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Dhooge PPA, Möller PT, Meland N, Stingl K, Boon CJF, Lotery AJ, Parodi MB, Herrmann P, Klein W, Fsadni MG, Wheeler-Schilling TH, Holz FG, Hoyng CB, Schmitz-Valckenberg S. Repeatability of Quantitative Autofluorescence Imaging in a Multicenter Study Involving Patients With Recessive Stargardt Disease 1. Transl Vis Sci Technol 2023; 12:1. [PMID: 36723966 PMCID: PMC9904328 DOI: 10.1167/tvst.12.2.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose This study assesses the repeatability of quantitative autofluorescence (qAF) in a multicenter setting and evaluates qAF as the end point for clinical trials in recessive Stargardt disease 1 (STGD1). Methods A total of 102 patients with STGD1 underwent qAF imaging as part of the Stargardt Remofuscin Treatment Trial (STARTT; EudraCT No. 2018-001496-20). For 166 eyes, we obtained qAF imaging at 2 visits, with 2 recordings per visit. The qAF8 values were independently determined by the study site and a central reading center. Intra- and inter-visit reproducibility, as well as interobserver (study site versus reading center) reproducibility were obtained using intraclass correlation (ICC), one-sample t-test, and Bland-Altman coefficient of repeatability. Results The qAF repeatability was ± 26.1% for intra-visit, ± 40.5% for inter-visit, and ± 20.2% for the interobserver reproducibility measures. Intra-visit repeatability was good to excellent for all sites (ICC of 0.88-0.96). Variability between visits was higher with an overall ICC of 0.76 (0.69-0.81). We observed no significant difference in qAF values across sites between visits (7.06 ± 93.33, P = 0.238). Conclusions Real-life test-retest variability of qAF is higher in this set of data than previously reported in single center settings. With improved operator training and by selecting the better of two recordings for evaluation, qAF serves as a useful method for assessing changes in autofluorescence signal. Translational Relevance The qAF can be adopted as a clinical trial end point, but steps to counterbalance variability should be considered.
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Affiliation(s)
- Patty P. A. Dhooge
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands,Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Philipp T. Möller
- Department of Ophthalmology, University of Bonn, Bonn, Germany,GRADE Reading Center, Bonn, Germany
| | - Nils Meland
- SMERUD Medical Research International AS, Thunes vei 2, Oslo, Norway
| | - Katarina Stingl
- Univeristy Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Camiel J. F. Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands,Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | - Philipp Herrmann
- Department of Ophthalmology, University of Bonn, Bonn, Germany,Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | | | - Mario G. Fsadni
- Katairo GmbH, Kusterdingen, Germany,International Pharm-Med Ltd., Bramhall, UK
| | | | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany,GRADE Reading Center, Bonn, Germany
| | - Carel B. Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands,Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany,GRADE Reading Center, Bonn, Germany,John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Dhooge PP, Möller PT, Boon CJ, Lotery AJ, Herrmann P, Battaglia Parodi M, Klein W, Fsadni MG, Wheeler-Schilling TH, Jungmann O, Müller H, Holz FG, Schmitz-Valckenberg S, Peters TM, Stingl K, Hoyng CB. The STArgardt Remofuscin Treatment Trial (STARTT): design and baseline characteristics of enrolled Stargardt patients. Open Res Eur 2022; 1:96. [PMID: 37645124 PMCID: PMC10445898 DOI: 10.12688/openreseurope.13872.3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 08/31/2023]
Abstract
Background: This report describes the study design and baseline characteristics of patients with Stargardt disease (STGD1) enrolled in the STArgardt Remofuscin Treatment Trial (STARTT). Methods: In total, 87 patients with genetically confirmed STGD1 were randomized in a double-masked, placebo-controlled proof of concept trial to evaluate the safety and efficacy of 20 milligram oral remofuscin for 24 months. The primary outcome measure is change in mean quantitative autofluorescence value of an 8-segment ring centred on the fovea (qAF 8). Secondary efficacy variables are best corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), mesopic microperimetry (mMP), spectral domain optical coherence tomography (SD-OCT), reading speed on Radner reading charts, and patient-reported visual function as assessed by the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) and Functional Reading Independence (FRI) Index. Results: Mean age of participants was 35±11 years with 49 (56%) female. Median qAF 8 value was 438 Units (range 210-729). Median BCVA and LLVA in decimal units were 0.50 (range 0.13-0.80) and 0.20 (range 0.06-0.63), respectively. The median of the mean retinal sensitivity with mMP was 20.4 dB (range 0.0-28.8). SD-OCT showed median central subfield retinal thickness of 142 µm (range 72-265) and median macular volume of 1.65 mm 3 (range 1.13-2.19). Compared to persons without vision impairment, both reading performance and patient-reported visual function were significantly lower (p<0.001, one sample t-test). Mean reading speed was 108±39 words/minute with logRAD-score of 0.45±0.28. Mean VFQ-25 composite score was 72±13. Mean FRI Index score 2.8±0.6. Conclusions: This trial design may serve as reference for future clinical trials as it explores the utility of qAF 8 as primary outcome measure. The baseline data represent the largest, multi-national, STGD1 cohort to date that underwent standardized qAF imaging, reading speed assessment and vision-related quality of life measures which all contribute to the characterization of STGD1. EudraCT registration: 2018-001496-20 (09/05/2019).
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Affiliation(s)
- Patty P.A. Dhooge
- Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Nijmegen, 6500HB, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6525EN, The Netherlands
| | - Philipp T. Möller
- GRADE reading center, Bonn, 53127, Germany
- Department of Ophthalmology, University of Bonn, Bonn, 53127, Germany
| | - Camiel J.F. Boon
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, 1081HV, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, 2333ZA, The Netherlands
| | - Andrew J. Lotery
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Philipp Herrmann
- Department of Ophthalmology, University of Bonn, Bonn, 53127, Germany
- Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, 53113, Germany
| | | | | | - Mario G. Fsadni
- Katairo GmbH, Kusterdingen, 72127, Germany
- International Pharm-Med Ltd, Hemel Hempstead, HP1 1LD, UK
| | - Thomas H. Wheeler-Schilling
- University Eye Hospital, Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, 72076, Germany
| | - Oliver Jungmann
- Smerud Medical Research Germany GmbH, Mannheim, D-68161, Germany
| | - Hans Müller
- Smerud Medical Research Germany GmbH, Mannheim, D-68161, Germany
| | - Frank G. Holz
- GRADE reading center, Bonn, 53127, Germany
- Department of Ophthalmology, University of Bonn, Bonn, 53127, Germany
| | - Steffen Schmitz-Valckenberg
- GRADE reading center, Bonn, 53127, Germany
- Department of Ophthalmology, University of Bonn, Bonn, 53127, Germany
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, 84132, USA
| | - Tobias M. Peters
- University Eye Hospital, Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, 72076, Germany
| | - Katarina Stingl
- University Eye Hospital, Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, 72076, Germany
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, 72076, Germany
| | - Carel B. Hoyng
- Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Nijmegen, 6500HB, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6525EN, The Netherlands
| | - Soraprazan Consortium
- Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Nijmegen, 6500HB, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6525EN, The Netherlands
- GRADE reading center, Bonn, 53127, Germany
- Department of Ophthalmology, University of Bonn, Bonn, 53127, Germany
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, 1081HV, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, 2333ZA, The Netherlands
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
- Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, 53113, Germany
- Department of Ophthalmology, Ospedale San Raffaele, Milan, 20132, Italy
- Katairo GmbH, Kusterdingen, 72127, Germany
- International Pharm-Med Ltd, Hemel Hempstead, HP1 1LD, UK
- University Eye Hospital, Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, 72076, Germany
- Smerud Medical Research Germany GmbH, Mannheim, D-68161, Germany
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, 84132, USA
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, 72076, Germany
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Stewart WC, Kristoffersen CJ, Demos CM, Fsadni MG, Stewart JA. Incidence of Conjunctival Exposure following Drainage Device Implantation in Patients with Glaucoma. Eur J Ophthalmol 2018; 20:124-30. [DOI: 10.1177/112067211002000117] [Citation(s) in RCA: 44] [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] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate prior studies including a glaucoma drainage device and to describe the timing and incidence of conjunctival exposure. A meta-analysis of previously published articles. Methods Articles included were prospective, single cohort, or comparative parallel design, with a mean treatment period of at least 3 months and at least 30 patients per treatment arm. We limited our analysis to studies that evaluated the most common devices, including Ahmed, Baerveldt, and Molteno. Results We included 38 studies containing 45 treatment arms (16 Ahmed, 12 Baerveldt, and 17 Molteno). These studies included 3,105 patients and 3,255 eyes with an average follow-up of 26.1±3.3 months. The overall incidence of exposure was 2.0±2.6% (n=64) of eyes with an average exposure/month of 0.09±0.14%. There was no significant correlation between study length and incidence of exposure (p=0.11), although multivariate regression analysis identified length of follow-up as a risk factor for exposure (p=0.001). Among individual drainage devices, there was no significant difference in the incidence of exposure (p=0.22) or percent exposure per month (p=0.18). In addition, no difference existed in the incidence of exposure between sizes for the Baerveldt 250, 350 or 500 mm (p=0.7), number of plates for the Molteno Single or Double (p=0.3), nor between the composition of the Ahmed Silicone or Polypropylene (p=0.7). Conclusions This study suggests that tube exposure of glaucoma implants is unusual and the incidence does not differ between the Ahmed, Baerveldt, and Molteno implants. However, exposure appears to occur at any time within the first 5 years following implantation.
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Shepherd WF, Fsadni MG, Raj PS. A clinical evaluation of diclofenac-gentamicin combination eye drops in the control of inflammation after cataract surgery. Diclofenac-Gentamicin versus Gentamicin Study Group. Ocul Immunol Inflamm 1998; 6:13-8. [PMID: 9798189 DOI: 10.1076/ocii.6.1.13.8083] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The purpose of this study was to compare the efficacy and safety of diclofenac-gentamicin (DR 1352/1) combination eye drops with gentamicin eye drops in the postoperative management of patients undergoing extracapsular cataract surgery and lens implantation. This was a prospective, randomised, double-masked, parallel-group, four-week, multicentre study with patient visits preoperatively, on the day of surgery, and postoperatively on days 1, 5-8, 12-16, and 26-32. Of the 196 patients (diclofenac-gentamicin 99, gentamicin 97) recruited into the study, 161 (diclofenac-gentamicin 83, gentamicin 78) were available for per-protocol analyses. The two treatment groups were clinically similar at baseline. On days 12-16 postoperatively, diclofenac-gentamicin was significantly more effective (p = 0.002) than gentamicin in reducing intraocular inflammation as assessed by the sum of grades of anterior chamber cells and flare. The level of conjunctival hyperaemia was significantly less in the diclofenac-gentamicin group compared with the gentamicin group on postoperative days 5-8 and 12-16. There was no significant difference between the two study groups in the global assessment of local tolerance. Possibly drug-related adverse events were slightly more in the diclofenac-gentamicin group (22,22%) compared with gentamicin (17,17%); however, all affected study patients normalised with appropriate therapy except one patient with endophthalmitis. In conclusion, diclofenac-gentamicin (DR1352/1) eye drops were more effective than gentamicin eye drops and appeared to be as safe in the control of post-cataract surgery inflammation.
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Affiliation(s)
- W F Shepherd
- Department of Ophthalmology, Borders General Hospital, Melrose, UK
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