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1.
PLoS One ; 15(3): e0230305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32168355

RESUMO

PURPOSE: To describe epidemiologic features of patients with presumed ocular histoplasmosis syndrome (POHS) in the United States using insurance claims data and compare POHS patients with and without choroidal neovascularization (CNV). DESIGN: Retrospective cohort study. METHODS: Patients with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for histoplasmosis retinitis on an outpatient claim in the 2014 IBM® MarketScan® Commercial Database and the Medicare Supplemental Database who were enrolled for at least 2 years after the POHS code. MAIN OUTCOME MEASURES: Data related to testing, treatment, and direct medical costs. RESULTS: Among >50 million total MarketScan enrollees, 6,678 (13 per 100,000) had a POHS diagnosis code. Of those, 2,718 were enrolled for 2 years; 698 (25%) of whom had a CNV code. Eleven of the 13 states with the highest POHS rates bordered the Mississippi and Ohio rivers. CNV patients had significantly more eye care provider visits (mean 8.8 vs. 3.2, p<0.0001), more ophthalmic imaging tests, higher rates of treatment with anti-vascular endothelial growth factor injections (45% vs. 4%, p<0.0001), and incurred higher mean total yearly costs ($1,251.83 vs. $251.36, p<0.0001) than POHS patients without CNV. CONCLUSIONS: Although the relationship between Histoplasma and POHS remains controversial, geographic patterns of POHS patient residence were consistent with the traditionally reported range of the fungus. CNV in the context of POHS was associated with additional healthcare use and costs. Further research to understand POHS etiology, risk factors, prevalence, and complications is needed, along with early diagnosis and treatment strategies.


Assuntos
Neovascularização de Coroide/economia , Histoplasmose/economia , Seguro Saúde/economia , Degeneração Macular/economia , Retinite/economia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Neovascularização de Coroide/complicações , Neovascularização de Coroide/patologia , Neovascularização de Coroide/terapia , Olho/patologia , Oftalmopatias/economia , Oftalmopatias/epidemiologia , Feminino , Pessoal de Saúde , Histoplasmose/complicações , Histoplasmose/patologia , Histoplasmose/terapia , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros , Degeneração Macular/patologia , Degeneração Macular/terapia , Masculino , Pessoa de Meia-Idade , Oftalmologia/economia , Retinite/complicações , Retinite/patologia , Retinite/terapia , Estados Unidos/epidemiologia , Visão Ocular/fisiologia , Adulto Jovem
2.
PLoS One ; 15(2): e0228858, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32045445

RESUMO

Despite the existence of evidence-based recommendations to decrease risk and progression of Age-Related Macular Degeneration (AMD) for some time, self-reported practices suggest that eyecare professionals' advice and people with AMD's adherence to these recommendations can be very poor. This study uses qualitative methods to explore Australian eyecare professionals' perspective on barriers to effective AMD care. Seven focus groups involving 65 optometrists were conducted by an experienced facilitator. A nominal group technique was used to identify, prioritize and semi-quantify barriers and enablers to AMD care. Participants individually ranked their perceived top five barriers and enablers with the most important granted a score of 5 and the least important a score of 1. For each barrier or enabler, the number of votes it received and its total score were recorded. Barriers and enablers selected by at least one participant in their top 5 were then qualitatively analysed, grouped using thematic analysis and total score calculated for each consolidated barrier or enabler. In-depth individual interviews were conducted with 10 ophthalmologists and 2 optometrists. Contributions were audio-recorded, transcribed verbatim and analysed with NVivo software. One hundred and sixty-nine barriers and 51 enablers to AMD care were identified in the focus groups. Of these, 102 barriers and 42 enablers were selected as one of their top 5 by at least one participant and further consolidated into 16 barriers and 10 enablers after thematic analysis. Factors impacting AMD care identified through analysis of the transcripts were coded to three categories of influence: patient-centered, practitioner-centered, and structural factors. Eyecare professionals considered poor care pathways, people with AMD's poor disease understanding / denial, and cost of care / lack of funding, as the most significant barriers to AMD care; they considered shared care model, access, and communication as the most significant enablers to good AMD care. These findings suggest that Australian eyecare professionals perceive that there is a need for improved patient support systems and appropriately funded, clearer care pathway to benefit people with AMD.


Assuntos
Degeneração Macular/terapia , Oftalmologistas , Optometristas , Adulto , Idoso , Atitude do Pessoal de Saúde , Austrália , Assistência à Saúde , Prática Clínica Baseada em Evidências , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Relações Profissional-Paciente , Pesquisa Qualitativa , Encaminhamento e Consulta
3.
Cyberpsychol Behav Soc Netw ; 23(3): 185-191, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32091918

RESUMO

Virtual reality (VR) is demonstrating increasing potential for therapeutic benefit in elderly care, but it is still generally considered to be the domain of the visually unimpaired. Even where VR and augmented reality (AR) are being explored for use with low vision, it is generally with a focus on creating bespoke software and hardware. However, the properties of commercial off-the-shelf (COTS) headsets, such as high luminance, may render them accessible even to very low vision users. Using a case-study approach, we explored the differences in visual perception from baseline to pass-through AR and commercial VR applications for an elderly female (Mrs. M) with advanced age-related macular degeneration. We found notable improvements in object, face, and color recognition, particularly with higher display brightness. Furthermore, Mrs. M was able to engage fully and enthusiastically with a number of (unmodified) VR applications, providing detailed descriptions of both static and moving elements. We suggest that the high luminance available in COTS VR may support more stable fixation closer to the fovea, improving visual resolution. Furthermore, the improvements we noted in color perception support previous suggestions that increasing luminance may improve photosensitivity by reducing the uptake of limited oxygen by the rod cells. We conclude that low vision should not automatically preclude users from engaging in VR research or entertainment, and that they may be able to use well-illuminated VR applications without any special modifications.


Assuntos
Degeneração Macular/terapia , Realidade Virtual , Baixa Visão/terapia , Idoso de 80 Anos ou mais , Realidade Aumentada , Feminino , Humanos
4.
Cell Mol Life Sci ; 77(5): 779-780, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31897540

RESUMO

Prolonged life expectancies contribute to the increasing prevalence of age-related macular degeneration (AMD) that is already the leading cause of severe vision loss among the elderly in developed countries. In dry AMD, the disease culminates into vast retinal atrophy, whereas the wet form is characterized by retinal edema and sudden vision loss due to neovascularization originating from the choroid beneath the Bruch's membrane. There is no treatment for dry AMD and despite intravitreal injections of anti-vascular endothelial growth factor (VEGF) that suppress the neovessel formation, also wet AMD needs new therapies to prevent the disease progression and to serve patients lacking of positive response to current medicines. Knowledge on disease mechanisms is a prerequisite for the drug development, which is hindered by the multifactorial nature of AMD. Numerous distinguished publications have revealed AMD mechanisms at the cellular and molecular level and in this multi-author review, we take a bit broader look at the topic with some novel aspects.


Assuntos
Degeneração Macular/patologia , Retina/patologia , Transtornos da Visão/patologia , Idoso de 80 Anos ou mais , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/terapia , Transtornos da Visão/diagnóstico , Transtornos da Visão/terapia
5.
Cell Mol Life Sci ; 77(5): 819-833, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31893312

RESUMO

Understanding the mechanisms that underlie age-related macular degeneration (AMD) has led to the identification of key molecules. Hypoxia-inducible transcription factors (HIFs) have been associated with choroidal neovascularization and the progression of AMD into the neovascular clinical phenotype (nAMD). HIFs regulate the expression of multiple growth factors and cytokines involved in angiogenesis and inflammation, hallmarks of nAMD. This knowledge has propelled the development of a new group of therapeutic strategies focused on gene therapy. The present review provides an update on current gene therapies in ocular angiogenesis, particularly nAMD, from both basic and clinical perspectives.


Assuntos
Proteínas Reguladoras de Apoptose/metabolismo , Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo , Terapia Genética/métodos , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Degeneração Macular/genética , Degeneração Macular/terapia , Proteínas Repressoras/metabolismo , Proteínas Reguladoras de Apoptose/antagonistas & inibidores , Proteínas Reguladoras de Apoptose/genética , Fatores de Transcrição Hélice-Alça-Hélice Básicos/antagonistas & inibidores , Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética , Neovascularização de Coroide/genética , Neovascularização de Coroide/patologia , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/antagonistas & inibidores , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Degeneração Macular/patologia , Proteínas Repressoras/antagonistas & inibidores , Proteínas Repressoras/genética , Transtornos da Visão/genética , Transtornos da Visão/patologia , Transtornos da Visão/terapia
7.
Klin Monbl Augenheilkd ; 236(12): 1418-1422, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31671463

RESUMO

Age-related macular degeneration (AMD) is the leading cause of blindness in the western world. Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) is an effective therapy of the neovascular form of this condition. Multimodal imaging and standardised electronic patient documentation have helped to improve the diagnosis and management of AMD patients recent years. With the advent of artificial intelligence and big data, there are many opportunities for the future. This article is intended to give an overview of possible applications.


Assuntos
Inteligência Artificial , Big Data , Neovascularização de Coroide , Degeneração Macular , Inibidores da Angiogênese , Humanos , Injeções Intravítreas , Degeneração Macular/terapia , Ranibizumab , Fator A de Crescimento do Endotélio Vascular
9.
Cesk Slov Oftalmol ; 75(3): 130-135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31779461

RESUMO

PURPOSE: To present pilot results of the project in which the primary goal is to optimize way how to increase the quality of life of patients with the stable maculopathy by implanting intraocular Scharioth macular lens (SML) and modulating visual plasticity by a transcranial electrical stimulation (tES) together with a visual rehabilitation. MATERIALS AND METHODS: The study will include 20 patients with stable maculopathy (mainly age-related macular degeneration - AMD) who underwent cataract surgery in past and are eligible for SML implantation. The duration of the project is 3 years. During the first year of the project 17 patients were screened, SML implantation was recommended to 4 of them. They met the indication criteria of SML implantation and SML was implanted into the better seeing eye. The third postoperative day, the tES sessions started and were applied 20 times in the first month after SML implantation. The stimulation was delivered in double blind design (a stimulated and a shame group). Visual exercises and rehabilitation took place during the tES. The patients were examined ophthalmologically and also using electrophysiological methods. RESULTS: Before the implantation, the best corrected distance visual acuity was 0.23. At near it was Jaeger number 15 uncorrected, with +3.0 sphere dioptres J.No.10.5 and with +6.0 sph dpt J.No. 4.5. After the surgery and visual rehabilitation BCVA was 0.13 after 3 weeks, 0.2 after 2 months and 0.14 after 6 months. At near it was uncorrected J.No.7.5 after 3 weeks, J.No.7 after 2 months and J.No.5 after 6 months. CONCLUSION: According to a few participants, the impact of SML implantation together with intensive visual rehabilitation on vision at near and on satisfaction of patients with AMD could not be significantly established. Nevertherless, these patients are limited in their daily activities and SML is one of the solutions for them. The project is ongoing and blinded still, there is also a need of more participants to assess the effect of tES on vision, the results will be presented. We have proven the safety of methods used in the project.


Assuntos
Terapia por Estimulação Elétrica , Lentes Intraoculares , Degeneração Macular , Facoemulsificação , Método Duplo-Cego , Humanos , Implante de Lente Intraocular , Degeneração Macular/terapia , Qualidade de Vida , Acuidade Visual
11.
Indian J Ophthalmol ; 67(9): 1502-1505, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31436216

RESUMO

We present a case of a 37-year-old gentleman with a rare diagnosis of Torpedo maculopathy (TM). We describe the multimodal imaging features of torpedo maculopathy using adaptive optics, visual fields, OCT and multifocal ERG, and understand the clinical and structural-functional correlation in TM. According to us, this is the first case report to describe the adaptive optics imaging findings in Torpedo maculopathy in English Medical literature.


Assuntos
Eletrorretinografia/métodos , Angiofluoresceinografia/métodos , Macula Lutea/patologia , Degeneração Macular/terapia , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Adulto , Fundo de Olho , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/fisiopatologia , Masculino , Óptica e Fotônica , Epitélio Pigmentado da Retina , Acuidade Visual
12.
Pol Merkur Lekarski ; 47(277): 35-39, 2019 Jul 29.
Artigo em Polonês | MEDLINE | ID: mdl-31385946

RESUMO

Age-related macular degeneration (AMD) is a progressively degenerative disease at the central area of the retina, which results in severe visual impairment. It is the leading cause of irreversible blindness among people aged over 65 in developed countries. Therapies that focus on prevention through optimization of modifiable risk factors such as diet and nutritional status are key approaches to reducing the burden of disease. An adequate diet, especially rich in antioxidant compounds, seems to play an important role in this case. Available scientific data suggest that vitamins A, E, C and carotenoids, in particular lutein and zeaxantine and some minerals, may play an important role in the prevention and / or delay of AMD. There are also new data on the importance of other ingredients such as flavonoids in the AMD development. In this work, based on the available data, the study reviews the relationship between the intake of selected antioxidant nutrients and age-related macular degeneration.


Assuntos
Antioxidantes , Degeneração Macular , Vitamina A , Vitaminas , Antioxidantes/uso terapêutico , Suplementos Nutricionais , Humanos , Degeneração Macular/terapia , Vitamina A/uso terapêutico , Vitaminas/uso terapêutico
13.
Int Ophthalmol ; 39(12): 2975-2983, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31313070

RESUMO

PURPOSE: To describe and evaluate the value of nutritional supplements in the management of age-related macular degeneration (AMD) through a review of the current literature. METHODS: An extensive literature search was performed, and key research articles exploring AREDS and AREDS-2 formulations, genetics, omega fatty acids, calcium and folic acid in high-risk women were reviewed. PubMed and Web of Science databases were used for generating articles to review. RESULTS: The AREDS and AREDS-2 trials, while difficult to validate, show support for antioxidant supplementation in reducing AMD progression in Caucasian populations. While genetic guided personalized medicine has been studied mainly with complement factor H and age-related maculopathy susceptibility 2 risk alleles, the data have not been reproducible. Women at a higher risk of cardiovascular disease may benefit from antioxidant therapies in preventing AMD. Omega 3 fatty acid supplementation has been widely supported through observational studies; however, randomized controlled trials have not shown benefit in disease progression. Calcium exposure has been linked to increased mechanisms in cell death and may be detrimental to older individuals with AMD. CONCLUSION: The data regarding nutritional supplements in preventing AMD progression are inconclusive, and therefore recommendations should be based on risk factors and demographic data.


Assuntos
Antioxidantes/uso terapêutico , Suplementos Nutricionais , Degeneração Macular/terapia , Vitaminas/uso terapêutico , Progressão da Doença , Humanos
14.
Nat Commun ; 10(1): 3347, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31350409

RESUMO

Age-related macular degeneration (AMD) is the most common cause of blindness among the elderly in the developed world. While treatment is effective for the neovascular or "wet" form of AMD, no therapy is successful for the non-neovascular or "dry" form. Here we discuss the current knowledge on dry AMD pathobiology and propose future research directions that would expedite the development of new treatments. In our view, these should emphasize system biology approaches that integrate omic, pharmacological, and clinical data into mathematical models that can predict disease onset and progression, identify biomarkers, establish disease causing mechanisms, and monitor response to therapy.


Assuntos
Degeneração Macular/terapia , Animais , Humanos , Degeneração Macular/imunologia , Degeneração Macular/metabolismo , Degeneração Macular/patologia , Estresse Oxidativo , Biologia de Sistemas
15.
Klin Monbl Augenheilkd ; 236(9): 1096-1102, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31212338

RESUMO

The growing incidence of neurodegenerative diseases is based on our increasingly aging society as well as the difficulties in establishing defined therapy regimens. For dry age-related macular degeneration (AMD) and the later stage of geographic atrophy (GA), various treatment options exist that only decelerate the progression of the disease. However, no therapy is currently available that can restore the degenerated retinal pigment epithelium (RPE) and/or photoreceptor cells. Cellular and gene-based approaches aim for the regeneration of the degenerated cells and/or the continuous secretion of cell-protecting agents. The article describes the approaches that are currently being investigated in different clinical trials. These trials are based on the use of cell-based drug delivery systems, stem cells of different origins as well as virus-mediated gene therapy approaches. Finally, we give an overview of ongoing therapeutic developments and present our own research activities, which consist of a combination of pigment epithelial cell transplantation and additive non-viral gene therapy to treat retinal degenerative diseases.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos , Terapia Genética , Atrofia Geográfica , Degeneração Macular , Atrofia Geográfica/terapia , Humanos , Degeneração Macular/terapia , Retina , Epitélio Pigmentado da Retina
16.
Drug Discov Today ; 24(8): 1685-1693, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31173914

RESUMO

Ocular gene therapy has entered into clinical practice. Although viral vectors are currently the best option to replace and/or correct genes, the optimal method to deliver these treatments to the retinal pigment epithelial (RPE) cells and/or photoreceptor cells remains to be improved to increase transduction efficacy and reduce iatrogenic risks. Beyond viral-mediated gene replacement therapies, nonviral gene delivery approaches offer the promise of sustained fine-tuned expression of secreted therapeutic proteins that can be adapted to the evolving stage of the disease course and can address more common nongenetic retinal diseases, such as age-related macular degeneration (AMD). Here, we review current gene therapy strategies for ocular diseases, with a focus on clinical stage products.


Assuntos
Vetores Genéticos/genética , Degeneração Macular/genética , Degeneração Macular/terapia , Animais , Olho/fisiopatologia , Terapia Genética/métodos , Humanos , Epitélio Pigmentado da Retina/fisiologia
18.
Nutrients ; 11(4)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30979051

RESUMO

: Eye care professionals should have access to high quality clinical practice guidelines that ideally are underpinned by evidence from robust systematic reviews of relevant research. The aim of this study was to identify clinical guidelines with recommendations pertaining to dietary modification and/or nutritional supplementation for age-related macular degeneration (AMD), and to evaluate the overall quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. We also mapped recommendations to existing systematic review evidence. A comprehensive search was undertaken using bibliographic databases and other electronic resources for eligible guidelines. Quality appraisal was undertaken to generate scores for each of the six AGREE II domains, and mapping of extracted nutritional recommendations was performed for systematic reviews published up to March 2017. We identified 13 national and international guidelines, developed or updated between 2004 and 2019. These varied substantially in quality. The lowest scoring AGREE II domains were for 'Rigour of Development', 'Applicability' (which measures implementation strategies to improve uptake of recommendations), and 'Editorial Independence'. Only four guidelines used evidence from systematic reviews to support their nutritional recommendations. In conclusion, there is significant scope for improving current Clinical Practice Guidelines for AMD, and guideline developers should use evidence from existing high quality systematic reviews to inform clinical recommendations.


Assuntos
Medicina Baseada em Evidências , Degeneração Macular/terapia , Guias de Prática Clínica como Assunto , Suplementos Nutricionais , Humanos , Degeneração Macular/dietoterapia , Degeneração Macular/prevenção & controle , Política Nutricional , Terapia Nutricional
19.
Tissue Eng Part A ; 25(9-10): 799-808, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30963803

RESUMO

IMPACT STATEMENT: In the promising field of cellular therapy for retinal degenerative diseases, a new biomaterial is proposed as a scaffold to grow and surgically introduce a monolayer of retinal pigment epithelial cells into the subretinal space, keeping the orientation of the cells for a proper functional integration of the transplant. The use of induced pluripotent stem cells as the starting material for retinal pigment epithelial cells is intended to advance toward a personalized medicine approach.


Assuntos
Células-Tronco Pluripotentes Induzidas/metabolismo , Degeneração Macular , Monócitos/metabolismo , Epitélio Pigmentado da Retina/metabolismo , Epitélio Pigmentado da Retina/transplante , Animais , Técnicas de Reprogramação Celular , Modelos Animais de Doenças , Células-Tronco Pluripotentes Induzidas/patologia , Degeneração Macular/metabolismo , Degeneração Macular/patologia , Degeneração Macular/terapia , Camundongos , Monócitos/patologia , Epitélio Pigmentado da Retina/patologia , Suínos
20.
Annu Rev Genomics Hum Genet ; 20: 201-216, 2019 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-31018110

RESUMO

Given the importance of visual information to many daily activities, retinal degenerative diseases-which include both inherited conditions (such as retinitis pigmentosa) and acquired conditions (such as age-related macular degeneration)-can have a dramatic impact on human lives. The therapeutic options for these diseases remain limited. Since the discovery of the first causal gene for retinitis pigmentosa almost three decades ago, more than 250 genes have been identified, and gene therapies have been rapidly developed. Simultaneously, stem cell technologies such as induced pluripotent stem cell-based transplantation have advanced and have been applied to the treatment of retinal degenerative diseases. Here, we review recent progress in these expanding fields and discuss the potential for precision medicine in ophthalmic care.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos/métodos , Proteínas do Olho/genética , Terapia Genética/métodos , Degeneração Macular/terapia , Retinite Pigmentosa/terapia , Transplante de Células-Tronco/métodos , Ensaios Clínicos como Assunto , Proteínas do Olho/metabolismo , Edição de Genes/métodos , Expressão Gênica , Predisposição Genética para Doença , Humanos , Células-Tronco Pluripotentes Induzidas/citologia , Células-Tronco Pluripotentes Induzidas/metabolismo , Células-Tronco Pluripotentes Induzidas/transplante , Degeneração Macular/genética , Degeneração Macular/metabolismo , Degeneração Macular/patologia , Mutação , Optogenética/métodos , Medicina de Precisão/métodos , Epitélio Pigmentado da Retina/metabolismo , Epitélio Pigmentado da Retina/patologia , Epitélio Pigmentado da Retina/transplante , Retinite Pigmentosa/genética , Retinite Pigmentosa/metabolismo , Retinite Pigmentosa/patologia
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