Visual Acuity Outcomes and Anti–Vascular Endothelial Growth Factor Therapy Intensity in Neovascular Age-Related Macular Degeneration Patients

Ciulla, Thomas A.; Hussain, Rehan M.; Pollack, John S.; Williams, David F.

doi:10.1016/j.oret.2019.05.017

Cited by 139 publications

(112 citation statements)

References 30 publications

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“…Analysis methodology was similar to that in prior studies. [14][15][16] Outcome measures were assessed at the patient eye level. As a sensitivity analysis, the main outcome measure was also analysed excluding patients with DMO who received bilateral treatment during the study period.…”

Section: Discussionmentioning

confidence: 99%

“…The database and its utilisation in prior studies have been described previously. [14][15][16] Briefly, it includes de-identified information from nearly 1.5 million unique patients and over 11 million encounters, from a panel of 350 US retina specialists, with 65%, 32% and 3% located in urban, suburban and rural settings, respectively (Vestrum Health Retina Database, Naperville, Illinois). They are geographically diversified in the Mid-Atlantic (24%), Southeast (24%), West (20%), Southwest (12%), Northeast (8%), Great Lakes (7%) and North Central (4%)…”

Section: Methods Databasementioning

confidence: 99%

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Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes

2020

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Background/AimTo assess visual acuity (VA) outcomes and antivascular endothelial growth factor (anti-VEGF) treatment intensity in diabetic macular oedema (DMO).MethodsRetrospective analysis was performed in treatment-naïve patients with DMO from 2013 to 2018 using a database of aggregated de-identified electronic medical records (Vestrum Health).ResultsAt 1 year, 28 658 patient eyes underwent a mean of 6.4 anti-VEGF injections, gaining a mean of +4.2 letters (95% confidence interval for mean gain: +4.0 to +4.5 letters, p<0.001). When stratified by anti-VEGF medication and by years 2013–2018, no clinically meaningful differences in injection frequency or 1-year VA change resulted. At 1 year, 50% of eyes received ≤6 injections, while <20% received 10–13 injections, representing monthly treatment. Mean letters gained at 1 year generally showed a linear relationship with mean number of anti-VEGF injections, beyond two injections. Eyes with good baseline VA (≥20/40) generally were at risk of VA loss at 1 year; those with moderately severe baseline impairment (20/70 to 20/200) who received ≥10 injections improved by a mean of +10.3 letters.ConclusionIn clinical practice, patients with DMO undergo fewer anti-VEGF injections and exhibit worse visual gains compared with patients in randomised clinical trials. Visual outcomes correlate with treatment intensity at 1 year, with ceiling effects related to baseline VA.

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Section: Discussionmentioning

confidence: 99%

Section: Methods Databasementioning

confidence: 99%

Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes

2020

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“…These discontinuous regimens include a ‘pro re nata’ (PRN) approach based on findings of exudation, or a ‘treat and extend’ (T&E) approach that gradually increases assessment and treatment intervals after exudation is controlled. However, recent real-world data have shown that patients who receive a low number of annual injections achieve meaningfully worse visual acuity outcomes than those in pivotal trials 7–11. In this paper, we will review landmark clinical trials using anti-VEGF injections in the treatment of nAMD.…”

Section: Introductionmentioning

confidence: 99%

Current and upcoming anti-VEGF therapies and dosing strategies for the treatment of neovascular AMD: a comparative review

et al. 2019

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Age-related macular degeneration is the leading cause of vision loss in the developed world, with the expected number of affected elderly individuals reaching 17.8 million. Antivascular endothelial growth factor (anti-VEGF) injection therapy has been instrumental in treating a disease process that was previously thought to be untreatable. Over the past two decades, landmark studies have demonstrated the efficacy of different anti-VEGF medications and investigated the optimal dosing regimen and delivery mechanism to increase overall vision and minimise patient burden. In this review, we outline landmark neovascular age-related macular degeneration clinical trials that have demonstrated level 1 evidence for its usage or have contributed to the understanding of how to dose these agents.

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“…Considering these patients and assuming they are treated on a fixed dose regime, each new patient would need between 7 to 12 visits a year. It is difficult to predict the number of injections required, but the average number of injections in the first year is 7.3 with 12.1 in total after 2 years . Most patients would only be discharged from the HES following a period of inactivity in both eyes, therefore the capacity requirement is increasing with little evidence of it slowing down.…”

Section: Introductionmentioning

confidence: 99%

“…It is difficult to predict the number of injections required, but the average number of injections in the first year is 7.3 with 12.1 in total after 2 years. 4 Most patients would only be discharged from the HES following a period of inactivity in both eyes, therefore the capacity requirement is increasing with little evidence of it slowing down. Capacity issues can cause delays in treatment which in turn can lead to worsening of visual acuity.…”

Section: Introductionmentioning

confidence: 99%

Treatment decisions of UK hospital optometrists and ophthalmologists in patients with nAMD: a vignette study

Creer

Roberts

Aslam

et al. 2019

Ophthalmic Physiologic Optic

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Purpose A vignette study to examine treatment decisions made by UK hospital optometrists in patients with neovascular age‐related macular degeneration (nAMD) and the effect of optometrists’ experience on agreement. Methods Patients with nAMD attending Manchester Royal Eye Hospital, Manchester, UK were identified as potential candidates for the case series of vignettes. The cases were chosen to reflect a varied case‐mix with respect to difficulty as well as ensuring good quality of the images. Each vignette included a history summary consisting of the number of previous injections given and visual acuity measurements at baseline, the previous visit, and the current visit. Images were compiled to show baseline fundus photographs and ocular coherence tomography (OCT) images with the current visit images on which the treatment decision was to be made along with the images from the previous visit. Hospital optometrists were recruited and asked to complete the series of vignettes, deciding if treatment was required at that visit and how confident they felt with that decision. Their responses were compared to the reference standard created by a consensus of consultant ophthalmologists with a sub‐speciality interest in medical retina. Results Regarding treatment decision for optometrists, the percentage correct value was 75% with the sensitivity being 75.6% (95% CI 70.1–80.3) and the specificity as 75.1% (95% CI 72.1–77.8). No statistically significant difference was found between differing levels of experience. However, there was a significant difference in confidence levels between groups. Potentially sight threatening decisions accounted for 6.4% of the optometrists’ decisions, 3.5% were made with a high confidence rating suggesting no discussion with an ophthalmologist was required. Conclusions Although the optometrists showed modest agreement with the reference standard in a series of cases that have higher than average complexity, the optometrists showed a similar amount of variability within their treatment decisions compared to the reference standard. The optometrists were therefore not inferior in their performance compared to the ophthalmologists and this can be seen as supporting evidence for their extended role within this clinical area. Experience did not have an effect on ‘correct’ treatment decisions although there was a statistically significant effect on increasing confidence of treatment decision.

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Visual Acuity Outcomes and Anti–Vascular Endothelial Growth Factor Therapy Intensity in Neovascular Age-Related Macular Degeneration Patients

Cited by 139 publications

References 30 publications

Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes

Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes

Current and upcoming anti-VEGF therapies and dosing strategies for the treatment of neovascular AMD: a comparative review

Treatment decisions of UK hospital optometrists and ophthalmologists in patients with nAMD: a vignette study

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