMID: 25488058 PMCID: PMC4269864 DOI: 10.1186/1471-2415-14-154] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/18/2014] [Indexed: 11/13/2022] Open
Abstract
Background Age-related macular degeneration (AMD) is the leading cause of central vision loss in older adults. Anti-retinal autoantibodies (AAbs) have been found in individuals with AMD. The goal of the study was to determine the AAb specificity in different stages of AMD, and determine whether there is a prevalent AAb signature. Methods Sera of 134 participants in the Age-related Eye Disease Study were analyzed for anti-retinal AAbs by western blotting. The subjects were classified by diagnostic subgroups based upon their clinical classification: No AMD, Intermediate AMD, and Late AMD - geographic atrophy (GA) and Late AMD - neovascular (NV). Results The presence of anti-retinal AAb was detected in 58% patients with Intermediate and Late AMD, and 54% of those with no AMD. AAbs bound to fifteen different retinal antigens. Most individuals had 1 specific AAbs (67%), with the remainder having 2 to 4 different AAbs. Over 40% of patients with Intermediate AMD, and 46% of those with GA had anti-enolase AAbs, compared with 29% of individuals with NV and 29% with no AMD. Different AAbs signatures related to NV as compared to GA and/or Intermediate AMD were distinguished. Anti-40-kDa (10%) and 42-kDa (16%) autoantibodies were associated with Intermediate AMD, while anti-30-kDa AAbs (23%) were primarily present in GA. Anti-32-kDa (12%), 35-kDa (21%), and 60-kDa (8%) AAbs were more frequent in NV AMD. Conclusions A unique AAb pattern for each of the disease subgroups was present when AMD progressed from the intermediate to the late forms of severity. Differences in the frequency of specific AAbs between AMD subgroups suggested that they may participate in pathogenicity of AMD. Further studies are necessary to confirm these observations in the larger cohort and individual AMD patients over time.
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Affiliation(s)
- Grazyna Adamus
- Casey Eye Institute, Ocular Immunology Laboratory, L467AD, Oregon Health and Science University, 3181 SW Sam Jackson Pk Rd, Portland, OR 97239, USA.
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Nussenblatt RB, Lee RW, Chew E, Wei L, Liu B, Sen HN, Dick AD, Ferris FL. Immune responses in age-related macular degeneration and a possible long-term therapeutic strategy for prevention. Am J Ophthalmol 2014; 158:5-11.e2. [PMID: 24709810 DOI: 10.1016/j.ajo.2014.03.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/27/2014] [Accepted: 03/28/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To describe the immune alterations associated with age-related macular degeneration (AMD); and, based on these findings, to offer an approach to possibly prevent the expression of late disease. DESIGN Perspective. METHODS Review of the existing literature dealing with epidemiology, models, and immunologic findings in patients. RESULTS Significant genetic associations have been identified and reported, but environmentally induced (including epigenetic) changes are also an important consideration. Immune alterations include a strong interleukin 17 family signature as well as marked expression of these molecules in the eye. Oxidative stress as well as other homeostatic altering mechanisms occur throughout life. With this immune dysregulation there is a rationale for considering immunotherapy. Indeed, immunotherapy has been shown to affect the late stages of AMD. CONCLUSION Immune dysregulation appears to be an underlying alteration in AMD, as in other diseases thought to be degenerative and attributable to aging. Para-inflammation and immunosenescence may importantly contribute to the development of disease. The role of complement factor H still needs to be better defined, but in light of its association with ocular inflammatory conditions such as sarcoidosis, it does not appear to be unique to AMD but rather may be a marker for retinal pigment epithelium function. With the strong interleukin 17 family signature and the need to treat early on in the disease process, oral tolerance may be considered to prevent disease progression.
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Chew EY, Clemons TE, Agrón E, Sperduto RD, Sangiovanni JP, Davis MD, Ferris FL. Ten-year follow-up of age-related macular degeneration in the age-related eye disease study: AREDS report no. 36. JAMA Ophthalmol 2014; 132:272-7. [PMID: 24385141 DOI: 10.1001/jamaophthalmol.2013.6636] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Providing long-term follow-up of the natural history of age-related macular degeneration (AMD) and associated risk factors will facilitate future epidemiologic studies and clinical trials. OBJECTIVE To describe 10-year progression rates to intermediate or advanced AMD. DESIGN, SETTING, AND PARTICIPANTS We observed the Age-Related Eye Disease Study (AREDS) participants for an additional 5 years after a randomized clinical trial of antioxidant vitamins and minerals was completed. Observation occurred at 11 clinical sites of medical retinal practices from academic institutions and community medical centers. Participants aged 55 to 80 years with no AMD or AMD of varying severity (n = 4757) were followed up in the AREDS trial for a median duration of 6.5 years. When the trial ended, 3549 of the 4203 surviving participants were followed for 5 additional years. EXPOSURE Treatment with antioxidant vitamins and minerals. MAIN OUTCOMES AND MEASURES Development of varying stages of AMD and changes in visual acuity. The rates of progression to large drusen and advanced AMD (neovascular AMD or central geographic atrophy) were evaluated using annual fundus photographs assessed centrally. Best-corrected visual acuity was measured at annual study visits. RESULTS The risk of progression to advanced AMD increased with increasing age (P = .01) and severity of drusen. Women (P = .005) and current smokers (P < .001) were at increased risk of neovascular AMD. In the oldest participants with the most severe AMD status at baseline, the risks of developing neovascular AMD and central geographic atrophy by 10 years were 48.1% and 26.0%, respectively. Similarly, rates of progression to large drusen increased with increasing severity of drusen at baseline, with 70.9% of participants with bilateral medium drusen progressing to large drusen and 13.8% to advanced AMD in 10 years. Median visual acuity at 10 years in eyes that had large drusen at baseline but never developed advanced AMD was 20/25; eyes that developed advanced AMD had a median visual acuity of 20/200. CONCLUSIONS AND RELEVANCE The natural history of AMD demonstrates relentless loss of vision in persons who developed advanced AMD. These progression data and the risk factor analyses may be helpful to investigators conducting research in clinic populations.
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Affiliation(s)
- Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - John Paul Sangiovanni
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Matthew D Davis
- Department of Ophthalmology, University of Wisconsin, Madison
| | - Frederick L Ferris
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
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Chew EY, Clemons TE, Sangiovanni JP, Danis RP, Ferris FL, Elman MJ, Antoszyk AN, Ruby AJ, Orth D, Bressler SB, Fish GE, Hubbard GB, Klein ML, Chandra SR, Blodi BA, Domalpally A, Friberg T, Wong WT, Rosenfeld PJ, Agrón E, Toth CA, Bernstein PS, Sperduto RD. Secondary analyses of the effects of lutein/zeaxanthin on age-related macular degeneration progression: AREDS2 report No. 3. JAMA Ophthalmol 2014; 132:142-9. [PMID: 24310343 DOI: 10.1001/jamaophthalmol.2013.7376] [Citation(s) in RCA: 262] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE The Age-Related Eye Disease Study (AREDS) formulation for the treatment of age-related macular degeneration (AMD) contains vitamin C, vitamin E, beta carotene, and zinc with copper. The Age-Related Eye Disease Study 2 (AREDS2) assessed the value of substituting lutein/zeaxanthin in the AREDS formulation because of the demonstrated risk for lung cancer from beta carotene in smokers and former smokers and because lutein and zeaxanthin are important components in the retina. OBJECTIVE To further examine the effect of lutein/zeaxanthin supplementation on progression to late AMD. DESIGN, SETTING, PARTICIPANTS The Age-Related Eye Disease Study 2 is a multicenter, double-masked randomized trial of 4203 participants, aged 50 to 85 years, at risk for developing late AMD; 66% of patients had bilateral large drusen and 34% had large drusen and late AMD in 1 eye. INTERVENTIONS In addition to taking the original or a variation of the AREDS supplement, participants were randomly assigned in a factorial design to 1 of the following 4 groups: placebo; lutein/zeaxanthin, 10 mg/2 mg; omega-3 long-chain polyunsaturated fatty 3 acids, 1.0 g; or the combination. MAIN OUTCOMES AND MEASURE S Documented development of late AMD by central, masked grading of annual retinal photographs or by treatment history. RESULTS In exploratory analysis of lutein/zeaxanthin vs no lutein/zeaxanthin, the hazard ratio of the development of late AMD was 0.90 (95% CI, 0.82-0.99; P = .04). Exploratory analyses of direct comparison of lutein/zeaxanthin vs beta carotene showed hazard ratios of 0.82 (95% CI, 0.69-0.96; P = .02) for development of late AMD, 0.78 (95% CI, 0.64-0.94; P = .01) for development of neovascular AMD, and 0.94 (95% CI, 0.70-1.26; P = .67) for development of central geographic atrophy. In analyses restricted to eyes with bilateral large drusen at baseline, the direct comparison of lutein/zeaxanthin vs beta carotene showed hazard ratios of 0.76 (95% CI, 0.61-0.96; P = .02) for progression to late AMD, 0.65 (95% CI, 0.49-0.85; P = .002) for neovascular AMD, and 0.98 (95% CI, 0.69-1.39; P = .91) for central geographic atrophy. CONCLUSION AND RELEVANCE The totality of evidence on beneficial and adverse effects from AREDS2 and other studies suggests that lutein/zeaxanthin could be more appropriate than beta carotene in the AREDS-type supplements. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00345176.
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Affiliation(s)
| | - Emily Y Chew
- Division of Epidemiology and Clinical Research, National Institutes of Health, Bethesda, Maryland
| | | | | | - Ronald P Danis
- Department of Ophthalmology, University of Wisconsin-Madison
| | | | | | | | - Alan J Ruby
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan
| | - David Orth
- Ingalls Memorial Hospital, Harvey, Illinois
| | - Susan B Bressler
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | | | | | - Michael L Klein
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland
| | - Suresh R Chandra
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health
| | - Barbara A Blodi
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health15Fundus Photograph Reading Center, University of Wisconsin-Madison
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health
| | - Thomas Friberg
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Wai T Wong
- Unit on Neuron-Glia Interactions in Retinal Disease, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | | | | | - Paul S Bernstein
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah Health Sciences Center, University of Utah, Salt Lake City
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Chew EY, SanGiovanni JP, Ferris FL, Wong WT, Agron E, Clemons TE, Sperduto R, Danis R, Chandra SR, Blodi BA, Domalpally A, Elman MJ, Antoszyk AN, Ruby AJ, Orth D, Bressler SB, Fish GE, Hubbard GB, Klein ML, Friberg TR, Rosenfeld PJ, Toth CA, Bernstein P. Lutein/zeaxanthin for the treatment of age-related cataract: AREDS2 randomized trial report no. 4. JAMA Ophthalmol 2013; 131:843-50. [PMID: 23645227 DOI: 10.1001/jamaophthalmol.2013.4412] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
IMPORTANCE Age-related cataract is a leading cause of visual impairment in the United States. The prevalence of age-related cataract is increasing, with an estimated 30.1 million Americans likely to be affected by 2020. OBJECTIVE To determine whether daily oral supplementation with lutein/zeaxanthin affects the risk for cataract surgery. DESIGN, SETTING, AND PATIENTS The Age-Related Eye Disease Study 2 (AREDS2), a multicenter, double-masked clinical trial, enrolled 4203 participants, aged 50 to 85 years, at risk for progression to advanced age-related macular degeneration. INTERVENTIONS Participants were randomly assigned to daily placebo; lutein/zeaxanthin, 10mg/2mg; omega-3 long-chain polyunsaturated fatty acids, 1 g; or a combination to evaluate the effects on the primary outcome of progression to advanced age-related macular degeneration. MAIN OUTCOMES AND MEASURES Cataract surgery was documented at annual study examination with the presence of pseudophakia or aphakia, or reported during telephone calls at 6-month intervals between study visits. Annual best-corrected visual acuity testing was performed. A secondary outcome of AREDS2 was to evaluate the effects of lutein/zeaxanthin on the subsequent need for cataract surgery. RESULTS A total of 3159 AREDS2 participants were phakic in at least 1 eye and 1389 of 6027 study eyes underwent cataract surgery during the study, with median follow-up of 4.7 years. The 5-year probability of progression to cataract surgery in the no lutein/zeaxanthin group was 24%. For lutein/zeaxanthin vs no lutein/zeaxanthin, the hazard ratios for progression to cataract surgery was 0.96 (95% CI, 0.84-1.10; P = .54). For participants in the lowest quintile of dietary intake of lutein/zeaxanthin, the hazard ratio comparing lutein/zeaxanthin vs no lutein/zeaxanthin for progression to cataract surgery was 0.68 (95% CI, 0.48-0.96; P = .03). The hazard ratio for 3 or more lines of vision loss was 1.03 (95% CI, 0.93-1.13; P = .61 for lutein/zeaxanthin vs no lutein/zeaxanthin). CONCLUSIONS AND RELEVANCE Daily supplementation with lutein/zeaxanthin had no statistically significant overall effect on rates of cataract surgery or vision loss. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00345176.
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Affiliation(s)
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- National Eye Institute/National Institutes of Health, Bethesda, MD 20892, USA
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