Age-related macular degeneration (AMD) is considered as the main worldwide cause of blindness in elderly adults. Exudative AMD type represents 10 to 15% of macular degeneration cases, but is the main cause of vision loss and blindness. Circadian rhythm changes are associated with aging and could further accelerate it. However, the link between circadian rhythms and exudative AMD is not fully understood. Some evidence suggests that dysregulation of circadian functions could be manifestations of diseases or could be risk factors for the development of disease in elderly adults. Biological rhythms are complex systems interacting with the environment and control several physiological pathways. Recent findings have shown that the dysregulation of circadian rhythms is correlated with exudative AMD. One of the main pathways involved in exudative AMD is the canonical WNT/β-catenin pathway. Circadian clocks have a main role in some tissues by driving the circadian expression of genes involved in physiological and metabolic functions. In exudative AMD, the increase of the canonical WNT/β-catenin pathway is enhanced by the dysregulation of circadian rhythms. Exudative AMD progression is associated with major metabolic reprogramming, initiated by aberrant WNT/β-catenin pathway, of aerobic glycolysis. This review focuses on the interest of circadian rhythm dysregulation in exudative AMD through the aberrant upregulation of the canonical WNT/β-catenin pathway.
Background and Objectives: The purpose was to provide the patients’ perspective on the monitoring of their wet age-related macular degeneration (wet AMD) during coronavirus disease 2019 (COVID-19) and the importance of telemedicine. Materials and Methods: Wet AMD patients that underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in two Swiss ophthalmology clinics, completed two questionnaires after the first confinement due to COVID-19 in Switzerland. The first evaluated their views concerning their adherence to scheduled injections during the confinement, and the application of telemedicine in the future. The second, adapted from the National Eye Institute Visual Function Questionnaire-25, assessed their opinions on visual function change during confinement. Results: From a total of 130 patients, 8.5% responded they did not respect their assigned schedule (group 1) while 91.5% responded they did (group 2). A total of 78.7% of group 2 considered treatment reception as more relevant compared to the risk of COVID-19 contraction. During the pre-lockdown period, group 2 patients required more help from others than group 1 patients (p = 0.02). In the possibility of another lockdown, 36.3% of group 1 and 8.7% of group 2 would choose telemedicine to monitor their wet AMD (p = 0.02), 54.5% and 86.9% would rather visit the clinic (p = 0.02), while 9.0% and 4.3% would cancel their appointment, respectively. It was found that 70% of group 1 and 33.6% of group 2 would prefer to use the telemedicine services than visiting a telemedicine centre (p = 0.04). Conclusions: During circumstances similar to the COVID-19 confinement, most patients would prefer to visit the clinic. Group 1 would prefer wet AMD monitoring via telemedicine at a higher rate than group 2.
PurposeTo present the patients’ view on the monitoring of their wet Age‐related Macular Degeneration (wet AMD) during Coronavirus disease 2019 (COVID‐19), and the impact that telemedicine could have on it.MethodsWet AMD patients of Swiss Visio Montchoisi and RétinElysée (Lausanne, Switzerland), who had intravitreal anti‐Vascular Endothelial Growth Factor (anti‐VEGF) injections before and after the first period of the Swiss confinement due to COVID‐19, completed two questionnaires. The first evaluated their view on their adherence to their scheduled injections during the confinement, and on the future use of telemedicine. The second, adapted from National Eye Institute Visual Function Questionnaire‐25, evaluated their opinion on their visual function during the confinement.ResultsFrom a total of 130 patients, 8.5% responded they did not respect their assigned injection interval during the confinement (group 1), while 91.5% responded they did (group 2). The majority of group 1 (37.5%) responded they did not attend their scheduled visit to avoid using public transportation. The majority of group 2 (78.7%) considered the continuation of their treatment more important than the risk of contracting COVID‐19. Before the lockdown, patients of group 2 had more need for help from others than the patients of group 1 (p = 0.02). In a future lockdown, 36.3% of group 1 and 8.7% of group 2 would prefer remote monitoring of their wet AMD via telemedicine (p = 0.02), 54.5% and 86.9% would prefer to visit the clinic (p = 0.02), while 9% and 4.3% would avoid the visit, respectively. 70% of group 1 and 33.6% of group 2 would rather use the telemedicine application in their home than visit a telemedicine center (p = 0.04).ConclusionsDespite our availability to provide continuous intravitreal anti‐VEGF injections during the COVID‐19 confinement, many wet AMD patients did not receive their scheduled treatment. In similar future circumstances, most patients would prefer to visit the clinic. The patients of group 1 would prefer remote monitoring of their AMD via telemedicine at a higher rate than the patients of group 2.Bibliography Visual Function Questionnaire 25. https://www.nei.nih.gov/learn‐about‐eye‐health/resources‐for‐health‐educators/outreach‐materials/visual‐function‐questionnaire‐25
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