PurposeTo review the current literature on the psychological impact of anti-VEGF treatments for wet age-related macular degeneration (wAMD), in terms of patients’ experiences of receiving these treatments, and the impact of these treatments for patients’ mental health and quality of life.MethodsWe critically analyzed current literature evaluating psychological impact of anti-VEGF treatments for wAMD. Primary searches of PubMed, Science Direct, and Web of Science were conducted in July and August of 2015. We reviewed all papers on the topic published until August 5, 2015.ResultsOur literature search found 14 papers addressing the psychological impact of anti-VEGF treatments for wAMD. Results highlighted potential anxieties and experiences of pain caused by receiving regular intravitreal injections. A positive visual outcome of anti-VEGF therapy is associated with positive vision-related QOL outcomes, although such association seems to be dependent on improvements on visual acuity. In the literature reviewed, patients receiving anti-VEGF treatments showed a prevalence rate of depression between 20 and 26 %.ConclusionsAlthough anti-VEGF treatments can cause some anxiety and being experienced as a stressful event, especially in the beginning of the treatment, preliminary findings suggest a potential benefit for long-term vision-related quality of life. Further longitudinal and qualitative research should bring more evidence on the positive and negative effects of these treatments on patients’ long-term mental health.
The supervised machine learning neural network developed is able to generate an estimated visual acuity value from OCT images in a population of patients with AMD. These findings should be of clinical and research interest in macular degeneration, for example in estimating visual prognosis or highlighting the importance of developing treatments targeting more visually destructive pathologies.
MRCP(UK), 4 on behalf of the EMERALD Study Group Purpose: The increasing diabetes prevalence and advent of new treatments for its major visual-threatening complications (diabetic macular edema [DME] and proliferative diabetic retinopathy [PDR]), which require frequent lifelong follow-up, have increased hospital demands markedly. Subsequent delays in patient's evaluation and treatment are causing sight loss. Strategies to increase capacity are needed urgently. The retinopathy (EMERALD) study tested diagnostic accuracy, acceptability, and costs of a new health care pathway for people with previously treated DME or PDR. Design: Prospective, multicenter, case-referent, cross-sectional, diagnostic accuracy study undertaken in 13 hospitals in the United Kingdom. Participants: Adults with type 1 or 2 diabetes previously successfully treated DME or PDR who, at the time of enrollment, had active or inactive disease. Methods: A new health care pathway entailing multimodal imaging (spectral-domain OCT for DME, and 7field Early Treatment Diabetic Retinopathy Study [ETDRS] and ultra-widefield [UWF] fundus images for PDR) interpreted by trained nonmedical staff (ophthalmic graders) to detect reactivation of disease was compared with the current standard care (face-to-face examination by ophthalmologists). Main Outcome Measures: Primary outcome: sensitivity of the new pathway. Secondary outcomes: specificity; agreement between pathways; costs; acceptability; proportions requiring subsequent ophthalmologist assessment, unable to undergo imaging, and with inadequate images or indeterminate findings. Results: The new pathway showed sensitivity of 97% (95% confidence interval [CI], 92%e99%) and specificity of 31% (95% CI, 23%e40%) to detect DME. For PDR, sensitivity and specificity using 7-field ETDRS images (85% [95% CI, 77%e91%] and 48% [95% CI, 41%e56%], respectively) or UWF images (83% [95% CI, 75%e89%] and 54% [95% CI, 46%e61%], respectively) were comparable. For detection of high-risk PDR, sensitivity and specificity were higher when using UWF images (87% [95% CI, 78%e93%] and 49% [95% CI, 42%e56%], respectively, for UWF versus 80% [95% CI, 69e88%] and 40% [95% CI, 34%e47%], respectively, for 7-field ETDRS images). Participants preferred ophthalmologists' assessments; in their absence, they preferred immediate feedback by graders, maintaining periodic ophthalmologist evaluations. When compared with the current standard of care, the new pathway could save £1390 per 100 DME visits and between £461 and £1189 per 100 PDR visits. Conclusions: The new pathway has acceptable sensitivity and would release resources. Users' suggestions should guide implementation. Ophthalmology 2020;-:1e13
PurposeThis is a feasibility study assessing use of a mobile phone application (app.) to measure nutrient intake relevant to age-related macular degeneration (AMD).MethodsInclusion criteria were age over 40 and ownership of a smartphone. Participants included healthy volunteers and those with ophthalmic conditions. They were asked to record daily food intake for a minimum of 3 days in a paper food diary and the app. A dietician analyzed the food diaries, and an independent researcher analyzed data from the app. Average daily intake of nutrients relevant to AMD (docosahexaenoic acid [DHA], eicosapentaenoic acid [EPA], vitamins E and C, copper, zinc, and lutein + zeaxanthin) were calculated for both and then compared.ResultsA total of 54 participants completed the app. and food diary. Male-to-female ratio was 7:20. Median (interquartile range [IQR]) age was 57 years (45.3–68.7 years). More than 90% of all values were within the limits of agreement for all micronutrients. Bland Altman agreement plots demonstrated clinically acceptable agreement between the two systems of analysis.ConclusionsThis study has demonstrated that the app. is a feasible alternative to the food diary for assessing nutrient intake relevant to AMD. Further studies are suggested to assess long-term adherence and effect of the app. on nutrient intake in AMD patients.Translational RelevanceAfter smoking, nutritional modification is the key modifiable factor to reduce incidence of AMD. Use of the app. could be an efficient, easy way to monitor and improve dietary intake of required nutrients pertinent to AMD.
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