Long-term results of treatment of neovascular age-related macular degeneration using antiangiogenic drugs: A review of the literature

Age-related macular degeneration (AMD) is one of the main causes of visual acuity (VA) loss in people over 50 years of age worldwide, with neovascular AMD (nAMD) accounting for 80% of cases of severe vision loss due to this disease. Anti-vascular endothelial growth factor (anti-VEGF) drugs have been used for the treatment of this disease for more than a decade, changing drastically the visual prognosis of these patients. However, initial studies reporting data on outcomes were short term. Currently, there are different series published on the long-term results of AMD after treatment with anti-VEGF, and the aim of this review is to synthesize these results. The mean follow-up of the included studies was 8.2 years (range 5-12 years). The mean initial VA was 55.3 letters in the Early Treatment Diabetic Retinopathy Study (ETDRS) (range 45.6-65) and the mean final VA was 50.1 letters (range 33.0-64.3), with a mean loss of 5.2 letters. At the end of follow-up, 29.4% of the patients maintained a VA > 70 letters. The 67.9% of patients remained stable at the end of follow-up (< 15 letter loss), with a severe loss (≥ 15 letters) of 30.1%. Fibrosis and atrophy were the main causes of long-term VA loss, occurring at the end of follow-up in 52.5% and 60.5%, respectively.

Approaches to the epidemiology of NOHL in the region of Madrid: Survey of neuro-ophthalmologists

OBJECTIVE

To estimate the epidemiology of Leber's optic neuropathy (NOHL) in the Region of Madrid.

MATERIAL AND METHODS

The neuro-ophthalmologists who work at public hospitals of the CAM were interviewed by telephone. They were asked about the number of patients with NOHL that they had diagnosed during the time that they had been responsible for the neuro-ophthalmology department of that public hospital. The time worked and the population attended by the hospital were used to calculate the number of inhabitant-years in follow-up by each center during the corresponding period. The basic information of each case (date of birth, mutation, date of visual loss) was registered to avoid duplications.

RESULTS

Our work estimates a global incidence of 2.34 cases for 10,000,000 inhabitants-year and a prevalence estimated from incidence of one case for each 106.682 inhabitants. This prevalence was very similar in all the studied areas and considerably lower than that reported by other studies.

CONCLUSION

This work constitutes the first approach to the epidemiology of this disease in Spain. The prevalence of LHON in the region of Madrid, is probably lower than that reported in the literature in other regions. The prevalence and the incidence were homogeneously low in the 26 studied areas.

Visual impairment associated with diabetic retinopathy and macular edema: a hospital-based study

BACKGROUND

Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence.

OBJECTIVE

To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting.

MATERIAL AND METHODS

Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated.

RESULTS

A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30%. DR was found in 62% of patients (30% had sight-threatening DR [STDR]), 17% had referable DME, and 3%, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006).

CONCLUSION

Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.

Unilateral visual impairment after a dental procedure: Case report

The use of intra-oral local anaesthetics for dental procedures is a widely extended practice that may cause side effects. As such, in rare cases it may cause ocular complications such as diplopia, ptosis, blurry vision, miosis, vision loss, or amaurosis. (Most of them are transient, recovering after several hours or days). A case is presented of a 26 year-old male patient who had visual impairment in the right eye 2 days after a dental procedure was performed. Six months later he had a complete restoration of the previous visual acuity, despite the fact that he had not received any treatment. Several ways have been proposed in the literature that may explain the appearance of ocular complications following these kinds of procedures. In this case, inadvertent intravenous injection is believed to have been the cause.

Unilateral visual impairment after a dental procedure: Case report

The use of intra-oral local anaesthetics for dental procedures is a widely extended practice that may cause side effects. As such, in rare cases it may cause ocular complications such as diplopia, ptosis, blurry vision, miosis, vision loss, or amaurosis. (Most of them are transient, recovering after several hours or days). A case is presented of a 26 year-old male patient who had visual impairment in the right eye 2 days after a dental procedure was performed. Six months later he had a complete restoration of the previous visual acuity, despite the fact that he had not received any treatment. Several ways have been proposed in the literature that may explain the appearance of ocular complications following these kinds of procedures. In this case, inadvertent intravenous injection is believed to have been the cause.

[Feasibility of an individualised psychological intervention for older adults with dementia and visual impairment]

INTRODUCTION

The ageing of the population has led to a progressive increase in age-related diseases, such as dementia or visual impairment, due to chronic diseases. This work describes and analyses the efficacy and feasibility of an individualised intervention carried out with two male users of a day-care centre with a diagnosis of dementia and a severe visual impairment, which made it difficult for them to take part in the regular activities of the centre.

MATERIAL AND METHOD

The intervention process had a time frame of three months, and had an assessment phase before and after the intervention. For the assessment, use was made of the Mini-Mental State Examination, Geriatric Depression Scale, and an observational tool based on the Dementia Categorization Recording Observational System. The intervention lasted for eight weeks, and consisted of different dynamics adjusted to the preferences of the participants.

RESULTS AND CONCLUSIONS

After the intervention, a clinically significant reduction in the depressive symptomatology was observed for both participants, along with a reduction in the frequency of apathetic behaviour during the time they spent in the centre. Furthermore, an increase was observed in the prosocial behaviour and on the engagement with the task. The results show that the personalisation of the activities for particular users increases the stimulation of the participants, improving their well-being through small and inexpensive adaptations to the interventions that are carried out in the centres.

Permanent visual work disabilities: 321 cases review

INTRODUCTION

Visual diseases are the fifth more frequent cause of labour permanent disability, what represents 4% of the total of them. In order to assess these cases we must take into account on one hand the visual requirements of each profession, and on the other hand the visual functional impairments that the worker is suffering. Special attention must be paid to situations of legal blindness and low vision, as a cause of serious disabilities. Despite the importance of the matter, we have hardly found any reviews about it in the consulted bibliography.

MATERIALS AND METHODS

We have carried out a retrospective research of 321 disability claims due to ocular causes, assessed at the Ophthalmology Section of the Forensic Medical Clinic of Madrid, in the last 18 years. They account for 3% of the total disability claims raised in our field.

RESULTS

The most frequent professions involved have been administrative services, construction, hotel workers, cleaning and professional drivers. In 90% of cases these professional activities had medium or low visual requirements. The plaintiff in 40% of cases was unemployed. The most frequent visual pathologies we found out were myopic complications (especially myopic maculopathy) 17%, and eye trauma (16%). To a lesser extent: retinal detachment (12%), optic neuritis (7%), glaucoma (6%), diabetic retinopathy (6%), pigmentary retinitis (4%), non-myopic maculopathies (2%) and melanomas (2%). In 23% of cases no significant visual limitation was found (it was lower than 33%). Out of these, 9% were diagnosed as NOVL (non-organic visual loss), 3% of them being very obvious cases of simulation.

CONCLUSIONS

In 82% of the cases the expert's report pointed out a significant global (visual and non-visual) functional limitation (greater than 33%) of their work capacity. In the previous administrative phase of all these cases the recognition fo disability had not been granted. From the results obtained it turns out the importance of an ophthalmologist acting as an expert in this type of demands.

Translation and cultural adaptation into Spanish of the Low Vision Quality of Life Questionnaire

OBJECTIVE

The purpose of the present study was to provide a translation into Spanish, as well as a cross-cultural adaptation, of the English version of the Low Vision Quality of Life Questionnaire (LVQOL). There are currently some questionnaires designed to assess vision related quality of life in Spanish, although none of them specifically examines the quality of life of patients with visual disability.

METHOD

The LVQOL consists of 25 items and examines 4 different dimensions: distance vision; mobility and ilumination; adaptation, reading and precision work, and daily life activities. The process of translation and cross-cultural adaptation was conducted following the recommendations of the International Society for Pharmacoeconomics and Outcomes. This included, amongst other variables, a direct translation, a back-translation, and a cognitive debriefing with a small sample of patients with visual impairment. Work was supervised by an expert committee consisting of an ophthalmologist, a psychologist with expertise in Patient Reported Outcomes, and an optician-optometrist with experience in the field of low vision.

RESULTS

A total of 46 phrases were considered for translation of which, 41 (89.1%) had excellent equivalence, 3 (6.5%) moderate equivalence, and 2 poor equivalence. The cognitive debriefing phase showed a high degree of acceptance of the questionnaire by the sample of participants with visual impairment.

CONCLUSIONS

The results obtained suggest that the Spanish version of this tool is understandable for patients with visual impairment. Its properties as a measuring tool will be evaluated in a later study to determine its validity, reliability, and sensitivity to changes.