JAMA Ophthalmol. 2019 Nov 14.
Economic Value of Anti-Vascular Endothelial Growth Factor Treatment for Patients With Wet Age-Related Macular Degeneration in the United States.
Mulligan K, Seabury SA, Dugel PU, Blim JF, Goldman DP, Humayun MS.
Importance: Anti-vascular endothelial growth factor (anti-VEGF) is a breakthrough treatment for wet age-related macular degeneration (wAMD), the most common cause of blindness in western countries. Anti-VEGF treatment prevents vision loss and has been shown to produce vision gains lasting as long as 5 years. Although this treatment is costly, the benefits associated with vision gains are large.
Objective: To estimate the economic value of benefits, costs for patients with wAMD, and societal value in the United States generated from vision improvement associated with anti-VEGF treatment.
Design, Setting & Participants: This economic evaluation study used data from the published literature to simulate vision outcomes for a cohort of 168 820 patients with wAMD aged 65 years or older and to translate them into economic variables. Data were collected and analyzed from March 2018 to November 2018.
Main Outcomes & Measures: Main outcomes included patient benefits, costs, and societal value. Each outcome was estimated for a newly diagnosed cohort and the full population across 5 years, with a focus on year 3 as the primary outcome because data beyond that point may be less representative of the general population. Drug costs were the weighted mean across anti-VEGF therapies. Two current treatment scenarios were considered: less frequent injections (mean [SD], 8.2 [1.6] injections annually) and more frequent injections (mean [range], 10.5 [6.8-13.1] injections annually). The 2 treatment innovation scenarios, improved adherence and best case, had the same vision outcomes as the current treatment scenarios had but included more patients treated from higher initiation and lower discontinuation.
Results: The study population included 168 820 patients aged 65 years at the time of diagnosis with wAMD. The underlying clinical trials that were used to parameterize the model did not stratify visual acuity outcomes or treatment frequency by sex; therefore, the model parameters could not be stratified by sex. The current treatment scenario of less frequent injections generated $1.1 billion for the full population in year 1 and $5.1 billion in year 3, whereas the scenario of more frequent injections generated $1.6 billion (year 1) and $8.2 billion (year 3). Three-year benefits ranged from $7.3 billion to $11.4 billion in the improved adherence scenario and from $9.7 billion to $15.0 billion if 100% of the patients initiated anti-VEGF treatment and the discontinuation rates were 6% per year or equivalent to clinical trial discontinuation (best-case scenario). Societal value (patient benefits net of treatment cost) ranged from $0.9 billion to $3.0 billion across 3 years in the current treatment scenarios and from $0.9 billion to $4.3 billion in the treatment innovation scenarios.
Conclusions & Relevance: This study's findings suggest that improved vision associated with anti-VEGF treatment may provide economic value to patients and society if the outcomes match published outcomes data used in these analyses; however, future innovations that increase treatment utilization may result in added economic benefit.
PMID: 31725830 DOI: 10.1001/jamaophthalmol.2019.4557
Retina. 2019 Nov 13.
Ten-year follow-up of patients with exudative age-related macular degeneration treated with intravitreal anti-vascular endothelial growth factor injections.
Starr MR, Kung FF, Mejia CA, Bui YT, Bakri SJ.
Purpose: To identify the visual acuity outcomes of patients with age-related macular degeneration treated with intravitreal anti-vascular endothelial growth factor injections over a 10-year period.
Methods: This was a retrospective, cohort study of eyes with exudative age-related macular degeneration that received ≥2 intravitreal anti-vascular endothelial growth factor injections and had at least 10 years of follow-up after the initiation of treatment. Snellen visual acuity was recorded at baseline and then annually until the last year of follow-up. Optical coherence tomography data were collected at the time of treatment initiation and at the last examination visit. A subanalysis was performed on patients who continued to receive anti-vascular endothelial growth factor therapy using a modified treat and extend protocol versus those who discontinued treatment for longer than 1 year.
Results: One hundred thirty eyes of 115 patients met the inclusion criteria. The mean follow-up after treatment initiation was 11.1 ± 0.7 years. Eyes received an average of 45.1 ± 32.3 intravitreal injections in total and a mean of 5 to 7 injections per year. The baseline mean logMAR visual acuity was 0.61 ± 0.5 (Snellen acuity 20/81), and the final mean logMAR visual acuity was 0.88 ± 0.7 (20/152, P value = <0.0001). There were 40 eyes that received at least one injection every year. These eyes did not have a significant change in visual acuity between the baseline and final examinations 0.47 ± 0.4 (20/59 vs. 0.58 ± 0.5 [20/76, P = 0.28]), whereas the eyes that did not receive at least one injection every year saw a significant decline in visual acuity 0.67 ± 0.5 (20/94 vs. 1.01 ± 0.7 [20/205, P < 0.0001]).
Conclusion: Eyes with exudative age-related macular degeneration that received intravitreal injections every year had stable visual acuity over a 10-year period. Continuous intravitreal anti-vascular endothelial growth factor therapy may stabilize visual acuity for 10 years and potentially longer.
PMID: 31725524 DOI: 10.1097/IAE.0000000000002668
Br J Ophthalmol. 2019 Nov 19. pii: bjophthalmol-2019-314923.
Subretinal pigment epithelium fibrotic tissue morphological changes after a single anti-vascular endothelial growth factor injection in age-related macular degeneration.
Ohayon A, De Rosa I, Semoun O, Jung C, Colantuono D, El Ameen A, Srour M, Souied EH.
Aims: To demonstrate and evaluate the morphological changes of multilayered fibrovascular pigment epithelial detachment (PED) to a single anti-vascular endothelial growth factor (VEGF) injection in age-related macular degeneration (AMD).
Methods: We retrospectively analysed the morphological changes of 30 eyes with exudative AMD showing fibrotic multilayered PED, between two consecutive visits. All patients had one anti-VEGF intravitreal injection at the first visit. We quantitatively analysed the different compartments within the PED and their morphological response.
Results: The mean follow-up time interval between the first and the second visit was 32.46±4.64 days. We defined three optical coherence tomography zones within the PED: a subretinal pigment epithelium inhomogeneous hyporeflective space (layer 1), a hyper-reflective band beneath layer 1 (layer 2), and a hyporeflective space between the Bruch's membrane and layer 2 (layer 3). The mean height of layer 1 was 142±44.63 and 99.30±39.79 µm at visits 1 and 2, respectively. The mean thickness of layer 2 was 101.42±46.66 and 82.76±35.24 µm at visits 1 and 2, respectively. The mean height of layer 3 was 35.77±32.77 and 5.66±8.68 µm at visits 1 and 2, respectively (p=0.009). The mean height change for layer 1 was statistically significantly higher than for layer 2 (p=0.0002).
Conclusions: Fibrovascular PED was compartmented into three layers with different reflectivities that morphologically responded differently to a single anti-VEGF injection. Layer 2 had a statistically significantly lower response compared with layer 1, suggesting the hypothesis of a fibrotic component in layer 2.
PMID: 31744799 DOI: 10.1136/bjophthalmol-2019-314923
Br J Ophthalmol. 2019 Nov 19. pii: bjophthalmol-2019-315257.
Twenty-four-month outcomes of inflammatory choroidal neovascularisation treated with intravitreal anti-vascular endothelial growth factors: a comparison between two treatment regimens.
Invernizzi A, Pichi F, Symes R, Zagora S, Agarwal AK, Nguyen P, Erba S, Xhepa A, De Simone L, Cimino L, Gillies MC, McCluskey PJ.
Background & Aim: There is still no established treatment regimen for eyes with inflammatory choroidal neovascularisation (iCNV) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. This study compared the 24-month outcomes of two treatment regimens of anti-VEGF injections in eyes with iCNV.
Methods: Eyes with iCNV treated with anti-VEGF injections were divided into two groups: eyes treated with a loading phase of 3 monthly injections and then re-treated as needed (LOADING group) and eyes treated as needed from the beginning (PRN group). Visual acuity (VA), number of injections and iCNV recurrences at 24 months were compared between the groups.
Results: Eighty-two eyes were included, 42 in the LOADING and 40 in the PRN group. Baseline VA (mean(SD)) was 72.3 (15.8) letters in the LOADING vs 75.7 (15.6) letters in the PRN group (p=0.32). The VA (mean (95% CI)) increased at 3 months (+14.8 (10.6 to 18.9) and +11.2 (6.4 to 16) letters in the LOADING and PRN group, respectively) and remained significantly higher than baseline over the entire follow-up in both groups (all p<0.001). At 24 months, there was no difference in VA between the LOADING and PRN group (87.8 (13.8) vs 90.3 (11.3) letters, p=0.36) but the LOADING group received significantly more injections (median (Q1-Q3)) than the PRN (4.5 (3-7) vs 2.5 (2-3.2), p<0.0001). The iCNV recurrences were similar in both groups.
Conclusions: iCNV responded well to anti-VEGF with significant and sustained VA improvement. The loading phase did not confer any advantage in terms of outcomes. PRN regimen from the beginning was as effective as more intensive treatment.
PMID: 31744798 DOI: 10.1136/bjophthalmol-2019-315257
Ophthalmologica. 2019 Nov 19:1-8.
Undertreatment of neovascular age-related macular degeneration after 10 years of anti-vascular endothelial growth factor therapy in the real world: the need for a change of mindset.
Monés J, Singh RP, Bandello F, Souied E, Liu X, Gale R.
Purpose: To assess the gap between visual acuity (VA) outcomes with anti-vascular endothelial growth factor (anti-VEGF) therapies in clinical trials and real-world practice, and explore the reasons for this gap.
Methods: The literature was searched from January 1, 2013, to June 30, 2018, for studies reporting VA gains and injection frequencies in clinical trials and real-world practice.
Results: Clinical trials of anti-VEGF agents and their extension studies demonstrated initial VA gains maintained at 4 years and beyond (up to 7 years) with continuous proactive treatment. Visual outcomes correlated with injection frequency. In real-world practice, patients are usually undertreated, accounting for the VA decline over time. Reasons for undertreatment include the burden of injections and monitoring visits imposed on patients/caregivers. However, another primary reason is the general mindset in the ophthalmological community that sustained benefits with treatment are not possible, leading to poor compliance and creating a vicious circle.
Conclusions: Initial VA gains can be maintained with more intensive/proactive approaches. Promising new treatments requiring less frequent injections/monitoring will help in the near future; meanwhile, better results could be achieved by changing the community mindset that contributes to undertreatment.
PMID: 31743912 DOI: 10.1159/000502747
DIAGNOSIS & IMAGING
BMJ Open Ophthalmol. 2019 Oct 30;4(1):e000276.
Patient-reported reasons for delay in diagnosis of age-related macular degeneration: a national survey.
Parfitt A, Boxell E, Amoaku WM, Bradley C.
Objectives: To investigate whether people with age-related macular degeneration (AMD) are able to self-detect symptoms and, if so, what symptoms they experience, from whom they first seek help, whether help is sought within the 1 week recommended by the Royal College of Ophthalmologists' guidelines and reasons for any delay.
Methods & Analysis: A retrospective, cross-sectional survey design. Postal surveys were sent to 4000 members of the UK Macular Society. Inclusion criteria were participants aged >50 years at diagnosis of AMD with diagnosis after August 2008; criteria were met by 621 respondents. The main outcome was reasons for delays in diagnosis for wet AMD. Data were analysed using χ2 and conventional content analysis.
Results: Only one third (n=199; 32%) of respondents were able to self-detect symptoms. In line with national guidance, over half (n=131; 64%) of those self-detecting symptoms sought help promptly. For those whose initial diagnosis was delayed more than 1 week, 27% had potentially treatable wet AMD requiring urgent treatment to prevent vision loss. Reasons for delay reflected individual & service-related issues, including AMD not being detected in the initial consultation, and individuals not perceiving the urgency for symptom investigation.
Conclusion: In practice most patients sought help within 1 week; however, potentially sight-damaging delays occurred from symptom onset to diagnosis. Suggestions for reducing delay include increasing population awareness of AMD symptoms, the need for urgent detection and close monitoring for AMD and signposting patients to appropriate support services to ensure prompt detection of any future signs of wet AMD.
PMID: 31750395 PMCID: PMC6830468 DOI: 10.1136/bmjophth-2019-000276
Transl Vis Sci Technol. 2019 Nov 12;8(6):3.
Presymptomatic retinal sensitivity changes in intermediate age-related macular degeneration associated with new retinal fluid.
Wightman AJ, Abbott CJ, McGuinness MB, Caruso E, Guymer RH, Luu CD.
Purpose: To determine whether change in retinal sensitivity in areas with subretinal or intraretinal fluid secondary to age-related macular degeneration (AMD) precedes visual symptoms. If confirmed, retinal sensitivity testing could be used for home monitoring in AMD.
Methods: Individuals with intermediate AMD enrolled in a longitudinal study were seen every 6 months and underwent best-corrected visual acuity testing (BCVA), spectral domain-optical coherence tomography (SD-OCT), and microperimetry. Asymptomatic individuals who developed incidental, reading center-determined retinal fluid detected on SD-OCT were identified. The point-wise sensitivity (PWS) at the time of fluid detection was compared with 6 and 12 months prior.
Results: Fourteen of 161 individuals developed fluid without symptoms. PWS over fluid areas at detection was reduced compared with 6 (difference -2.04 dB, P < 0.001) and 12 months (-2.27 dB, P < 0.001) prior. PWS over fluid areas was reduced compared with perifluid areas (difference -1.02 dB, P = 0.03), peripheral areas (-1.51 dB, P < 0.001), nonprogressed fellow eyes (-1.49 dB, P = 0.006), and nonprogressed age-matched intermediate AMD eyes (-2.29 dB, P = 0.001). No difference in BCVA was observed in eyes developing fluid compared to eyes that do not develop fluid (P = 0.76).
Conclusions: Retinal areas with fluid on SD-OCT had a corresponding reduction in retinal sensitivity at the time of fluid detection compared with 6 and 12 months prior, in asymptomatic intermediate AMD without change in BCVA.
Translational Relevance: Development of self-monitoring tools to detect changes in retinal sensitivity may be helpful for early detection of retinal fluid suggestive of progression to neovascular AMD before acuity is affected.
PMID: 31737427 PMCID: PMC6855368 DOI: 10.1167/tvst.8.6.3
Ophthalmol Retina. 2019 Sep 18. pii: S2468-6530(19)30558-5.
Are dilated fundus examinations needed for OCT-guided retreatment of exudative age-related macular degeneration?
Patel Y, Miller DM, Fung AE, Hill LF, Rosenfeld PJ.
Purpose: To determine whether presence of macular hemorrhage on dilated fundus examination (DFE) or fundus photography influences vision outcomes with OCT-guided pro re nata (PRN) ranibizumab retreatment in patients with neovascular age-related macular degeneration (nAMD), we investigated whether hemorrhage without OCT-detectable fluid impacted vision outcomes.
Design: Post hoc analysis of prospectively collected data from the 24-month pHase III, double-masked, multicenter, randomized, Active treatment-controlled study of the efficacy and safety of 0.5 mg and 2.0 mg Ranibizumab administered monthly or on an as-needed Basis (PRN) in patients with subfoveal neOvascular age-related macular degeneration (HARBOR) trial (ClinicalTrials.gov identifier, NCT00891735).
Participants: This post hoc analysis examined 1097 patients from the intention-to-treat population of HARBOR.
Methods: Dilated fundus examination and fundus photography were evaluated for hemorrhage, and spectral-domain (SD) OCT images from HARBOR participants were analyzed for macular fluid secondary to macular neovascularization. Agreement between methods was determined for each time point. Visual outcomes were evaluated for 82 patients with evidence of hemorrhage on DFE or fundus photography at 3 months and no evidence of SD-exudative activity requiring retreatment at month 3.
Main Outcome Measures: Pooled data from the intention-to-treat population of HARBOR were analyzed for hemorrhage on DFE or fundus photography and exudative activity on SD OCT. A subgroup of PRN patients were analyzed for best-corrected visual acuity gains at 24 months.
Results: Most study eyes (89% [973/1095]) showed macular hemorrhages at baseline, declining to 31% (319/1042) at month 3 and stabilizing at 11% (111/989) by month 6 of follow-up. After baseline, exudative activity was detected on SD-OCT in more than 89% of eyes when hemorrhage was present on DFE or fundus photography. Patients not requiring a month 3 PRN ranibizumab injection achieved similar visual gains over 24 months, regardless of month 3 hemorrhage presence versus absence: 9.4 and 8.7 Early Treatment Diabetic Retinopathy Study letter scores, respectively (P = 0.74).
Conclusions: After 3 initial ranibizumab injections, SD-OCT detected nAMD activity in 89% of eyes when hemorrhage was present on fundus photography. Ranibizumab retreatment guided by monthly SD-OCT achieved similar vision gains with or without injection when hemorrhage was present without OCT-detectable fluid. This suggests that macular hemorrhages without OCT-detectable macular fluid may not require treatment and DFE may not be needed at every visit. These conclusions should be confirmed in a prospective randomized trial before firm recommendations regarding clinical practice can be made.
PMID: 31735634 DOI: 10.1016/j.oret.2019.09.006
BMC Ophthalmol. 2019 Nov 16;19(1):229.
Noninvasive multimodal imaging in diagnosing polypoidal choroidal vasculopathy.
Yang J, Yuan M, Wang E, Xia S, Chen Y.
Purpose: To investigate the diagnostic accuracy of noninvasive multimodal imaging methods in diagnosing polypoidal choroidal vasculopathy (PCV) and distinguishing PCV from typical neovascular age-related macular degeneration (nvAMD).
Methods: Retrospective study. Imaging features of noninvasive multimodal imaging methods, including fundus photography (FP), B-scan optical coherence tomography (OCT), en face OCT, OCT angiography, and autofluorescence, of 103 eyes with PCV or typical nvAMD were reviewed. Diagnostic strategy was established based on imaging features and was validated in other 105 eyes with PCV or typical nvAMD.
Results: Features of subretinal orange nodule on FP, thumb-like PED on OCT, notched PED on OCT, bubble sign on OCT, and Bruch's membrane depression under serosanguinous PED on OCT were more common. When the diagnostic strategy of using at least 2 of 5 features was performed, there is 0.88 sensitivity and 0.92 specificity for diagnosing PCV. The results of the validation test further confirmed the diagnostic strategy with 0.94 sensitivity and 0.93 specificity.
Conclusions: Noninvasive multimodal imaging, especially FP and B-scan OCT, provide high sensitivity and specificity for diagnosing PCV and distinguishing PCV from typical nvAMD, when at least 2 of 5 suggestive imaging features are present.
PMID: 31733642 PMCID: PMC6858976 DOI: 10.1186/s12886-019-1244-5
Ophthalmology. 2019 Sep 30. pii: S0161-6420(19)32102-5.
Incomplete retinal pigment epithelial and outer retinal atrophy in age-related macular degeneration: classification of atrophy meeting report 4.
Guymer RH, Rosenfeld PJ, Curcio CA, Holz FG, Staurenghi G, Freund KB, Schmitz-Valckenberg S, Sparrow J, Spaide RF, Tufail A, Chakravarthy U, Jaffe GJ, Csaky K, Sarraf D, Monés JM, Tadayoni R, Grunwald J, Bottoni F, Liakopoulos S, Pauleikhoff D, Pagliarini S, Chew EY, Viola F, Fleckenstein M, Blodi BA, Lim TH, Chong V, Lutty J, Bird AC, Sadda SR.
Purpose: To describe the defining features of incomplete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA), a consensus term referring to the OCT-based anatomic changes often identified before the development of complete RPE and outer retinal atrophy (cRORA) in age-related macular degeneration (AMD). We provide descriptive OCT and histologic examples of disease progression.
Design: Consensus meeting.
Participants: Panel of retina specialists, including retinal imaging experts, reading center leaders, and retinal histologists.
Methods: As part of the Classification of Atrophy Meeting (CAM) program, an international group of experts analyzed and discussed longitudinal multimodal imaging of eyes with AMD. Consensus was reached on a classification system for OCT-based structural alterations that occurred before the development of atrophy secondary to AMD. New terms of iRORA and cRORA were defined. This report describes in detail the CAM consensus on iRORA.
Main Outcome Measures: Defining the term iRORA through OCT imaging and longitudinal cases showing progression of atrophy, with histologic correlates.
Results: OCT was used in cases of early and intermediate AMD as the base imaging method to identify cases of iRORA. In the context of drusen, iRORA is defined on OCT as (1) a region of signal hypertransmission into the choroid, (2) a corresponding zone of attenuation or disruption of the RPE, and (3) evidence of overlying photoreceptor degeneration. The term iRORA should not be used when there is an RPE tear. Longitudinal studies confirmed the concept of progression from iRORA to cRORA.
Conclusions: An international consensus classification for OCT-defined anatomic features of iRORA are described and examples of longitudinal progression to cRORA are provided. The ability to identify these OCT changes reproducibly is essential to understand better the natural history of the disease, to identify high-risk signs of progression, and to study early interventions. Longitudinal data are required to quantify the implied risk of vision loss associated with these terms. The CAM classification provides initial definitions to enable these future endeavors, acknowledging that the classification will be refined as new data are generated.
PMID: 31708275 DOI: 10.1016/j.ophtha.2019.09.035
Ophthalmologica. 2019 Nov 8:1-9.
Clinical characteristics of polypoidal choroidal vasculopathy and anti-vascular endothelial growth factor treatment response in caucasians.
Kokame GT, Liu K, Kokame KA, Kaneko KN, Omizo JN.
Background/Aims: To identify the clinical characteristics of polypoidal choroidal vasculopathy (PCV) in Caucasian patients and assess the prevalence of anti-vascular endothelial growth factor (anti-VEGF) resistance.
Methods: This involved a retrospective chart review of Caucasian patients diagnosed with PCV and utilizing indocyanine green angiography with the scanning laser ophthalmoscope. Data collected included patients' demographics, disease characteristics, and treatment response.
Results: There were 54 eyes of 49 patients with PCV; 51.0% were male and 49.0% were female with a mean age of 72.9 years. Forty-four patients (89.8%) had PCV unilaterally and 10.2% (5 patients) had PCV bilaterally. PCV was located in the macula in 79.6%, in the peripapillary region in 16.7%, and in both regions in 3.7%. PCV commonly presents with serous detachment (66.7%), retinal pigment epithelial detachment (RPED) (51.9%) and subretinal hemorrhage (37.0%). Twenty-nine eyes were included in the treatment response analysis, with 18 eyes (62.1%) showing persistent disease activity after 3 initial injections of anti-VEGF treatment.
Conclusion: PCV in Caucasian patients is more often unilateral and presents more commonly in the macular region than the peripapillary region. Serous detachment and RPED are the 2 most common findings. Resistance to current anti-VEGF treatment was noted frequently; it is thus extremely important to identify this subtype of type I subretinal neovascularization.
PMID: 31707394 DOI: 10.1159/000503834
Am J Ophthalmol. 2019 Nov 8. pii: S0002-9394(19)30531-8.
Association of age-related macular degeneration on Alzheimer's or Parkinson's disease: a retrospective cohort study.
Choi S, Jahng WJ, Park SM, Jee D.
Purpose: To determine the association of age-related macular degeneration (AMD) with Alzheimer's disease (AD) and Parkinson's disease (PD).
Design: Retrospective cohort study.
Methods: The study population consisted of 308,340 participants aged 50 years or older from the Korean National Health Insurance Service - Health Screening Cohort. After excluding participants with AMD during 2002, participants were detected for AMD during 2003-2005. Starting from 1 January 2006, all participants were followed-up for AD and PD until 31 December 2013. Multivariate Cox proportional hazards regression was used to calculate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for AD and PD risk.
Results: Compared to non-AMD participants, AMD patients had higher risk for AD (aHR 1.48, 95% CI 1.25-1.74) and PD (aHR 1.46, 95% CI 1.14-1.88). The risk-increasing association of AMD with AD (aHR 2.25, 95% CI 1.39-3.66) and PD (aHR 2.02, 95% CI 1.00-4.08) were preserved among participants who were never smokers, did not consume alcohol, and exercised regularly. Finally, AMD was associated with higher risk of AD (aHR 1.96, 95% CI 1.46-2.65 for age <70 years and aHR 1.53, 95% CI 1.26-1.86 for age ≥70 years) and PD (aHR 1.90, 95% CI 1.29-2.80 for age <70 years and aHR 1.47, 95% CI 1.06-2.04 for age ≥70 years) for according to subgroups divided by age.
Conclusions: Compared to non-AMD participants, AMD patients had higher risk for AD and PD even among those with healthy lifestyle behaviors. Patients with AMD must be closely monitored for possible subsequent development of AD or PD.
PMID: 31712068 DOI: 10.1016/j.ajo.2019.11.001
Br J Ophthalmol. 2019 Nov 11. pii: bjophthalmol-2019-314422.
Prevalence and incidence of age-related macular degeneration in Europe: a systematic review and meta-analysis.
Li JQ, Welchowski T, Schmid M, Mauschitz MM, Holz FG, Finger RP.
Background/Aims: Age-related macular degeneration (AMD) is the main cause of visual impairment and blindness in Europe. A further increase in the number of affected persons is expected and current European data are needed for healthcare resource planning.
Methods: We performed a systematic review on the prevalence and incidence of AMD based on the meta-analysis of observational studies in epidemiology guideline. Meta-analysis and meta-regression on time-trends, age, countries, regions, sex and classification systems for AMD were performed. Based on Eurostat population projections, the pooled prevalence estimates were extrapolated to the year 2050.
Results: Twenty-two prevalence and four incidence studies published since 1996 were included. Our pooled prevalence estimate of early or intermediate AMD and any late AMD in those 60 years and older was 25.3% (95% CI 18.0% to 34.4%) and 2.4% (95% CI 1.8% to 3.3%), respectively. A significant increase in prevalence was seen in older populations. In the meta-analysis of incidence, the pooled annual incidence of any late AMD was 1.4 per 1 000 individuals (95% CI 0.8 to 2.6). Overall, the number of EU inhabitants with any late AMD is expected to increase from 67 to 77 million until 2050. Incident late AMD is estimated to increase from 400 000 per year today to 700 000 per year in 2050.
Conclusions: Approximately 67 million people in the EU are currently affected by any AMD and, due to population ageing, this number is expected to increase by 15% until 2050. Monitoring and treatment of people with advanced disease stages will require additional healthcare resources and thorough healthcare planning in the years and decades to come.
PMID: 31712255 DOI: 10.1136/bjophthalmol-2019-314422
J Med Case Rep. 2019 Nov 17;13(1):335.
Spontaneous disappearance and recurrence of impending macular hole: a case report.
Miyamoto M, Shimizu K, Sato Y, Konose B, Mano N, Watanabe H, Ikeda T.
Background: There have been several reports of spontaneous closure and reopening of a macular hole, however, in most of those cases, it was observed in eyes post vitrectomy. Here, we report a case of multiple episodes of spontaneous disappearance and recurrence of impending macular hole (stage 1B macular hole) with no history of previous surgery.
Case Presentation: A 76-year-old Japanese man presented with a primary complaint of reduced visual acuity in his right eye. On initial examination, the visual acuity in his right and left eye was 0.4 and 0.01, respectively. He had previously been diagnosed as having macular degeneration of unknown origin in his left eye. Optical coherence tomography imaging confirmed vitreomacular traction and impending macular hole in his right eye. After a 1-week follow-up period, posterior vitreous detachment was detected, and the impending macular hole appeared to be resolved. Two months later, the impending macular hole had completely disappeared and his visual acuity had improved to 0.9. Six months later, he again noticed decreased vision in his right eye. An examination revealed that his visual acuity had dropped to 0.4, and there was a recurrence of impending macular hole. An optical coherence tomography examination showed no definitive findings of vitreous traction, and, 1 month later, spontaneous disappearance was observed again and his visual acuity improved to 0.7.
Conclusions: In this case, both the initial onset and the recurrence involved impending macular hole, however, the optical coherence tomography findings differed at each examination. These findings suggest that some causes other than vitreous traction were responsible for both the spontaneous disappearance and recurrence of the impending macular hole in this present case.
PMID: 31733654 PMCID: PMC6858975 DOI: 10.1186/s13256-019-2277-3