Environmental Amsler test as a monitoring tool for retreatment with ranibizumab for neovascular age-related macular degeneration

Mathew, Raeba; Sivaprasad, Sobha

doi:10.1038/eye.2011.326

Cited by 11 publications

(14 citation statements)

References 10 publications

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“…Participants in that study seemed better able to predict the presence of sub-retinal fluid or intra-retinal oedema on OCT imaging after further training to identify distortion in the home environment. Although the participants in this study also received both initial training and subsequent re-enforcement, we were unable to reproduce the 87.5% sensitivity and 98.5% specificity reported by Sivaprasad [12]. The reasons for this are unclear but there may have been differences in the patient population, length of treatment or the training provided.…”

Section: Methodsmentioning

confidence: 78%

“…The finding of higher specificity than sensitivity would suggest that participants in this study were more able to identify stable visual function than the subtle changes in visual function that were expected to be associated with renewed or increasing disease activity. In contrast, Sivaprasad found greater sensitivity compared to specificity in a prior study in which participants were asked to identify new or increasing environmental distortion or an overall decrease in visual function [12]. Participants in that study seemed better able to predict the presence of sub-retinal fluid or intra-retinal oedema on OCT imaging after further training to identify distortion in the home environment.…”

Section: Methodsmentioning

confidence: 80%

“…compliance with and the reliability to detect increasing distortion have been questioned. [11,12]. Detection of distortion in the home environment has however, been shown to be reliable.…”

Section: Methodsmentioning

confidence: 99%

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The accuracy of home monitoring to detect disease activity during maintenance therapy for neovascular ARMD

McKibbin

Baker

Baxter

et al. 2014

Graefes Arch Clin Exp Ophthalmol

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2 Purpose: To report the reproducibility, sensitivity, specificity and predictive value of home monitoring for disease activity in neovascular age-related macular degeneration (ARMD). Methods:Participants were trained to complete 3 separate home monitoring tasks, designed to identify subtle changes in visual function that may indicate increasing neovascular ARMD disease activity. These included measurement of near acuity and assessments of environmental distortion and overall visual function. The need for repeat intra-vitreal injection, as predicted by home monitoring, was compared to standard clinical assessment involving ETDRS distance acuity, slit lamp examination and spectral domain ocular coherence tomography.Results: Although all participants were able to complete the home monitoring tasks, the reproducibility of each of the 3 tasks was modest. Cohen's kappa was 0.118 (p=0.54) for the comparison of the outcome of the home monitoring exercise with the gold standard of hospital assessment to determine disease activity. The sensitivity of the home monitoring exercise was 33.3% (95% CI 15.2-51.4) and the specificity was 77.8% (95% CI 61.8-93.8). Conclusions:This study suggests that current tests of visual function, readily completed at home, cannot replace traditional clinic-based assessments for neovascular ARMD disease activity. Instead, such tests are likely to remain complementary to standard assessment in clinic.

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Section: Methodsmentioning

confidence: 78%

Section: Methodsmentioning

confidence: 80%

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The accuracy of home monitoring to detect disease activity during maintenance therapy for neovascular ARMD

McKibbin

Baker

Baxter

et al. 2014

Graefes Arch Clin Exp Ophthalmol

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“…Using this approach, patients receiving anti-VEGF therapy for neovascular AMD have recently been shown to be capable of predicting disease reactivation, and thus the need for retreatment. 35 …”

Section: Amsler Chart Monitoringmentioning

confidence: 99%

Strategies for improving early detection and diagnosis of neovascular age-related macular degeneration

Keane¹,

Salvo²,

Sim³

et al. 2015

OPTH

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Treatment of the neovascular form of age-related macular degeneration (AMD) has been revolutionized by the introduction of such agents as ranibizumab, bevacizumab, and aflibercept. As a result, the incidence of legal blindness occurring secondary to AMD has fallen dramatically in recent years in many countries. While these agents have undoubtedly been successful in reducing visual impairment and blindness, patients with neovascular AMD typically lose some vision over time, and often lose the ability to read, drive, or perform other important activities of daily living. Efforts are therefore under way to develop strategies that allow for earlier detection and treatment of this disease. In this review, we begin by providing an overview of the rationale for, and the benefits of, early detection and treatment of neovascular AMD. To achieve this, we begin by providing an overview of the pathophysiology and natural history of choroidal neovascularization, before reviewing the evidence from both clinical trials and “real-world” outcome studies. We continue by highlighting an area that is often overlooked: the importance of patient education and awareness for early AMD detection. We conclude the review by reviewing an array of both established and emerging technologies for early detection of choroidal neovascularization, ranging from Amsler chart testing, to hyperacuity testing, to advanced imaging techniques, such as optical coherence tomography.

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“…In 2012, Mathew and Sivaprasad introduced the concept of "environmental Amsler" defined as: the perception of visual deterioration or distortion of objects in everyday life [21]. By asking patients whether they believed that disease had reactivated, they showed that the "environmental Amsler grid" was well correlated with Optical Coherence Tomography (OCT) findings, drop of visual acuity and other clinical findings requiring re-treatment.…”

Section: Challenges Of Clinical Management Early Identification and Mmentioning

confidence: 99%

A Decade of Anti-VEGF Drugs in Ophthalmology- Successes and Challenges

Schmid¹,

Thiel²

2015

J Clin Exp Ophthalmol

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The discovery of anti-VEGF drugs has revolutionized the management of age-related macular degeneration, diabetic macular oedema and retinal vein occlusion. This paper discusses how the management evolved in the anti-VEGF era, addresses salient yet unresolved aspects of early identification and monitoring but also takes notice of challenges associated with long term care. The paper proposes to increase the role of patient self-management, as this has been shown to be effective in many other chronic clinical conditions, and sets out the requirements making self-management operational.

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Environmental Amsler test as a monitoring tool for retreatment with ranibizumab for neovascular age-related macular degeneration

Cited by 11 publications

References 10 publications

The accuracy of home monitoring to detect disease activity during maintenance therapy for neovascular ARMD

The accuracy of home monitoring to detect disease activity during maintenance therapy for neovascular ARMD

Strategies for improving early detection and diagnosis of neovascular age-related macular degeneration

A Decade of Anti-VEGF Drugs in Ophthalmology- Successes and Challenges

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Environmental Amsler test as a monitoring tool for retreatment with ranibizumab for neovascular age-related macular degeneration

Cited by 11 publications

References 10 publications

The accuracy of home monitoring to detect disease activity during maintenance therapy for neovascular ARMD

The accuracy of home monitoring to detect disease activity during maintenance therapy for neovascular ARMD

Strategies for improving early detection and&nbsp;diagnosis of neovascular age-related macular&nbsp;degeneration

A Decade of Anti-VEGF Drugs in Ophthalmology- Successes and Challenges

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Strategies for improving early detection and diagnosis of neovascular age-related macular degeneration