Current Knowledge and Trends in Age-Related Macular Degeneration

Vélez-Montoya, Raúl; Oliver, Scott C. N.; Olson, Jeffrey L.; Fine, Stuart L.; Mandava, Naresh; Quiroz‐Mercado, Hugo

doi:10.1097/iae.0b013e318271f265

Cited by 83 publications

(84 citation statements)

References 126 publications

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“…1 Pegaptanib, an aptamer targeting VEGF-A165, was first approved for the treatment of AMD. 2 It has been succeeded by two drugs that have been more efficacious: the humanized IgG antibody bevacizumab (Avastin), and ranibizumab (Lucentis), containing only the antigen-binding part of the antibody.…”

Section: Introductionmentioning

confidence: 99%

Switch of anti-VEGF agents is an option for nonresponders in the treatment of AMD

Ehlken

Jungmann

Böhringer

et al. 2014

Eye

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Section: Introductionmentioning

confidence: 99%

Switch of anti-VEGF agents is an option for nonresponders in the treatment of AMD

Ehlken

Jungmann

Böhringer

et al. 2014

Eye

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“…Late AMD is classified into two types: wet AMD, which is also known as exudative or neovascular AMD (the term neovascular is used in this report); and dry AMD, which, in advanced cases, is also known as GA. AMD is the commonest cause of visual impairment, and results in progressive, irreversible damage to the macula, the retinal pigment epithelium and retinal photoreceptors. 4 Clinical and phenotypic variations have been identified, and increasing age and smoking are risk factors for the condition. 5 Although AMD usually affects both eyes, it rarely results in complete blindness, as the peripheral vision is not usually affected.…”

Section: Age-related Macular Degenerationmentioning

confidence: 99%

Accuracy of fundus autofluorescence imaging for the diagnosis and monitoring of retinal conditions: a systematic review

Frampton

Kalita

Payne

et al. 2016

Health Technol Assess

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BackgroundNatural fluorescence in the eye may be increased or decreased by diseases that affect the retina. Imaging methods based on confocal scanning laser ophthalmoscopy (cSLO) can detect this ‘fundus autofluorescence’ (FAF) by illuminating the retina using a specific light ‘excitation wavelength’. FAF imaging could assist the diagnosis or monitoring of retinal conditions. However, the accuracy of the method for diagnosis or monitoring is unclear.ObjectiveTo conduct a systematic review to determine the accuracy of FAF imaging using cSLO for the diagnosis or monitoring of retinal conditions, including monitoring of response to therapy.Data sourcesElectronic bibliographic databases; scrutiny of reference lists of included studies and relevant systematic reviews; and searches of internet pages of relevant organisations, meetings and trial registries. Databases included MEDLINE, EMBASE, The Cochrane Library, Web of Science and the Medion database of diagnostic accuracy studies. Searches covered 1990 to November 2014 and were limited to the English language.Review methodsReferences were screened for relevance using prespecified inclusion criteria to capture a broad range of retinal conditions. Two reviewers assessed titles and abstracts independently. Full-text versions of relevant records were retrieved and screened by one reviewer and checked by a second. Data were extracted and critically appraised using the Quality Assessment of Diagnostic Accuracy Studies criteria (QUADAS) for assessing risk of bias in test accuracy studies by one reviewer and checked by a second. At all stages any reviewer disagreement was resolved through discussion or arbitration by a third reviewer.ResultsEight primary research studies have investigated the diagnostic accuracy of FAF imaging in retinal conditions: choroidal neovascularisation (one study), reticular pseudodrusen (three studies), cystoid macular oedema (two studies) and diabetic macular oedema (two studies). Sensitivity of FAF imaging using an excitation wavelength of 488 nm was generally high (range 81–100%), but was lower (55% and 32%) in two studies using longer excitation wavelengths (514 nm and 790 nm, respectively). Specificity ranged from 34% to 100%. However, owing to limitations of the data, none of the studies provide conclusive evidence of the diagnostic accuracy of FAF imaging.LimitationsNo studies on the accuracy of FAF imaging for monitoring the progression of retinal conditions or response to therapy were identified. Owing to study heterogeneity, pooling of diagnostic outcomes in meta-analysis was not conducted. All included studies had high risk of bias. In most studies the patient spectrum was not reflective of those who would present in clinical practice and no studies adequately reported how FAF images were interpreted.ConclusionsAlthough already in use in clinical practice, it is unclear whether or not FAF imaging is accurate, and whether or not it is applied and interpreted consistently for the diagnosis and/or monitoring of retinal conditions. Well-designed prospective primary research studies, which conform to the paradigm of diagnostic test accuracy assessment, are required to investigate the accuracy of FAF imaging in diagnosis and monitoring of inherited retinal dystrophies, early age-related macular degeneration, geographic atrophy and central serous chorioretinopathy.Study registrationThis study is registered as PROSPERO CRD42014014997.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…12 Despite dry AMD being the most prevalent form of AMD, such major breakthrough as anti-VEGF (vascular endothelial growth factor) drugs for neovascular AMD has not been yet introduced. 2 Potential GA therapeutic options have just stepped in the phase of clinical randomised trials. 2 Thus, it gives a good opportunity to reflect on what were the main outcomes selected and how the sample size was determined in recent GA trials.…”

Section: Introductionmentioning

confidence: 99%

“…1 Although some progress has been made to understand the pathophysiology of GA and there is no treatment to prevent progression of GA, 1 a number of randomised controlled trials (RCTs) testing potential interventions have taken place. 2 RCTs are considered the most powerful tools when determining the efficacy of interventions. 3 However, poor planning of RCTs may result in substandard studies.…”

Section: Introductionmentioning

confidence: 99%

Design characteristic of randomised controlled trials for geographic atrophy in age-related macular degeneration: selection of outcomes and sample size calculation

Krezel

Hogg

Krezel

et al. 2015

Eye

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Purpose The selection of suitable outcomes and sample size calculation are critical factors in the design of a randomised controlled trial (RCT). The goal of this study was to identify the range of outcomes and information on sample size calculation in RCTs on geographic atrophy (GA). Methods We carried out a systematic review of age-related macular degeneration (AMD) RCTs. We searched MEDLINE, EMBASE, Scopus, Cochrane Library, www.controlledtrials.com, and www.ClinicalTrials.gov. Two independent reviewers screened records. One reviewer collected data and the second reviewer appraised 10% of collected data. We scanned references lists of selected papers to include other relevant RCTs. Results Literature and registry search identified 3816 abstracts of journal articles and 493 records from trial registries. From a total of 177 RCTs on all types of AMD, 23 RCTs on GA were included. Eighty-one clinical outcomes were identified. Visual acuity (VA) was the most frequently used outcome, presented in 18 out of 23 RCTs and followed by the measures of lesion area. For sample size analysis, 8 GA RCTs were included. None of them provided sufficient Information on sample size calculations. Conclusions This systematic review illustrates a lack of standardisation in terms of outcome reporting in GA trials and issues regarding sample size calculation. These limitations significantly hamper attempts to compare outcomes across studies and also perform meta-analyses.

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Current Knowledge and Trends in Age-Related Macular Degeneration

Cited by 83 publications

References 126 publications

Switch of anti-VEGF agents is an option for nonresponders in the treatment of AMD

Switch of anti-VEGF agents is an option for nonresponders in the treatment of AMD

Accuracy of fundus autofluorescence imaging for the diagnosis and monitoring of retinal conditions: a systematic review

Design characteristic of randomised controlled trials for geographic atrophy in age-related macular degeneration: selection of outcomes and sample size calculation

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