Associations Between Autoimmune Disease and the Development of Age-Related Macular Degeneration.

Purpose: The pathogenesis of age-related macular degeneration (AMD) likely implicates the dysregulation of immune response pathways. Several studies demonstrate that the pathogenic elements of AMD resemble those of autoimmune diseases, yet the association between AMD development and most autoimmune diseases remain unexplored. Methods: We conducted a case-control analysis of patients ages 55 and older with new-onset International Classification of Diseases (ICD) coding of dry, wet, or unspecified AMD between 2005 and 2019 in the Merative MarketScan Commercial and Medicare Databases. The diagnosis of an autoimmune disease was defined by an outpatient or inpatient claim with a relevant ICD code in the 12 months before the index visit. Conditional multivariable logistic regression, adjusted for AMD risk factors, was used to calculate odd ratios and 95% confidence intervals. Results: We identified 415,027 cases with new-onset ICD coding for AMD matched with propensity scores to 414,853 controls. In total, 16.1% of cases and 15.9% of controls were diagnosed with any autoimmune disease. The diagnosis of any autoimmune disease did not affect the odds of new-onset ICD coding for AMD in multivariable regression (OR = 1.01; 95% CI, 0.999-1.02). Discoid lupus erythematosus (OR = 1.29; 95% CI, 1.12-1.48), systemic lupus erythematosus (SLE) (OR = 1.21; 95% CI, 1.15-1.27), giant cell arteritis (OR = 1.19; 95% CI, 1.09-1.30), Sjogren's syndrome (OR = 1.17; 95% CI, 1.09-1.26), and Crohn's disease (OR = 1.13; 95% CI, 1.06-1.22) increased the odds of a new-onset ICD coding for AMD. Conclusions: Most autoimmune diseases do not affect the odds of developing AMD but several common autoimmune disorders such as SLE and Crohn's disease were associated with modestly increased odds of AMD. Further studies are needed to validate and investigate the underlying mechanisms of these associations.

Assessment of laser induction of Bruch's membrane disruption in monkey by spectral-domain optical coherence tomography.

PURPOSE: Laser-induced choroidal neovascularisation is a widely used model for age-related macular degeneration. The success rates of induction have been relatively low in large animals such as monkeys. Our study aimed to investigate the laser-induced damages to the Bruch's membrane of monkeys using the spectral-domain optical coherence tomography (OCT). METHODS: Laser photocoagulation was performed in the posterior and peripheral fundus of a rhesus monkey using a 532 nm laser. The lesions were examined by fundus photography and spectral-domain OCT immediately after the procedure. Fluorescein angiography was performed after 3 and 4 weeks in the animal to assess the development of choroidal neovascularisation. RESULTS: A total of 44 lesions were produced in both eyes of the animal. Subretinal bubbles with or without haemorrhage were observed at 41 spots during the procedure. Spectral-domain OCT showed that laser damages varied considerably among lesions and the disruption of the Bruch's membrane could be visualised at 23 spots on the OCT images. Leakage of fluorescein was only observed after 3 and 4 weeks within the macular area at lesions where Bruch's membrane disruptions had been detected by OCT. CONCLUSIONS: The presence of subretinal bubbles with haemorrhage is not an accurate indicator for successful disruption of the Bruch's membrane. Instead, spectral-domain OCT provides a better alternative to assess the retinal damages to the Bruch's membrane during laser induction of choroidal neovascularisation in monkeys.

A follow-up survey on the knowledge of age-related macular degeneration and its risk factors among Singapore residents after 5 years of nation-wide awareness campaigns.

PURPOSE: To re-evaluate the awareness of age-related macular degeneration (AMD) and knowledge of its risk factors among Singapore residents after 5 years of awareness campaigns. METHODS: Cross-sectional, questionnaire-based telephone survey (modified from the AMD Alliance International Global Report), conducted in Singapore in 2011. Participants were randomly selected using the Global Yellow Pages Singapore residential listings 2009/2010. Awareness of AMD and its risk factors was assessed among participants. RESULTS: Of 1773 Singapore residents contacted over the telephone, 559 participated (31.5% response rate). The mean age of participants was 43.1 years (range 21-85 years). A total of 157 participants (28.1%) were familiar with AMD. Among these, the number who correctly identified the risk factors were: smoking, n = 132 (84.1%); ageing, n = 123 (78.3%); lack of vitamins/nutrients, n = 121 (77.1%); genetics, n = 101 (64.3%); unprotected light exposure, n = 100 (63.7%) and; sex, n = 62 (39.5%). Participants aged >50 years (prevalence rate ratio, PRR 2.23, confidence interval, CI, 1.31-3.81) or who had undergone an eye test within the previous year (PRR 2.61, 95% CI 1.79-3.82) were more familiar with AMD, while females (PRR 0.68, 95% CI 0.47-0.98) were less familiar. CONCLUSION: Self-reported awareness of AMD among Singapore residents increased four-fold from 7.3% in 2006 to 28.1% in 2011 following 5 years of awareness campaigns. Participants who were >50 years or had undergone an eye test within the previous year were more aware of AMD while female participants were less aware of AMD.

Novel measures of cardiovascular health and its association with prevalence and progression of age-related macular degeneration: the CHARM Study.

BACKGROUND: To determine if novel measures of cardiovascular health are associated with prevalence or progression of age-related macular degeneration (AMD). METHODS: Measures of the cardiovascular system: included intima media thickness (IMT), pulse wave velocity (PWV), systemic arterial compliance (SAC), carotid augmentation index (AI). For the prevalence study, hospital-based AMD cases and population-based age- and gender-matched controls with no signs of AMD in either eye were enrolled. For the progression component, participants with early AMD were recruited from two previous studies; cases were defined as progression in one or both eyes and controls were defined as no progression in either eye. RESULTS: 160 cases and 160 controls were included in the prevalence component. The upper two quartiles of SAC, implying good cardiovascular health, were significantly associated with increased risk of AMD (OR = 2.54, 95% CL = 1.29, 4.99). High PWV was associated with increased prevalent AMD. Progression was observed in 82 (32.3%) of the 254 subjects recruited for the progression component. Higher AI (worse cardiovascular function) was protective for AMD progression (OR = 0.30, 95%CL = 0.13, 0.69). Higher aortic PWV was associated with increased risk of AMD progression; the highest risk was seen with the second lowest velocity (OR = 6.22, 95% CL = 2.35, 16.46). CONCLUSION: The results were unexpected in that better cardiovascular health was associated with increased risk of prevalent AMD and progression. Inconsistent findings between the prevalence and progression components could be due to truly different disease etiologies or to spurious findings, as can occur with inherent biases in case control studies of prevalence. Further investigation of these non-invasive methods of characterizing the cardiovascular system should be undertaken as they may help to further elucidate the role of the cardiovascular system in the etiology of prevalent AMD and progression.

An introduction to decision analysis in the economic evaluation of the prevention and treatment of vision-related diseases.

Economic evaluation in the form of reports of cost-effectiveness of the treatment and prevention of disease has only recently found widespread application in the visual sciences. While economic evaluation takes a number of forms: cost-minimization analysis, cost-benefit analysis, and cost-effectiveness analysis--it is the latter that is seen most often in the evaluation of vision-related health programs. Cost-effectiveness analysis is in particular seen most commonly in its very particular form of cost-utility analysis. Decision analysis is the analytic method most commonly used to perform cost-effectiveness analysis. In decision analysis, the expected cost and effectiveness of a health program are estimated in a rigorous fashion. In this report, we take the reader through the process of decision analysis including building the tree; populating the model with parameters for risk, cost and benefit; estimating expected cost and benefit; and deterministic and probabilistic sensitivity analysis. Examples employed include prominent studies of the cost-effectiveness of photodynamic therapy for treatment of neovascular macular degeneration and the treatment ocular hypertension to prevent glaucoma.

Surgical treatment of age-related macular degeneration: will there be a role in the future?

Surgical treatment has been shown to be able to improve vision that is lost as a result of age-related macular degeneration. Surgery is complex, such that improvement has always to be weighed against risk of complications. The availability of Ranibizumab and Bevacizumab is set to dramatically alter our management options. Surgical treatment will have a limited role to play in the next few years.

[Comparative assessment of the course of age-related macular degeneration in patients after phacoemulsification cataract surgery with implantation of AcrySof Natural SN 60 at and AcrySof SA 60 at lenses]. / Ocena porównawcza przebiegu zwyrodnienia plamki zwiazanego z wiekiem u pacjentów po operacji zacmy metoda fakoemulsyfikacji z wszczepem soczewek Acrysof Natural SN 60 at i Acrysof SA 60 at.

PURPOSE: To evaluate the influence of AcrySofNatural SN 60 AT lens on the progression of age-related macular degeneration (AMD). MATERIAL AND METHODS: Forty eyes of 20 patients (12 women and 8 men, mean age of 74 years) with bilateral cataract and age-related macular degeneration were analyzed. In both eyes (3 weeks interval) cataract surgery with intraocular lens implantation was performed. In one eye, the lens with blue light blocking filter 400-500 nm (AcrySof Natural SN 60 AT) was implanted. In the opposite eye, which served as a control, standard (AcrySof SA 60 AT) lens was implanted. To estimate AMD progression after bilateral surgery, the routine ophthalmic examination, fluorescein angiography and multifocal ERG results were performed. After mean 18 months obtained results from eye with AcrySof Natural were compared to the results from the opposite eye. RESULTS: After surgery (mean follow-up--18 months) in eyes with implantations of AcrySof Natural and standard lenses there were no significant differences in routine ophthalmic examination and fluorescein angiography results. In eyes with implanted AcrySofNatural SN 60 AT lens, in mfERG a significant decrease of central retinal function was observed (p < or = 0.05). In eyes with standard AcrySof lens in mfERG statistical differences of analyzed parameters were not found. CONCLUSION: The results of our study suggest lack of protective influence of AcrySofNatural lens on the AMD progression. Further investigation on the larger group of patients should be performed to confirm our initial results.

The economic impact of blue-light filtering intraocular lenses on age-related macular degeneration associated with cataract surgery: a third-party payer's perspective.

OBJECTIVES: Epidemiological data support an association between age-related macular degeneration (AMD) and cataract surgery that may be attributed to post-operative blue light exposure. By limiting the retina's blue light exposure, new blue-light filtering intraocular lenses (BLF IOLs) have the potential to reduce the development of AMD following cataract surgery. In the current economic healthcare environment, there is increased interest in the cost impact of new medical technologies. The objective of this analysis was to evaluate the cost impact of a BLF IOL versus a non-BLF IOL in cataract surgery. METHODS: An economic model was developed to emulate three age-specific cohorts and to assess the clinical and economic outcomes over 5 years. Data from the published literature was supplemented with clinical expert opinion. Key literature inputs involved the risk of AMD after cataract surgery as well as laboratory and animal data on the effectiveness of the BLF IOL in reducing the risk of AMD. Clinical experts provided information on the management of AMD. Direct medical costs including the cost of the IOL, monitoring, and AMD prophylaxis and treatment were incorporated into the model. All costs were standardized to 2004 US dollars. Age-stratified sensitivity analyses were conducted. RESULTS: In the BLF IOL group, the 5-year age-stratified incidence of AMD ranged from 0.58 to 9.23 per 100 eyes, compared with 1.69 to 24.55 per 100 eyes in the non-BLF IOL group. The incremental cost of the BLF was offset by reduced costs associated with averted AMD treatment. Estimated savings with BLF IOLs per 100 eyes were $4275, $29 997, and $111 734 in the 55 to 64 year-old, 65 to 74 year-old, and >or= 75-year-old cohorts, respectively; these findings remained robust throughout the sensitivity analyses. CONCLUSION: Limitations of this analysis include the lack of prospective clinical trial data that definitively demonstrate the efficacy of a BLF IOL in preventing AMD. Moreover, the efficacy data used to populate the model were derived from laboratory and animal studies. Thus, based on preliminary data, this study suggests that the economic benefits of implanting BLF IOLs during cataract surgery are observed in all patients over a 5-year timeframe although cost savings are greatest in patients >or= 75 years.

An update on photodynamic therapy in age-related macular degeneration.

Age-related macular degeneration (AMD) is the leading cause of irreversible loss of central vision in people aged > 50 years in the western world. Until recently, the only proven treatment to reduce the risk of vision loss from its more severe neovascular form was laser photocoagulation, but this treatment was suitable for only 15% of cases. Photodynamic therapy (PDT) with verteporfin was recently proposed to be effective in reducing the risk of visual loss for an estimated 20 - 30% of neovascular AMD patients. This review covers AMD epidemiology, the mechanism of PDT, the 2-year results of the two major clinical studies of PDT with verteporfin, the cost-effectiveness of PDT and the current research status of other drugs for PDT in AMD.

Age-related macular degeneration: what's new.

INTRODUCTION: Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed western world, accounting for approximately 50% of all cases of registered blindness. The rising prevalence of this disease in Asia seems to parallel the same trend in the developed world. Because of the socio-economic impact of this disorder, much attention has been paid to elucidating the underlying pathogenic mechanisms, as well as seeking alternative forms of treatment. This review discusses the latest advances in AMD diagnosis, treatment and prophylaxis. METHODS: Medline search with emphasis on randomised controlled clinical trials and large case-control series. Only articles cited on the Index Medicus were included in this review. RESULTS: Recent advances in the diagnosis and treatment of AMD include conventional argon laser photocoagulation, photodynamic therapy (PDT), radiation therapy, surgical options and gene therapy. CONCLUSIONS: There have been numerous advances in the management of AMD and exciting new research applications have emerged. The introduction of exciting new modalities, such as PDT, has revolutionised the approach to treating CNVM and their effects on central vision. However, there has been no breakthrough in achieving satisfactory outcomes with the available techniques for treating occult neovascular lesions. As results of large prospective randomised clinical trials evaluating new treatment alternatives become available, a treatment algorithm for neovascular AMD will emerge that best minimises visual loss and may even result in visual improvement.