Vision-related quality of life in patients suffering from age-related macular degeneration

PURPOSE: To evaluate the relative impact of best and worst eye on vision-related quality of life in patients suffering from age-related macular degeneration (AMD). DESIGN: Quality of life and visual acuity data were collected at baseline during a randomized clinical trial. METHODS: SETTING: Multicenter (11 centers), international study. PATIENTS: One hundred fourteen patients with a diagnosis of exudative AMD and primary or recurrent subfoveal neovascular membrane (greatest linear dimension of lesion < or =5400 microm; > or =50% of the total lesion was choroidal neovascularization (CNV); classic component of the total CNV > or = 1.0 mm(2)). All patients were over age 50 years, of any race, either sex. INTERVENTION OR OBSERVATION PROCEDURE: NEI-VFQ-39 questionnaire administered to patients at home by trained telephone interviewers. MAIN OUTCOME MEASURES: ETDRS visual acuity (VA) was measured in both eyes separately. Vision-related quality of life (QoL) was assessed using the NEI-VFQ-39. An analysis of variance was performed on the NEI-VFQ scores, including best eye VA (VA > 20/40 vs VA < or = 20/40), worst eye VA (VA > 20/200 vs VA < or = 20/200), and the interaction between the two as independent variables. RESULTS: Best eye VA was 0.34 on average, with VA > 20/40 in 43.0% of patients. Worst eye VA was 0.85 on average, with VA > 20/200 in 32.5% of patients. VA was not linked to general health and ocular pain scores. General Vision, Near Activities, Distance Vision, Driving, Mental Health, Role Difficulties, Dependency, Peripheral Vision, and the Global NEI-VFQ scores were affected by both best eye VA and worst eye VA. CONCLUSION: In the study sample, worst eye VA (< or =20/200) and best eye VA (< or =20/40) contributed independently to vision-related QoL. These results suggest that preserving a minimal visual acuity in the worst eye may contribute to vision-related quality of life.     

Burden of illness, visual impairment and health resource utilisation of patients with neovascular age-related macular degeneration: results from the UK cohort of a five-country cross-sectional study

BACKGROUND/AIMS: Quantitative data regarding the impact of neovascular age-related macular degeneration (NV-AMD) on individuals and society is a prerequisite for rational decision-making processes when evaluating alternative treatments for the disease. METHODS: 75 bilateral NV-AMD (patients) and 91 elderly non-AMD (controls) subjects forming the UK cohort of an international cross-sectional, observational study were independently analysed. Subjects completed a telephone survey including the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), the EuroQol (EQ-5D), the Hospital Anxiety and Depression Scale (HADS), history of falls and health resource utilisation. RESULTS: Patients with NV-AMD reported substantially worse vision-related functioning and overall well-being, including higher depression scores, than controls after adjusting for age, gender and co-morbidities (adjusted mean scores: NEI-VFQ-25 overall 52.7 vs 90.7, p<0.0001; EQ-5D 0.67 vs 0.77, p = 0.0273; HADS depression 6.8 vs 4.0, p = 0.0026). Significantly more patients reported a need for assistance with daily activities compared with controls (25.3% vs 6.6%, p = 0.003). Total annual healthcare utilisation costs were more than sevenfold higher for patients with AMD compared with controls ( pound 3,823.89 vs pound 517.05, respectively; p<0.0001) CONCLUSIONS: Patients with NV-AMD show a significant decline in quality of life and increased need for daily living assistance compared to a control population without AMD. With the availability of effective new therapies there is a need for improved early access to treatment.     

Visual outcome and success of amblyopia treatment in unilateral small posterior lens opacities and lenticonus initially treated nonsurgically.

PURPOSE: We sought to assess the success of amblyopia treatment in patients with small posterior lens opacities as well as the factors associated with a good visual outcome. METHODS: This was a retrospective study of patients with posterior lens opacities that initially were thought to be too small in size to warrant cataract surgery. The following variables were examined: cataract type, location, diameter, persistent hyaloid vessel, anisometropia, strabismus, and age of detection. Success of treatment of amblyopia was defined as improvement by at least 0.3 logMAR units. Good visual outcome was defined as 20/40 or better. Amblyopia was treated by glasses, patching, and/or atropine. Patients who failed with conservative treatment or had an increase in cataract size underwent surgery. RESULTS: Forty-eight (91%) of 53 eyes were amblyopic. Thirty amblyopic eyes had pre- and post-treatment Snellen acuities. Twenty (67%) had their visual acuity (VA) improved by 0.3 logMAR units or greater. None of the measured variables were associated with successful amblyopia treatment. Twenty-five (49%) of 51 patients had a final VA of 20/40 or better. The only variable associated with good visual outcome was cataract type: 18 of 25 (72%) posterior subcapsular cataract and 6 of 23 (32%) posterior lenticonus eyes achieved VA of 20/40 or better (P = 0.008). Six patients who went on to have cataract surgery experienced a larger improvement in BCVA (4.50 logMar units +/- 2.52 lines) compared with patients treated without cataract surgery (2.36 logMar units +/- 3.11 lines). DISCUSSION: Amblyopia treatment was successful in most cases. A small group of patients who underwent cataract surgery experienced a greater VA improvement; however, it was not statistically significant. Further studies are needed to determine which patients would benefit from cataract surgery.     

Patient Perception and Emotional Disturbance in Out-of-Hour Ophthalmic Emergency Care

Purpose: To investigate patient’s perception of the severity of their symptoms, reasons for attending an ophthalmic emergency department (ED) out of hours, and to review the prevalence of anxiety and depression. Methods: We carried out a prospective analysis of the cases presenting out of hours (8:30 PM to 8:30 AM) over a four-month period. We also conducted two questionnaire studies. First, patient’s perception of the severity of their symptoms (graded from 1–10). A score of 7 or above was defined as significant. A second questionnaire study used the Hospital Anxiety and Depression Scale (HADS), with a maximum score of 21. Patients who scored between 7–10 points on either anxiety or depression scales are defined as borderline; above 10 as pathological. Results: A total of 1,531 patients attended the out-of-hours service. The most common diagnoses were trauma (22.8%), infective conjunctivitis (10.2%), and contact-lens-related problems (6.6%). Of 175 completed questionnaires, worry about sight impairment and pain were the most common concerns for attendance. A total of 91% of patients believed their conditions were emergencies that require medical review within 24 hours. 127 HADS questionnaires were completed, showing that 18.9% and 15.0% of patients were suffering from borderline and pathological anxiety, respectively, with a mean HADS-A score of 6.5, SD=3.9. The prevalence of possible and pathological depression was 14.2% and 6.3%, mean=4.9 (SD=3.6). There was no statistical significance difference of score with the time of patient presentation. Conclusion: The prevalence of anxiety and depression is relatively high in patients who attended the ophthalmic ED and awareness of psychological impact should be raised amongst healthcare professionals.     

The MacDQoL individualized measure of the impact of macular degeneration on quality of life: reliability and responsiveness

PURPOSE: To investigate the MacDQoL test-retest reliability and sensitivity to change in vision over a period of one year in a sample of patients with age-related macular degeneration (AMD). DESIGN: A prospective, observational study. METHOD: Patients with AMD from an ophthalmologist's list (n = 135) completed the MacDQoL questionnaire by telephone interview and underwent a vision assessment on two occasions, one year apart. RESULTS: Among participants whose vision was stable over one year (n = 87), MacDQoL scores at baseline and follow-up were highly correlated (r = 0.95; P < .0001). Twelve of the 22 scale items had intraclass correlations of >.80; only two were correlated <.7. There was no difference between baseline and follow-up scores (P = .85), indicating excellent test-retest reliability. Poorer quality of life (QoL) at follow-up, measured by the MacDQoL present QoL overview item, was associated with deterioration in both the better eye and binocular distance visual acuity [VA] (r = 0.29; P = .001, r = 0.21; P = .016, respectively; n = 135). There was a positive correlation between deterioration in the MacDQoL average weighted impact score and deterioration in both binocular near VA and reading speed (r = 0.20; P = .019, r = 0.18; P = .041, respectively; n = 135). CONCLUSION: The MacDQoL has excellent test-retest reliability. Its sensitivity to change in vision status was demonstrated in correlational analyses. The measure indicates that the negative impact of AMD on QoL increases with increasing severity of visual impairment.     

Vision improvement in retinal degeneration patients by implantation of retina together with retinal pigment epithelium

PURPOSE: To demonstrate efficacy and safety of the implantation of neural retinal progenitor cell layers (sheets) with its retinal pigment epithelium (RPE) in retinitis pigmentosa (RP) and dry age-related macular degeneration (AMD) patients with 20/200 or worse vision in the surgery eye. DESIGN: Interventional nonrandomized clinical trial. METHODS: Ten patients (six RP, four AMD) received retinal implants in one eye and were followed in a phase II trial conducted in a clinical practice setting. Early Treatment Diabetic Retinopathy Study (EDTRS) was the primary outcome measure. All implant recipients and nine of 10 tissue donors were deoxyribonucleic acids typed. RESULTS: Seven patients (three RP, four AMD) showed improved EDTRS visual acuity (VA) scores. Three of these patients (one RP, two AMD) showed improvement in both eyes to the same extent. Vision in one RP patient remained the same, while vision in two RP patients decreased. One RP patient has maintained an improvement in vision from 20/800 to 20/200 ETDRS for more than five years; at the six-year examination, it was still maintained at 20/320 while the nonsurgery eye had deteriorated to hand motion vision. This patient also showed a 22.72% increase in light sensitivity at five years compared to microperimetry results at two years; the other patients showed no improved sensitivity. Although no match was found between donors and recipients, no rejection of the implanted tissue was observed clinically. CONCLUSIONS: Seven (70%) of 10 patients showed improved VA. This outcome provides clinical evidence of the safety and beneficial effect of retinal implants and corroborates results in animal models of retinal degeneration.     

Preoperative visual acuity as a prognostic indicator for laser treatment of macular edema due to branch retinal vein occlusion.

BACKGROUND AND OBJECTIVE: To determine the visual outcome of laser treatments for macular edema due to branch retinal vein occlusion (BRVO) in patients with a preoperative visual acuity (VA) of 20/200 or worse compared to patients with a preoperative VA of better than 20/200. PATIENTS AND METHODS: Records of 88 patients with macular edema secondary to BRVO undergoing laser treatment from 1984 to 2003 were reviewed. Mean VA was measured before and after each treatment and after the final treatment. RESULTS: All patients received between one and five laser treatments. Preoperative VA was better than 20/200 in 56 patients (group 1) and 20/200 or worse in 32 patients (group 2). Patients in group 1 had a mean improvement of 0.48 lines and 57% had a final VA of 20/40 or better. Patients in group 2 had a mean improvement of 1.69 lines and 20% had a final VA of 20/40 or better. CONCLUSIONS: Patients with poor VA (20/200 or worse) secondary to macular edema due to BRVO responded positively to laser treatment. The level of preoperative VA can be a useful predictor of visual outcome. These patients should consider laser treatment before alternative, more aggressive approaches.     

Burden of illness of neovascular age-related macular degeneration in Canada

BACKGROUND: Age-related macular degeneration (AMD) is a retinal disease affecting more than 2 million Canadians over the age of 50. The neovascular form of AMD is responsible for 90% of severe vision loss associated with the disease. This study was conducted to assess the burden of neovascular AMD in the Canadian population. METHODS: A cross-sectional, observational study was conducted of self-reported functional health, well-being, and disease burden among elderly subjects in Canada with (n = 67) and without (n = 99) neovascular AMD. Subjects completed telephone surveys of the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), the EuroQol questionnaire (EQ-5D), and the Hospital Anxiety and Depression Scale (HADS). Subjects also reported their history of falls and fractures and annual health care resource utilization. RESULTS: Subjects with neovascular AMD reported significantly worse vision-related functioning and overall well-being than controls (adjusted mean scores on the NEI-VFQ-25: 48.0 vs. 87.5; p < 0.0001) and significantly more depression symptoms than controls (HADS depression: 5.8 vs. 4.3; p = 0.037). Subjects with neovascular AMD also reported more than twice the need for assistance with daily activities compared with controls (19.4% vs. 9.1%; p = 0.013) and a nearly 3 times higher fall rate than the control group (22.4% vs. 8.1%; p = 0.014). The annual neovascular AMD cost per patient was Can dollars 11,334, which is over 8 times that of elderly subjects without neovascular AMD (Can dollars 1,412). Over half of the neovascular AMD costs were direct medical costs. INTERPRETATION: Neovascular AMD is associated with significant limitation in functional abilities and quality of life, resulting in increased health care resource utilization and high patient support costs. These findings emphasize the need for new treatments for neovascular AMD that will prevent vision loss and progression to blindness in order to lessen the ensuing economic burden.     

Public health impact of neovascular age-related macular degeneration treatments extrapolated from visual acuity

PURPOSE: To estimate the potential public health impact of treatment with new medications intended to preserve vision in patients with neovascular age-related macular degeneration (AMD). METHODS: A Markov model was used to simulate the natural history of AMD over the lifetime of patients with diagnosed neovascular AMD from clinical trials and epidemiologic surveys. It applied to a cohort of patients aged 75 years, with newly diagnosed neovascular AMD in one eye, whose visual acuity was 0.7 logMAR. Probabilities were calculated for the risk of AMD in the remaining eye and for premature mortality. Results of the model were expressed as the duration of low vision (worse eye VA>1.0 and better eye VA>0.7 logMAR) and blindness (bilateral VA >1.0 logMAR). Health consequences of blindness and low vision were estimated for depression, hip fractures, institutionalization, and life expectancy. RESULTS: For AMD patients with a 50% probability of VA >1.0 logMAR at 1 year, in one eye, the probability of lifetime bilateral blindness was >47%. The patients would live approximately 7 years with monocular vision >1.0 logMAR and an additional 4 years with bilateral blindness and a >15% probability of depression due to AMD. Life expectancy was decreased by approximately 2 years, >90/1000 patients would sustain a new hip fracture, and 1.5% of the patients would require institutional care for visual impairment due to AMD. To achieve a defined public health outcome (visual impairment and consequent comorbidity), it was necessary for the VA effectiveness of new treatments to increase in parallel with disease severity. CONCLUSIONS: Comorbidity related to visual impairment contributes significantly to the public health impact of AMD. Aggressive lesions need highly effective treatments. Models may be used to compare the public health impact of placebo-controlled clinical trial results.     

Juxtapapillary capillary hemangiomas. Clinical features and visual acuity outcomes

OBJECTIVE: To describe the clinical features, association with von Hippel-Lindau (VHL) disease and visual acuity outcomes of patients with a juxtapapillary capillary hemangioma. DESIGN: Retrospective observational case series. PARTICIPANTS: Seventy-two eyes of 68 patients identified with a juxtapapillary capillary hemangioma. Follow-up data of at least 6 months duration were available for 60 eyes. METHODS: A retrospective chart review of patients diagnosed with a juxtapapillary capillary hemangioma examined at four medical centers. MAIN OUTCOME MEASURES: Age at diagnosis, visual acuity (VA) at first examination and at last follow-up, tumor growth pattern and location, associated clinical features, type of treatment, association with VHL, and presence of peripheral hemangiomas were recorded for each patient. RESULTS: On initial examination, VA was >/=20/40 in 43 of 70 eyes (61%) and was >/=20/200 in 60 eyes (86%). At an average follow-up of 5.4 years (range, 0.5-19 years), VA of >/=20/40 was achieved in 21 eyes (35%) and >/=20/200 in 33 eyes (55%). Patients with VHL had poorer initial VA (48% vs. 70% with VA >/=20/40, and 74% vs. 93% with VA >/=20/200) and final VA (26% vs. 41% with VA >/=20/40, and 39% vs. 65% with VA >/=20/200) compared with patients without VHL. Patients with VHL more commonly were seen at an earlier age (average, 20 vs. 44 years, P: < 0.001), with bilateral (17% vs. 0%), and/or peripheral (39% vs. 0%) (P: < 0.001) tumors that more often had an endophytic growth pattern (63% vs. 22%, P: = 0.001) compared with patients without VHL. Patients selected for laser treatment generally had poorer initial (52% vs. 74% with VA >/=20/40, 79% vs. 96% with VA >/=20/200) and final VAs (18% vs. 56% with VA >/=20/40, 45% vs. 67% with VA >/=20/200) compared with patients not treated with laser. CONCLUSIONS: On long-term follow-up of patients with a juxtapapillary capillary hemangioma, the VA generally worsens. Patients with VHL and a juxtapapillary hemangioma more often present at a younger age, have tumors with an endophytic growth pattern, and have bilateral, multiple tumors. Treatment with laser photocoagulation results in variable VA outcomes.     

Combined cataract surgery and vitrectomy for breakthrough vitreous hemorrhage from age-related macular degeneration

PURPOSE: To report combined cataract extraction (CE), posterior chamber intraocular lens (PCIOL) implantation, and pars plana vitrectomy (PPV) for concurrent cataract and breakthrough vitreous hemorrhage from age-related macular degeneration (AMD). METHODS: Retrospective case series. RESULTS: Six eyes were included in the study. The postoperative follow-up interval ranged from 3 to 22 months (mean 8 months). Preoperative visual acuity (VA) ranged from 20/400 to hand motion. Postoperatively, 5/6 eyes had 2 or more lines of visual improvement. Three eyes were better than 20/200. CONCLUSIONS: Combined CE, PCIOL insertion, and PPV in selected patients with cataract and breakthrough vitreous hemorrhage from AMD was successful in improving VA in the majority of patients.     

Predictive factors for comorbid psychiatric disorders and their impact on vision-related quality of life in patients with high myopia

To determine the incidence of depression and anxiety disorders in patients with high myopia as well as the factors that would predict the development of psychiatric complications and their impact on vision-related quality of life (VR-QoL). Two hundred and five patients with pathologic myopia (axial length ≥26.50 mm) were studied. Incidence of depression and anxiety disorders was determined using the Hospital Anxiety and Depression Scale (HADS). VR-QoL was determined by the 25-item National Eye Institute Visual Function Questionnaire. Incidence of depression was 22.0 % and incidence of anxiety disorder was 25.9 %. Absence of children was the only factor significantly associated with the presence of depression, and a past history of cataract surgery was the only factor significantly associated with the presence of anxiety disorder. Factors which decreased the VR-QoL were in order of importance—anxiety disorder, decreased visual acuity in the best eye, depression, and being female. Responses of the subjects to two HADS statements ‘I can laugh and see the funny side of things’ and ‘I can enjoy a good book or radio or television program’ identified 82.2 % of depressed patients, and ‘I get sudden feelings of panic’ and ‘I can sit at ease and feel relaxed’ identified 71.7 % of patients with anxiety disorder. Twenty-two to 26 % of highly myopic patients had psychiatric disorders which had a strong negative impact on their VR-QoL. Two statements from the HADS questionnaire can be used to screen highly myopic patients for depression or anxiety disorders.     

Visual outcomes following cataract surgery in age-related macular degeneration patients

ObjectiveTo evaluate visual acuity (VA) outcomes, prognostic factors, and changes in disease severity in patients with age-related macular degeneration (AMD) undergoing cataract surgery.DesignRetrospective cohort studyParticipantsPatients with AMD or healthy control patients who underwent cataract surgery between 2012 and 2017.MethodsEyes were categorized into 3 AMD groups—intermediate AMD (iAMD), fovea-involving geographic atrophy (GA), neovascular AMD (nAMD)—and 3 preoperative VA-matched control groups (iAMDc), fovea-involving geographic atrophy control (GAc), neovaascular AMD control (nAMDc).ResultsWe compared 216 iAMD, 35 GA, and 184 nAMD eyes with 130, 31, and 129 controls. At postoperative month 12 (POM12), VA increased significantly in iAMD and nAMD (+10.1 ± 14.5 and +9.7 ± 18.9 letters, p < 0.001), but not in GA (p = 0.68). All control groups showed significant VA gains (iAMDc: +17.1 ± 9.7, GAc: +30 ± 12.9, and nAMDc: +26.4 ± 15.6 letters, p < 0.001). For AMD groups, POM12 VA and gain in VA were significantly lower than that of controls (p < 0.01), and better preoperative VA predicted smaller VA gains (p ≤ 0.007). Longer duration of AMD in iAMD, ellipsoid zone disruption in nAMD, and lower central subfield thickness in GA were associated with poorer VA outcomes (p < 0.05). Development of nAMD occurred in 8 iAMD eyes and was associated with longer duration of disease (p = 0.001). For nAMD eyes, injection frequency did not vary between the 12-month pre- and postoperative periods (p = 0.051).ConclusionsCataract surgery improves VA for patients with iAMD and nAMD, albeit not to the level of those without retinal pathology. Preoperative VA, AMD duration, and optical coherence tomography parameters may be important prognostic factors for cataract surgery in patients with AMD.     

Comparison of outcomes after switching treatment from intravitreal bevacizumab to ranibizumab in neovascular age-related macular degeneration

ObjectiveTo compare visual acuity and central retinal thickness in patients initially treated with bevacizumab (Avastin) and switched to ranibizumab (Lucentis) for neovascular age-related macular degeneration (AMD).DesignA retrospective chart review.ParticipantsThis study included 87 eyes from 80 patients over the age of 65 with neovascular AMD.MethodsPatients were initially treated with bevacizumab injections every 6 weeks and then switched to ranibizumab every 4 weeks when it became publicly funded by the Ontario government. Outcomes include comparison of visual acuity and central retinal thickness after bevacizumab treatment, and after switching to ranibizumab.ResultsVisual acuity improved significantly versus initial baseline values following a treatment course of 3 or more injections of bevacizumab (0.58 logMar, SD = 0.30 vs 0.73 logMar, SD = 0.41; p = 0.0007). Patients then showed a further significant improvement in visual acuity after switching and receiving a course of ranibizumab (0.51 logMar, SD = 0.32) (p = 0.0122). Mean central retinal thickness as measured by optical coherence tomography significantly decreased after a course of bevacizumab (p = 0.0158), and a further decrease was noted after a subsequent course of ranibizumab (p < 0.0001).ConclusionsThere was a significant improvement in visual acuity and central retinal thickness in patients with neovascular AMD initially treated with bevacizumab. When these patients were uniformly switched to ranibizumab there was a further significant improvement in visual acuity and a reduction of retinal thickness. It appears that ranibizumab can maintain, or improve the effect achieved after an initial course of bevacizumab.     

Tunable dye laser photocoagulation for choroidal neovascularization complicating age-related macular degeneration

We report our first 146 consecutive eyes treated with tunable dye laser for choroidal neovascular membrane (NVM) complicating age-related macular degeneration (AMD). They were treated with the orange (595 nm; N = 6), red (630 nm; N = 23), yellow (577 nm; N = 67), or sequential red-yellow (N = 50) wavelength of the tunable dye laser. All had a minimum 180 days follow-up. Eyes were analyzed as two groups categorized by pretreatment visual acuity (VA): 20/100 or better (N = 101), and 20/200 or worse (N = 45). Change in VA between baseline and most recent follow-up was studied by age, laser color, previous non-dye laser treatment, and number of treatments. Age was a statistically significant variable (chi 2 = 6.61, degree of freedom = 2, P less than 0.05). In eyes with initial VA of 20/100 or better, age also was significant for cumulative percent loss in VA of greater than or equal to 2 lines. We discontinued using orange after poor early clinical results. Our results suggest that the dye laser's variety and combination of wavelengths may provide advantages in treating NVM complicating AMD.     

Surgical removal of subfoveal choroidal neovascularization: visual outcome and prognostic value of fluorescein angiography and optical coherence tomography.

PURPOSE: To study the functional results of macular surgery and determine pre-operative features associated with better final visual outcome. METHODS: Forty-two consecutive patients underwent surgical removal of subfoveal choroidal neovascularization (CNV), related to age-related macular degeneration (AMD) in 8 eyes, degenerative myopia in 14 eyes, multifocal choroiditis (MFC) in 10 eyes, idiopathic CNV in 6 eyes and other etiologies in 4 eyes. Mean age was 49 years. Pre-operative visual acuity (VA) was 20/200 or less in 30 eyes (71.4%) and never better than 20/40. Fluorescein angiography was analyzed before and after surgery. Pre-operative optical coherence tomographs (OCT) were studied in a masked fashion. Mean follow-up was 12 months (range 4-48 months). RESULTS: Final VA was 20/200 or less in 25 eyes (60%). According to the CNV etiology, the percentage were 87.5%, 80%, 57.1% and 20% respectively in eyes with AMD, MFC, high myopia, and idiopathic or other diseases. Post-operative VA improved in 21 eyes (50%) but subsequently declined in 7% by the final examination. Patients younger than 50 years had better functional results (p=0.006). Lack of retinal pigment epithelium (RPE) changes on pre-operative angiography was correlated with good visual outcome (p<0.001). The OCT study confirmed some features already described and showed some different CNVpatterns: above and usually separated from the RPE, below and not separated from the RPE, and ungradable. Eyes with the first OCT pattern had the best visual outcome. Main complications included 4 (10%) retinal detachments and 9 (21%) recurrences. OCT was also useful to confirm CNV recurrences post-operatively. CONCLUSIONS: CNV surgical excision results vary depending on the underlying disease, the RPE and choriocapillaris function, and the features observed on pre-operative OCT images.     

Arterio-venous dissection after isovolaemic haemodilution in branch retinal vein occlusion: a non-randomised prospective study

Purpose The rationale for this pilot study was to add arterio-venous dissection (AVD) after unsuccessful medical treatment in a well-defined group of patients with branch retinal vein occlusion (BRVO).Methods In this prospective, interventional case series 35 consecutive patients with a visual acuity (VA) of 0.4 (logMar) or worse were scheduled for surgery within the first 3 months of the onset of BRVO. The study endpoint was VA 1 year after AVD. Secondary study endpoints were: correlation of VA and successful vessel dissection; complication rate; and number of additional surgical procedures within the first year of AVD.Results Preoperative VA (logMar) was 0.82±0.05 (range 0.2–1.6). VA 6 weeks postoperatively was 0.54±0.06 (range 0–1.6), 3 months postoperatively 0.61±0.07 (0–1.56), 6 months postoperatively 0.74±0.08 (range 0–2) and 12 months postoperatively 0.55±0.07 (range 0.1–1.5). VA improved 1 year after AVD (p=0.0004). An improvement in VA did not depend on successful separation of the artery and the vein. Four patients had a retinal detachment, 19 patients needed cataract surgery within the first year of AVD. A total of 24 additional surgical procedures were needed.Conclusions Patients with BRVO may profit from AVD compared with a historical control group. Visual improvement was found irrespective of the successful dissection of vessels. The cataract formation rate and additional surgery was a shortcoming of the AVD procedure.     

Ultrasound assessment of short‐term ocular vascular effects of intravitreal injection of bevacizumab (Avastin®) in neovascular age‐related macular degeneration

Acta Ophthalmol. 2010: 88: 641–645

Abstract.

Purpose: Angiogenic inhibitors, alone or combined with other therapies, are believed to represent a promising treatment for neovascularization in age‐related macular degeneration (wet AMD). They can maintain or improve visual acuity (VA), at least for the first 2 years. However, evolution to retinal atrophy cannot be ruled out and it may be useful to assess the effects of antiangiogenic therapy on retinal and choroidal circulation. Methods: We carried out a pilot study in 15 patients with wet AMD. Time‐averaged mean blood flow velocities (BFVs) in the central retinal, temporal posterior ciliary and ophthalmic arteries (CRA, TPCA and OA) were measured by ultrasound imaging before and 4 weeks after a single intravitreal injection of 1.25 mg bevacizumab in 0.05 ml. Patients underwent two ophthalmic examinations, before and 4 weeks after injection, including VA measurement and optical coherence tomography (OCT3) examination. Results: In treated eyes, bevacizumab injection was followed by a significant improvement in VA (from 20/125 to 20/80; p = 0.0214), and a decrease in mean central macular thickness (from 392 ± 96 μm to 271 ± 50 μm; p = 0.0038). Mean BFV decreased by 10% in the CRA (p = 0.0226), 20% in the TPCA (p = 0.0026) and 20% in the OA (p = 0.0003). No effect was observed in fellow eyes. Conclusions: Intravitreal bevacizumab acutely improved VA and reduced central macular thickness in wet AMD. Ultrasound imaging revealed that BFVs decreased in all retrobulbar arteries, suggesting that after local diffusion, bevacizumab exerts a short‐term regional effect. Bevacizumab might therefore induce hypoperfusion of the whole eye, which may correspond to a vascular side‐effect.     

Pre- and postoperative C-reactive protein levels in patients with cataract and age-related macular degeneration

PURPOSE: To assess whether patients with early or intermediate forms of age-related macular degeneration (AMD) benefit from cataract surgery in terms of visual acuity and contrast sensitivity, and to determine the levels of high sensitivity C-reactive protein (hsCRP) as a systemic marker of inflammation before and after cataract surgery in patients with AMD. METHODS: Three groups of patients (n=132) were studied at baseline and 8-12 weeks later: 1) a study group of patients with AMD who underwent cataract surgery (n=47), 2) a control group of patients without ocular comorbidities who underwent cataract surgery (n=36), and 3) a second control group with AMD and no surgery (n=49). Visual acuity (VA) was obtained by letter charts and expressed as decimal notations +/- SD. Contrast sensitivity was measured employing a Ginsburg Box, VSCR-CST-6500. The hsCRP was measured by means of particle enhanced immunonephelometry on a BN Systems. RESULTS: Postoperatively in both groups of the operated patients an improvement of VA (0.23+/-0.17 vs 0.64+/-0.25 and 0.23+/-0.18 vs 0.83+/-0.17, respectively, p<0.0001) and contrast sensitivity (at different spatial frequencies, from 1.5 to 18 cycles/degree, p<0.05) was determined. At baseline, the hsCRP level in Group 1 patients was higher than the level in controls (2.67+/-2.36 vs 1.67+/-1.36, p<0.01, or 1.12+/-0.99 mg/L, p<0.0001, respectively). After 8-12 weeks, the hsCRB level only in Group 1 significantly increased (2.67+/-2.36 vs 3.74+/-3.54 mg/L, p<0.05), whereas in the controls it did not change. CONCLUSIONS: Patients with AMD benefit from cataract surgery, both in terms of VA and contrast sensitivity. The level of hsCRP is significantly higher in patients with AMD and moderate cataract than in patients with one of these eye disorders. The hsCRP only increases after cataract surgery in patients with AMD.     

Assessment of vision-related function in patients with age-related macular degeneration

OBJECTIVE: To investigate the validity of the visual function index (VF-14) in assessing visual function in patients with age-related macular degeneration (AMD). DESIGN: Prospective noncomparative observational case series. PARTICIPANTS: One hundred fifty-nine consecutive patients attending a sole practitioner's academic retina-only clinic from May 1998 through August 1998 and from May 1999 through August 1999. MAIN OUTCOME MEASURES: Correlations were calculated between the VF-14 scores and the medical outcomes study 36-item short form (SF-36), weighted comorbidity scale, visual acuity and clinical AMD severity (stage), and vision self-assessment scales. Documentation of the severity of macular degeneration was performed by a sole examiner. RESULTS: There was a moderately strong correlation between visual acuity and trouble with vision (r = 0.51), satisfaction with vision (r = -0.50), and overall quality of vision (r = -0.56). A strong correlation was noted between VF-14 score and patients' self-rating of amount of trouble with vision (r = -0.67), satisfaction with vision (r = 0.62), and overall quality of vision (r = 0.67). In comparison, correlations between SF-36 score and patients' self-rating of amount of trouble with vision, satisfaction with vision, and overall quality of vision ranged from r = 0.37 to r = -0.40. Linear regression analysis for the overall study population indicated that AMD severity was not an independently significant predictor of VF-14 score after adjusting for visual acuity. However, among patients with 20/20 vision in the better eye, AMD severity was an independently significant predictor of VF-14 score after adjusting for visual acuity in the worse eye. CONCLUSIONS: The VF-14 exhibits a considerable degree of validity as a measure of functional impairment in patients with AMD. Age-related macular degeneration severity was an independently significant predictor of VF-14 score in the group of patients with 20/20 vision in the better eye, but this did not hold true for the overall study population. Age-related macular degeneration is associated with substantial impairment in reported visual function.