The Need for Treatment of Neovascular Age-Related Macular Degeneration: A Study Based on the Polish National Registry.

INTRODUCTION: The Polish National AMD Therapeutic Program offered us a unique opportunity to determine the need for treatment of neovascular age-related macular degeneration (nAMD). METHODS: A search, extraction, and analysis of data from the monitoring system of the Therapeutic Program of the National Health Fund was performed. Demographic data from the Central Statistical Office were also obtained and analyzed. All national data, and from the Silesian Voivodeship specifically, from patients who had received treatment prior to January 14, 2022 (57,876 eyes) were analyzed. RESULTS: Approximately 0.1% of the Polish population requires treatment for nAMD when the best-corrected visual acuity (BCVA) criteria exclude irreversible severe changes in the fovea (0.2-0.8 by Snellen). There were 30,771 eyes in the therapeutic program in January 2022, and 4898 (15.9%) of them were in Silesia, which contains 11.7% of the total population and 12.4% of the elderly population (65 years of age and older). However, as a result of the COVID-19 pandemic, the average number of monthly enrollments in the therapeutic program decreased from 717 in the first quarter of 2020 to 505 in the second quarter (with a low of 407 in April). Moreover, in 2020, a negative balance was recorded between included and excluded patients. CONCLUSION: The need for nAMD treatment in the elderly community (65 years of age and older) is estimated to be 0.55-0.66%.

Update on the Management of Uveitic Macular Edema.

Uveitic macular edema (ME) is a frequent complication in 8.3% of uveitis patients and is a leading cause of serious visual impairment in about 40% of cases. Despite the numerous available drugs for its treatment, at least a third of patients fail to achieve satisfactory improvement in visual acuity. First-line drugs are steroids administered by various routes, but drug intolerance or ineffectiveness occur frequently, requiring the addition of other groups of therapeutic drugs. Immunomodulatory and biological drugs can have positive effects on inflammation and often on the accompanying ME, but most uveitic randomized clinical trials to date have not aimed to reduce ME; hence, there is no clear scientific evidence of their effectiveness in this regard. Before starting therapy to reduce general or local immunity, infectious causes of inflammation should be ruled out. This paper discusses local and systemic drugs, including steroids, biological drugs, immunomodulators, VEGF inhibitors, and anti-infection medication.

Ultra-Widefield Fluorescein Angiography Image Brightness Compensation Based on Geometrical Features.

Ultra-widefield fluorescein angiography (UWFA) is an emerging imaging modality used to characterise pathologies in the retinal vasculature, such as microaneurysms (MAs) and vascular leakages. Despite its potential value for diagnosis and disease screening, objective quantitative assessment of retinal pathologies by UWFA is currently limited because laborious manual processing is required. In this report, we describe a geometrical method for uneven brightness compensation inherent to UWFA imaging technique. The correction function is based on the geometrical eyeball shape, therefore it is fully automated and depends only on pixel distance from the center of the imaged retina. The method's performance was assessed on a database containing 256 UWFA images with the use of several image quality measures that show the correction method improves image quality. The method is also compared to the commonly used CLAHE approach and was also employed in a pilot study for vascular segmentation, giving a noticeable improvement in segmentation results. Therefore, the method can be used as an image preprocessing step in retinal UWFA image analysis.

Fully automatic algorithm for the analysis of vessels in the angiographic image of the eye fundus.

BACKGROUND: The available scientific literature contains descriptions of manual, semi-automated and automated methods for analysing angiographic images. The presented algorithms segment vessels calculating their tortuosity or number in a given area. We describe a statistical analysis of the inclination of the vessels in the fundus as related to their distance from the center of the optic disc. METHODS: The paper presents an automated method for analysing vessels which are found in angiographic images of the eye using a Matlab implemented algorithm. It performs filtration and convolution operations with suggested masks. The result is an image containing information on the location of vessels and their inclination angle in relation to the center of the optic disc. This is a new approach to the analysis of vessels whose usefulness has been confirmed in the diagnosis of hypertension. RESULTS: The proposed algorithm analyzed and processed the images of the eye fundus using a classifier in the form of decision trees. It enabled the proper classification of healthy patients and those with hypertension. The result is a very good separation of healthy subjects from the hypertensive ones: sensitivity - 83%, specificity - 100%, accuracy - 96%. This confirms a practical usefulness of the proposed method. CONCLUSIONS: This paper presents an algorithm for the automatic analysis of morphological parameters of the fundus vessels. Such an analysis is performed during fluorescein angiography of the eye. The presented algorithm automatically calculates the global statistical features connected with both tortuosity of vessels and their total area or their number.

[VEGF in age-related macular degeneration. Part I. Physiologic and pathologic role of VEGF]. / VEGF a zwyrodnienie plamki zwiazane z wiekiem. Czesc I. Fizjologiczna i patologiczna rola VEGF.

VEGF, an endothelial specific growth factor, stimulates vascular permeability and angiogenesis. VEGF is involved in many physiological and pathological processes including embryogenesis, wound healing, tumor growth, choroidal neovascularization and many others. Authors discuss VEGF structure, known isoforms and their mechanisms of function, focusing on VEGF influence on eye tissues.

[VEGF in age-related macular degeneration. Part II. VEGF inhibitors use in age-related macular degeneration treatment]. / VEGF a zwyrodnienie plamki zwiazane z wiekiem. Czesc II. Inhibitory VEGF w leczeniu zwyrodnienia plamki zwiazanego z wiekiem.

Wet AMD remains a therapeutic challenge. VEGF inhibitors are new promising group of medical agents undergoing advanced clinical trials. Oncology is the main specialty using anti-VEGF therapy. Two agents were designed from the beginning as ophthalmologic medicines. These are pegaptanib and ranibizumab. In the paper there is mechanism, efficacy and safety data presented, especially coming from multi-center randomized clinical trials. Monoclonal VEGF-antibodies (ranibizumab and bevacizumab) seem to be most effective in wet AMD treatment. Because of important physiological VEGF role long-term observation is needed to confirm safety of VEGF inhibition.