Importance of Treatment Duration: Unmasking Barriers and Discovering the Reasons for Undertreatment of Anti-VEGF Agents in Neovascular Age-Related Macular Degeneration

Sobolewska, Bianka; Sabsabi, Muhammed; Ziemssen, Focke

doi:10.2147/opth.s325763

Cited by 23 publications

(28 citation statements)

References 51 publications

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“…ere are veins inside, which course through the eyes and make the eyes brighter. e treatment is based on tonifying the liver and kidney, accompanied by removing the blood stasis and clearing collaterals, thus reducing the production of pathological VEGF [25][26][27][28][29]. Contemporary pharmacological studies show that part of traditional Chinese medicine for supplementing the liver and kidneys has antioxidation, stabilizes the blood-eye barrier, and has sex hormone-like effects [30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Clinical Effect of Tongmai Fuming Decoction on Neovascular Ophthalmopathy

Yang

Zhou

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background. The incidence of neovascular eye disease is increasing year by year, seriously threatening human vision health and becoming an urgent public health problem. Tongmai fuming decoction as an experienced prescription can treat ischemic eye disease. Objective. To investigate the therapeutic effect of Tongmai fuming decoction combined with anti-VEGF therapy on neovascular ophthalmopathy. Methods. 52 patients (62 eyes) with neovascular ophthalmopathy who met the inclusion criteria from January 2018 to July 2020 were randomly divided into the control and observation groups. The control group was given an intravitreal injection of antivascular endothelial growth factor (VEGF) drugs once a day combined with on-demand treatment. The observation group was treated with traditional Chinese medicine Tongmai fuming decoction in addition to the treatment of anti-VEGF drugs. The best-corrected visual acuity (BCVA) was examined before and after treatment, and optical coherence tomography angiography (OCTA) was used to examine the mean retinal thickness and neovascularization in the macular area. Patients were followed for one year and the number of anti-VEGF injections was recorded. Results. After treatment, the average thickness of BCVA and macular retina in the two groups significantly improved. The BCVA of the control group was 0.59 ± 0.39 3 months after treatment, and that of the experimental group was 0.42 ± 0.25 3 months after treatment. The average thickness of the macular retina in the control group was 304.8 ± 79.7 3 months after treatment, and that in the experimental group was 267.7 ± 64.6 3 months after treatment; The average number of injections of anti-VEGF therapy in the control group was 2.32 ± 1.15 times, and that in the experimental group was 1.74 ± 0.76 times. There was a significant difference between the two groups. Conclusion. Tongmai fuming decoction and anti-VEGF therapy have a synergistic effect in the treatment of neovascular ophthalmopathy, which can reduce the treatment times of anti-VEGF drugs.

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Section: Discussionmentioning

confidence: 99%

Clinical Effect of Tongmai Fuming Decoction on Neovascular Ophthalmopathy

Yang

Zhou

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Various barriers prevent adequate treatment adherence [ 17 , 18 ]. The COVID-19 pandemic added more barriers; this resulted in further decline in treatments and follow-up visits [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

The negative impact of COVID-19 pandemic on age-related macular degeneration patients treated with intravitreal bevacizumab injections

et al. 2022

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Purpose COVID-19 emerged in the end of 2019 and was declared a worldwide pandemic shortly after. Social distancing and lockdowns resulted in lower compliance in intravitreal injections and office visits. We aimed to assess clinical outcomes among patients who missed these visits compared to those who arrived as planned. Methods Patients who missed or were late to office visits or intravitreal injections were defined as non-adherent and were compared to adherent patients. Our main outcomes were the need for subsequent injections, mean change in best-corrected visual acuity (BCVA), and central macular thickness (CMT). Results This study included 77 patients (24 adherent and 53 non-adherent). The mean BCVA remained stable during the study period for the adherent group ( p = 0.159) and worsened in the non-adherent group ( p < 0.001). Changes in CMT and maximum thickness were not significant for either group. A higher proportion of patients in the non-adherent group needed subsequent intravitreal injections (49% vs 20%, p = 0.014). Conclusion The findings demonstrate the negative implications of the COVID-19 pandemic and the effect of deferring bevacizumab injections among individuals with age-related macular degeneration. This emphasizes the importance of a scheduled follow-up, also during a pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s10792-022-02337-y.

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“…However, there is still a high number of patients who discontinue treatment [59]. Patients named the need for assistance, either in the form of a travel companion or a family member, as the main reason for dropping out of therapy [50], and quoted traveling illness as a major reason for therapy discontinuation [24]. Additionally, recurrence of quiescent disease requiring prompt treatment is common, making life-long monitoring necessary [4].…”

Section: Discussionmentioning

confidence: 99%

“…as the main reason for dropping out of therapy [51], and quoted traveling illness as a major reason for therapy discontinuation [24]. Additionally, recurrence of quiescent disease requiring prompt treatment is common, making life-long monitoring necessary [4].…”

Section: Discussionmentioning

confidence: 99%

Multi-task learning for activity detection in neovascular age-related macular degeneration

Ayhan

Faber

Kuehlewein

et al. 2022

Preprint

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Objective: Modeling of the ophthalmologist's decision-making process for activity detection in neovascular age-related macular degeneration with a multi-task convolutional deep neuronal network which takes intra- and subretinal fluid into account. Design: A cohort study to evaluate the multi-task deep learning model for activity detection. Participants: n = 70 patients (46 female, 24 male) attended the University Eye Hospital Tuebingen between 21.2.2018 and 27.6.2018. 3762 optical coherence tomography B-scans (right eye: 2011, left eye: 1751) were acquired from them with Heidelberg Spectralis, Heidelberg, Germany. Methods: B-scans were graded by a retina specialist and an ophthalmology resident, and then used to develop a multi-task deep learning model to concurrently predict disease activity in neovascular age-related macular degeneration along with the presence of sub- and intraretinal fluid. Main outcome measures: Performance metrics compared to single-task networks, visualization of the representation driving the DNN-based decisions using t-distributed stochastic neighbor embedding and analysis of the model's decisions via clinically validated saliency mapping techniques. Results: The multi-task model surpassed single-task networks in accuracy for activity detection. Visualizations via t-distributed stochastic neighbor embedding and saliency maps highlighted that the network's decisions for activity of neovascular age-related macular degeneration were based on the presence of sub- and intraretinal fluids, the optical coherence tomography characteristics used for treatment decision in clinical routine. Conclusion: Multi-task learning increases the performance of neuronal networks for predicting disease activity, while providing clinicians with an easily accessible decision control, which resembles human reasoning.

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Importance of Treatment Duration: Unmasking Barriers and Discovering the Reasons for Undertreatment of Anti-VEGF Agents in Neovascular Age-Related Macular Degeneration

Cited by 23 publications

References 51 publications

Clinical Effect of Tongmai Fuming Decoction on Neovascular Ophthalmopathy

Clinical Effect of Tongmai Fuming Decoction on Neovascular Ophthalmopathy

The negative impact of COVID-19 pandemic on age-related macular degeneration patients treated with intravitreal bevacizumab injections

Multi-task learning for activity detection in neovascular age-related macular degeneration

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