Long-Term Visual Outcomes in Neovascular Age-Related Macular Degeneration Eyes With Baseline Macular Atrophy on Anti-Vascular Endothelial Growth Factor Treatment.

BACKGROUND AND OBJECTIVE: This study explores the connection between macular atrophy (MA) status at baseline and best visual acuity (BVA) after 5 to 7 years of anti-vascular endothelial growth factor (anti-VEGF) injections on eyes with neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS: This retrospective study included patients with neovascular age-related macular degeneration receiving anti-VEGF injections at least twice-yearly for 5+ years at Cole Eye Institute. Analyses of variance and linear regressions explored the connection between MA status, baseline MA intensity, and 5-year BVA change. RESULTS: Of 223 included patients, 5-year BVA change was not statistically significant between MA status groups or from baseline. The population's average 7-year BVA change was -6.3 Early Treatment Diabetic Retinopathy Study letters. Type and frequency of anti-VEGF injections were comparable between MA status groups (P > 0.05). CONCLUSION: Regardless of MA status, 5- and 7-year BVA change lacked clinical relevance. If receiving regular treatment for 5+ years, patients with baseline MA achieve comparable visual outcomes to those without MA, with similar treatment and visit burdens. [Ophthalmic Surg Lasers Imaging Retina 2023;54:223-230.].

Macular thickness fluctuation in neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor.

OBJECTIVE: To establish whether increased variability in macular thickness in neovascular age-related macular degeneration (nAMD) patients affects visual outcomes in clinical practice DESIGN: Retrospective cohort study PARTICIPANTS: Treatment-naive nAMD patients studied over 24 months METHODS: Central subfield thickness (CST) values from optical coherence tomography were collected quarterly from baseline to 24 months, and standard deviations (SDs) were calculated. The relationship was modeled with mixed-effects regression between CST SD and 24-month change in visual acuity (VA). Linear regression modeling determined predictors of CST SD. RESULTS: A total of 422 eyes with nAMD were studied. Baseline and 24-month CST values (mean ± SD) were 331.2 ± 97.6 and 253.4 ± 53.6 µm (Δ = -77.8 ± 104.7 µm, p < 0.001), with CST SD across 24 months of 42.0 ± 32.8 µm. Baseline and 24-month VA were 58.8 ± 19.2 and 62.4 ± 20.6 Early Treatment of Diabetic Retinopathy Study letters (Δ = +3.7 ± 20.8 letters, p = 0.008). CST SD over 24 months was a statistically significant negative predictor of 24-month change in VA (-15.41 [-20.98, -9.83] letters per 100 µm, p < 0.001). Quartile analysis of 24-month VA by CST SD showed a +11.2-letter difference between the first and last quartiles (p < 0.001). Baseline CST was a predictor of 24-month CST SD (24.88 [22.69, 27.06] µm per 100 µm, p < 0.001). CONCLUSIONS: Higher macular thickness fluctuations are related to poorer visual outcomes at 24 months in patients with nAMD treated with anti-vascular endothelial growth factor injections. Macular thickness variability may be an important prognostic factor of visual outcomes in nAMD eyes.

Real-World Treatment Patterns in a Population With Neovascular AMD Treated With Anti-VEGF Agents.

BACKGROUND AND OBJECTIVES: To characterize mean number of injections, injection type, and injection frequency during the first year of treatment; assess factors significantly related to injection interval; and identify predictive factors related to patient outcomes. PATIENTS AND METHODS: A retrospective, noncomparative, nonrandomized cohort study of ocular treatment with intravitreal injections of bevacizumab, ranibizumab, and aflibercept in eyes with neovascular age-related macular degeneration (nAMD). Data from January 1, 2012, through March 31, 2018, were systematically extracted from the electronic medical record system at Cole Eye Institute. Eligible patients had three or more injections within the first 12 months of treatment and received no prior injections. RESULTS: Patients received an average 8.12 ± 2.45 injections, and 45% of patients received injections at an interval of 8 weeks or less (≤q8 weeks), 33% received injections at 8 to 12 weeks (q8-12 weeks), and 22% received injections at greater than 12 weeks (>q12 weeks). Age (P = .007) and initial central subfield thickness (CST) (P = .043) had statistically significant trend relationships (P = .007) with injection interval, whereas younger patients and patients with higher CST measurements tended to have shorter injection intervals. Injection interval was a significant predictor of visual acuity (VA) and CST. Patients receiving injections at q8-12 weeks were more likely to have better VA outcomes than patients with injection intervals at ≤q8 weeks (odds ratio [OR] = 1.66 [1.16, 2.37]; P = .005). Patients receiving injections at >q12 weeks did not show a significant improvement in VA (P = .06) and were more likely to have worse CST outcomes than patients receiving injections at ≤q8 weeks (OR = 1.95 [1.17, 3.26]; P = .011). CONCLUSION: A significant portion of patients receive injections at an interval longer than every 8 weeks. Age and baseline CST had a significant relationship with injection interval. Injection interval was a significant predictor of VA and CST at 1 year. Patients with an injection interval of >q12 weeks tended to have less VA improvement and CST reduction compared to the ≤q8 weeks and q8-12 weeks groups. These findings suggest an extended injection interval >q12 weeks may be at the expense of potential VA improvement. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:190-198.].

Effects of Quality Improvement Education in Diabetic Retinopathy on Routine Clinical Practice Patterns of Optometrists.

SIGNIFICANCE: Optometrists play a preventive role in diabetic care by detecting early signs of diabetic retinopathy (DR), a leading cause of blindness in adults. This study demonstrates that additional training can improve optometrists' ability to assess the presence and severity of DR in individuals with diabetes. PURPOSE: This study aimed to determine the impact of a quality improvement intervention involving education, assessment, and feedback on improving the evaluation and referral patterns of optometrists with regard to their patients with diabetes. METHODS: A pre-interventional and post-interventional analysis of optometrist practices was conducted through a retrospective chart review of diabetic patient encounters from July 2018 to March 2019. Dilated fundus examination (DFE) documentation, follow-up scheduling, referral practices, and usage of various imaging modalities were collected from patient records. Concordance of DR severity recordings between DFE findings, assessment and plan notes, and International Classification of Diseases codes was calculated. RESULTS: After intervention, the proportion of optometrists who conducted a DFE significantly increased from 79.5 (95% confidence interval [CI], 77.3 to 81.7%) to 84.4% (95% CI, 82.4 to 86.4%). In addition, the rate of improper follow-up instructions decreased from 13.8 (95% CI, 12.0 to 15.7%) to 10.8% (95% CI, 9.2 to 12.6%), and the decrease was significant (P = .02). Although overall referrals decreased from 19.8 (95% CI, 17.6 to 21.9%) to 14.6% (95% CI, 12.6 to 16.5%), optometrists were as likely to refer to retinal specialists. Finally, concordance between documented DFE findings, assessment and plan notes, and International Classification of Diseases codes significantly increased from 78.8 (95% CI, 76.5 to 81.0%) to 88.7% (95% CI, 86.9 to 90.4%). CONCLUSIONS: Providing optometrists education in screening and assessing DR is effective in improving diabetic patient care.