Age-Related Macular Degeneration Preferred Practice Pattern®

Flaxel, Christina J.; Adelman, Ron A.; Bailey, Steven T.; Fawzi, Amani A.; Lim, Jennifer I.; Vemulakonda, G. Atma; Ying, Gui Shuang

doi:10.1016/j.ophtha.2019.09.024

Cited by 239 publications

(254 citation statements)

References 284 publications

(272 reference statements)

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“…Third, our framework can predict the risk not only of late AMD, but also of GA and NV separately. This is important since treatment approaches for the two subtypes of late AMD are very different: NV needs to be diagnosed extremely promptly, since delay in access to intravitreal anti-VEGF injections is usually associated with very poor visual outcomes 33 , while various therapeutic options to slow GA enlargement are under investigation 34,35 . Finally, the twostep approach has important advantages.…”

Section: Introductionmentioning

confidence: 99%

Predicting risk of late age-related macular degeneration using deep learning

et al. 2020

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By 2040, age-related macular degeneration (AMD) will affect~288 million people worldwide. Identifying individuals at high risk of progression to late AMD, the sight-threatening stage, is critical for clinical actions, including medical interventions and timely monitoring. Although deep learning has shown promise in diagnosing/screening AMD using color fundus photographs, it remains difficult to predict individuals' risks of late AMD accurately. For both tasks, these initial deep learning attempts have remained largely unvalidated in independent cohorts. Here, we demonstrate how deep learning and survival analysis can predict the probability of progression to late AMD using 3298 participants (over 80,000 images) from the Age-Related Eye Disease Studies AREDS and AREDS2, the largest longitudinal clinical trials in AMD. When validated against an independent test data set of 601 participants, our model achieved high prognostic accuracy (5-year C-statistic 86.4 (95% confidence interval 86.2-86.6)) that substantially exceeded that of retinal specialists using two existing clinical standards (81.3 (81.1-81.5) and 82.0 (81.8-82.3), respectively). Interestingly, our approach offers additional strengths over the existing clinical standards in AMD prognosis (e.g., risk ascertainment above 50%) and is likely to be highly generalizable, given the breadth of training data from 82 US retinal specialty clinics. Indeed, during external validation through training on AREDS and testing on AREDS2 as an independent cohort, our model retained substantially higher prognostic accuracy than existing clinical standards. These results highlight the potential of deep learning systems to enhance clinical decision-making in AMD patients.

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Section: Introductionmentioning

confidence: 99%

Predicting risk of late age-related macular degeneration using deep learning

et al. 2020

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“…Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) are leading causes of blindness among working-age and elderly populations, respectively. Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is considered the standard of care for nAMD and DME, 1,2 with four agents commonly used in current clinical practice: US Food and Drug Administration (FDA)-approved ranibizumab and aflibercept for nAMD and DME; FDA-approved brolucizumab for nAMD; and off-label bevacizumab for both conditions. [3][4][5][6] Landmark trials suggest that these agents have comparable safety and efficacy in their respective indications; [7][8][9][10][11][12] therefore, treatment preferences among physicians and patients may instead be driven by other factors, such as differences in cost and labeled injection frequency.…”

Section: Introductionmentioning

confidence: 99%

<p>Patient Preferences Associated with Anti-Vascular Endothelial Growth Factor Therapies for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema</p>

Bhagat

Kirby

Bhatt³

et al. 2020

OPTH

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Purpose: To evaluate treatment-related preferences among patients receiving intravitreal anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME). Patients and Methods: We conducted a prospective survey of patients with nAMD or DME treated at one of three US-based retina clinics. Prior to survey development, small focus groups with anti-VEGF-treated patients identified five treatment-related "attributes" considered important to those with nAMD or DME: vision outcomes, cost to the insurance provider, cost to the patient, frequency of treatment, and drug label status. Attributes were described using two to three "levels", and hypothetical treatment profiles were generated by assigning one level to each attribute. Surveyed patients were asked to indicate their preference between two given treatment profiles for a total of eight pairwise comparisons. Discrete choice conjoint analysis was performed to estimate the relative importance of each attribute for the overall patient cohort, and for subgroups stratified by age and highest education level. Results: Among 300 respondents, 54% were female, 78% were aged ≥65 years, and 67% indicated that high school was their highest level of education. Achieving good vision was the most important factor associated with anti-VEGF therapy for nAMD or DME (relative importance, 40.4%), followed by low cost to the patient, on-label drug status, less frequent treatment intervals, and low cost to the insurance provider (23.1%, 21.3%, 12.2%, and 3.0%, respectively). When patients were stratified by age group or highest education level, preference trends across subgroups were generally comparable with the overall cohort. Conclusion: Our data suggest that treatment decisions regarding anti-VEGF therapies for nAMD or DME are most likely driven by their efficacy, and that patients may be willing to accept less desirable treatment attributes, such as increased cost and/or injection frequency, in order to achieve superior vision outcomes.

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“…Age-related macular degeneration (AMD) is a major cause of visual impairment and blindness among elderly people in developed countries [1], accounting for more than 50% of blindness in white population aged 40 years and older in the US [2]. Early AMD is characterized by drusen presence and pigmentary abnormalities, and late AMD has two subtypes, namely, geographic atrophy (GA) ("dry") and choroidal neovascularization (CNV) ("wet").…”

Section: Introductionmentioning

confidence: 99%

Renin-Angiotensin System Inhibitor Usage and Age-Related Macular Degeneration among Hypertensive Patients: Results from the National Health and Nutrition Examination Survey, 2005–2008

Ren

Liu

Yin

et al. 2020

Journal of Ophthalmology

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Purpose. To assess whether renin-angiotensin system inhibitor (RASI) utilization is associated with age-related macular degeneration (AMD) prevalence among hypertensive patients. Methods. A US population-based, cross-sectional study was conducted. 3,023 hypertensive participants aged 40 years and older with gradable retinal images and ascertained RASI usage in the National Health and Nutrition Examination Survey (NHANES), 2005–2008, were finally enrolled into the study. RASI usage was obtained by interview, and AMD was determined through retinal image assessment. We performed multivariable analyses to assess the relationship between utilization of RASIs and AMD prevalence. We also took drug treatment duration into account, in order to better understand the effects of RASIs. Results. Multivariable logistic regression analyses revealed that AMD prevalence had no significant association with RASI usage but was inversely correlated with RASI treatment duration (odds ratio (OR) = 0.87, 95% confidence interval (CI) = 0.78–0.98, p=0.02). Long-term usage (>5 years) of RASIs was significantly associated with not only reduced overall risk of AMD (OR = 0.23, 95% CI = 0.14–0.38, p<0.001) but also lower propensity to have early (OR = 0.23, 95% CI = 0.14–0.37, p<0.001) and late (OR = 0.25, 95% CI = 0.07–0.87, p=0.03) AMD. Furthermore, long-term RASI users were less prone to develop soft drusen (OR = 0.67, 95% CI = 0.45–0.99, p=0.04) and geographic atrophy (GA) (OR = 0.39, 95% CI = 0.22–0.71, p=0.003). Conclusions. Evidence supporting that RASI utilization could directly protect against AMD in hypertensive patients was still insufficient, but long-term RASI treatment seemed to be beneficial for both early and late AMD, implicating a promising therapeutic approach that RASIs might offer for AMD prevention and management.

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Age-Related Macular Degeneration Preferred Practice Pattern®

Cited by 239 publications

References 284 publications

Predicting risk of late age-related macular degeneration using deep learning

Predicting risk of late age-related macular degeneration using deep learning

<p>Patient Preferences Associated with Anti-Vascular Endothelial Growth Factor Therapies for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema</p>

Renin-Angiotensin System Inhibitor Usage and Age-Related Macular Degeneration among Hypertensive Patients: Results from the National Health and Nutrition Examination Survey, 2005–2008

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