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Husum YS, Bråten RH, Sæther EM, Moe MC, Kristiansen IS, Jørstad ØK. Intravitreal anti-vascular endothelial growth factor therapy for retinal diseases in Norway from 2011 to 2021: A combined registry and survey study. Acta Ophthalmol 2024; 102:544-554. [PMID: 38071435 DOI: 10.1111/aos.16598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 07/09/2024]
Abstract
PURPOSE To investigate the use of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in Norway from 2011 to 2021 and explore how the eye departments organized their injection services. METHODS We combined data from the Norwegian Patient Registry (NPR) with survey responses from Norway's 22 eye departments. The NPR data encompassed all registered intravitreal injection episodes from 2011 to 2021. The survey contained questions about local treatment practices and emphasized neovascular age-related macular degeneration (nAMD), retinal vein occlusion and diabetic macular edema. RESULTS A total of 47247 unique patients received 841 646 intravitreal injections in the study period. The number of patients per year increased from 6522 in 2011 to 20 635 in 2021. The number of injections per year increased from 30 926 in 2011 to 125 258 in 2021. The most frequent diagnosis was nAMD. In 2021, the age-adjusted treatment activity in Norway's 11 counties ranged from 47.8 to 75.5 injections per 1000 inhabitants aged ≥50 years. The use of aflibercept gradually exceeded bevacizumab, but the aflibercept proportion per county ranged from 38 to 82% in 2021. The survey revealed varying treatment practices, local guidelines were often absent, and only half of the departments defined a lower visual limit for initiating or maintaining treatment. CONCLUSION The use of intravitreal anti-VEGF therapy increased considerably from 2011 to 2021, but there was considerable regional variation in treatment activity, drug utilization and organization of injection services. These findings emphasize the need for strengthened governance and national guidelines to ensure equal treatment nationally.
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Affiliation(s)
- Yngvil Solheim Husum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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2
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Tuulonen A, Leinonen S, Jóhannesson G. Missed Opportunities in Screening for Glaucoma. J Glaucoma 2024; 33:S54-S59. [PMID: 38573956 DOI: 10.1097/ijg.0000000000002389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To create a holistic and realistic view regarding current knowledge, understanding, and challenges of screening in general and in glaucoma. METHODS/RESULTS Based upon available literature, all systems suffer from the same challenges: huge variability of care practices (despite guidelines), simultaneous under care and over care, as well as the unsustainable increase of costs. While the magnitude of these challenges differs immoderately between well-off and developing countries, the Western world has already demonstrated that simply doing more than what we currently do is not the solution. System outcomes also matter in screening, that is, its benefits should outweigh any harms (over-care, false positives/negatives, uncertain findings, etc.) and be cost-effective. However, even when the evidence does not support screening (as is currently the case in glaucoma), it may feel justified as "at least we are doing something." Strong commercial interests, lobbying and politics star as well and will influence the control arm even in high-quality randomized screening trials (RCT). CONCLUSIONS As resources will never be sufficient for all health care activities that providers wish to deliver and what people wish to receive, we need to ask big questions and adopt a public health perspective in glaucoma and eye care. How can we create and maintain a sustainable balance between finding and treating underserved high-risk patients without burdening the broader patient population and societies with over-diagnostics and treatments? Considering numerous biases related to screening, including the variability in care practices, a high-quality RCT for the screening of glaucoma would be very challenging to organize and evaluate its universal usefulness.
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Affiliation(s)
- Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Sanna Leinonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine, Tampere University, Tampere, Finland
| | - Gauti Jóhannesson
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
- Department of Ophthalmology, University of Iceland, Iceland
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3
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Hecht I, Kanclerz P, Achiron A, Elbaz U, Tuuminen R. The Effect of Blue-Light Filtering Intraocular Lenses on the Development and Progression of Glaucoma. J Glaucoma 2023; 32:451-457. [PMID: 37054398 DOI: 10.1097/ijg.0000000000002220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 03/09/2023] [Indexed: 04/15/2023]
Abstract
PRCIS Among patients who underwent uneventful cataract surgery, an advantage was seen to blue-light filtering (BLF) intraocular lenses (IOLs) in terms of glaucoma-free survival and glaucoma procedure-free survival. Among patients with preexisting glaucoma, no advantage was seen. PURPOSE To assess the effect of BLF IOLs on the development and progression of glaucoma after cataract surgery. PATIENTS AND METHODS A retrospective cohort study of patients who underwent uneventful cataract surgery between 2007 and 2018 at Kymenlaakso Central Hospital, Finland. Survival analyses for the overall risk of developing glaucoma or undergoing glaucoma procedures were assessed between patients who received a BLF IOL (SN60WF) and a non-BLF IOL (ZA9003 and ZCB00). A separate analysis was performed on patients with preexisting glaucoma. RESULTS Included 11,028 eyes of 11,028 patients with a mean age of 75 ± 9 years (62% females). The BLF IOL was used in 5188 eyes (47%) and the non-BLF IOL in 5840 eyes (53%). During the follow-up (mean: 55 ± 34 mo), 316 cases of glaucoma were diagnosed. Glaucoma-free survival rates showed an advantage to the BLF IOL ( P = 0.036). In a Cox regression analysis controlling for age and sex the use of a BLF IOL was again associated with a lower ratio of glaucoma development (hazard ratio:0.778; 95% CI: 0.621-0.975). Furthermore, glaucoma procedure-free survival analysis revealed an advantage to the BLF IOL (hazard ratio:0.616; 95% CI: 0.406-0.935). Among 662 cases, which already had glaucoma at the time of surgery, no significant differences were seen in any outcome. CONCLUSIONS Among a large cohort of patients who underwent cataract surgery, the use of BLF IOLs was associated with favorable glaucoma outcomes compared with the use of non-BLF IOLs. Among patients with preexisting glaucoma, no significant advantage was seen.
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Affiliation(s)
- Idan Hecht
- Helsinki Retina Research Group, University of Helsinki, Helsinki
- Sackler School of Medicine, Tel Aviv University
- Department of Ophthalmology, Shamir Medical Center
| | - Piotr Kanclerz
- Helsinki Retina Research Group, University of Helsinki, Helsinki
- Hygeia Clinic, Gdańsk, Poland
| | - Asaf Achiron
- Sackler School of Medicine, Tel Aviv University
- Tel Aviv Sourasky Medical Center, Tel Aviv
| | - Uri Elbaz
- Sackler School of Medicine, Tel Aviv University
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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4
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Tuulonen A, Kataja M, Aaltonen V, Kinnunen K, Moilanen J, Saarela V, Linna M, Malmivaara A, Uusitalo‐Jarvinen H. A comprehensive model for measuring real-life cost-effectiveness in eyecare: automation in care and evaluation of system (aces-rwm™). Acta Ophthalmol 2022; 100:e833-e840. [PMID: 34263537 DOI: 10.1111/aos.14959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/23/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
This paper describes a holistic, yet simple and comprehensible, ecosystem model to deal with multiple and complex challenges in eyecare. It aims at producing the best possible wellbeing and eyesight with the available resources. When targeting to improve the real-world cost-effectiveness, what gets done in everyday practice needs be measured routinely, efficiently and unselectively. Collection of all real-world data of all patients will enable evaluation and comparison of eyecare systems and departments between themselves nationally and internationally. The concept advocates a strategy to optimize real-life effectiveness, sustainability and outcomes of the service delivery in ophthalmology. The model consists of three components: (1) resource-governing principles (i.e., to deal with increasing demand and limited resources), (2) real-world monitoring (i.e., to collect structured real-world data utilizing automation and visualization of clinical parameters, health-related quality of life and costs), and (3) digital innovation strategy (i.e., to evaluate and benchmark real-world outcomes and cost-effectiveness). The core value and strength of the model lies in the consensus and collaboration of all Finnish university eye clinics to collect and evaluate the uniformly structured real-world outcomes data. In addition to ophthalmology, the approach is adaptable to any medical discipline to efficiently generate real-world insights and resilience in health systems.
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Affiliation(s)
- Anja Tuulonen
- Tays Eye Centre Tampere University Hospital Tampere Finland
| | - Marko Kataja
- Tays Eye Centre Tampere University Hospital Tampere Finland
| | - Vesa Aaltonen
- Department of Ophthalmology Turku University Hospital Turku Finland
| | - Kati Kinnunen
- Department of Ophthalmology Kuopio University Hospital Kuopio Finland
| | - Jukka Moilanen
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Ville Saarela
- Department of Ophthalmology and Medical Research Center Oulu University Hospital Oulu Finland
- PEDEGO Research Unit University of Oulu Oulu Finland
| | - Miika Linna
- Institute of Healthcare Engineering, Management and Architecture (HEMA) Aalto University School of Science Helsinki Finland
- University of Eastern Finland Kuopio Finland
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5
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Jørstad ØK, Kongsrud A, Kinge B, Fossen K, Basit S, Forsaa VA, Moe MC, Haugen OH. Choosing Wisely: recommendations from the Norwegian Ophthalmological Society. Acta Ophthalmol 2021; 100:716. [PMID: 34904382 DOI: 10.1111/aos.15080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Anne Kongsrud
- Department of Ophthalmology Drammen Hospital Drammen Norway
| | | | - Kristian Fossen
- Department of Ophthalmology University Hospital of North Norway Tromsø Norway
| | - Sammy Basit
- Visus Ophthalmologist Centre Trondheim Norway
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Karvonen E, Stoor K, Luodonpää M, Hägg P, Leiviskä I, Liinamaa J, Tuulonen A, Saarela V. Combined structure-function analysis in glaucoma screening. Br J Ophthalmol 2021; 106:1689-1695. [PMID: 34230023 DOI: 10.1136/bjophthalmol-2021-319178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/11/2021] [Indexed: 11/03/2022]
Abstract
AIM To assess the applicability of a structure-function (S-F) analysis combining spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP) in glaucoma screening in a middle-aged population. METHODS A randomised sample of 3001 Caucasian participants aged 45-49 years of the Northern Finland Birth Cohort Eye Study was examined. We performed an eye examination, including 24-2 SAP, optic nerve head (ONH) and retinal nerve fibre layer (RNFL) photography and SD-OCT of the peripapillary RNFL. The S-F report was generated by Forum Glaucoma Workplace software. OCT, SAP and the S-F analysis were evaluated against clinical glaucoma diagnosis, that is, the positive '2 out of 3' rule based on the clinician's evaluation of ONH and RNFL photographs and visual fields (VFs). RESULTS At a specificity of 97.5%, the sensitivity for glaucomatous damage was 26% for abnormal OCT, 35% for SAP and 44% for S-F analysis. Estimated areas under the curve were 0.74, 0.85 and 0.76, and the corresponding positive predictive values were 8 %, 10% and 12%, respectively. By applying a classification tree approach combining OCT, SAP and defect localisation data, a sensitivity of 77% was achieved at 90% specificity. In a localisation analysis of glaucomatous structural and functional defects, the correlation with glaucoma increased significantly if the abnormal VF test points were located on borderline or abnormal OCT zones. CONCLUSION SAP performs slightly better than OCT in glaucoma screening of middle-aged population. However, the diagnostic capability can be improved by S-F analysis.
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Affiliation(s)
- Elina Karvonen
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland .,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland.,Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katri Stoor
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Marja Luodonpää
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Pasi Hägg
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Ilmari Leiviskä
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Ville Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
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7
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Autophagy Genes for Wet Age-Related Macular Degeneration in a Finnish Case-Control Study. Genes (Basel) 2020; 11:genes11111318. [PMID: 33172148 PMCID: PMC7694766 DOI: 10.3390/genes11111318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/29/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Age-related macular degeneration is an eye disease that is the main cause of legal blindness in the elderly in developed countries. Despite this, its pathogenesis is not completely known, and many genetic, epigenetic, environmental and lifestyle factors may be involved. Vision loss in age-related macular degeneration (AMD) is usually consequence of the occurrence of its wet (neovascular) form that is targeted in the clinic by anti-VEGF (vascular endothelial growth factor) treatment. The wet form of AMD is associated with the accumulation of cellular waste in the retinal pigment epithelium, which is removed by autophagy and the proteosomal degradation system. In the present work, we searched for the association between genotypes and alleles of single nucleotide polymorphisms (SNPs) of autophagy-related genes and wet AMD occurrence in a cohort of Finnish patients undergoing anti-VEGF therapy and controls. Additionally, the correlation between treatment efficacy and genotypes was investigated. Overall, 225 wet AMD patients and 161 controls were enrolled in this study. Ten SNPs (rs2295080, rs11121704, rs1057079, rs1064261, rs573775, rs11246867, rs3088051, rs10902469, rs73105013, rs10277) in the mTOR (Mechanistic Target of Rapamycin), ATG5 (Autophagy Related 5), ULK1 (Unc-51-Like Autophagy Activating Kinase 1), MAP1LC3A (Microtubule Associated Protein 1 Light Chain 3 α), SQSTM1 (Sequestosome 1) were analyzed with RT-PCR-based genotyping. The genotype/alleles rs2295080-G, rs11121704-C, rs1057079-C and rs73105013-T associated with an increased, whereas rs2295080-TT, rs2295080-T, rs11121704-TT, rs1057079-TT, rs1057079-T, rs573775-AA and rs73105013-C with a decreased occurrence of wet AMD. In addition, the rs2295080-GG, rs2295080-GT, rs1057079-TT, rs11246867-AG, rs3088051-CC and rs10277-CC genotypes were a positively correlated cumulative number of anti-VEGF injections in 2 years. Therefore, variability in autophagy genes may have an impact on the risk of wet AMD occurrence and the efficacy of anti-VEGF treatment.
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Karesvuo P, Hakkala L, Kaarniranta K, Uusitalo H, Ojamo M, Tuuminen R. Correlation between the rate of intravitreal injections, use of aflibercept as a second-line treatment and visual impairment for wet AMD in Finland. Acta Ophthalmol 2020; 98:472-476. [PMID: 32096347 DOI: 10.1111/aos.14376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/25/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To correlate the rate of intravitreal anti-VEGF injections and the use of aflibercept as a second-line treatment with visual impairment throughout Finland. METHODS Information related to anti-VEGF treatment, proportions of bevacizumab and aflibercept and new visual impairments due to wet age-related macular degeneration (AMD) was gathered from 5 university hospitals and 14 central hospital districts between 2015 and 2017 covering 232 568 injections and 1172 visual impairments. RESULTS Between 2015 and 2017, the number of annual total anti-VEGF injections increased from 60 412 to 93 589 (+24.5% annual change) and of aflibercept injections from 8299 to 20 833 (+58.7% annual change). The 3-year average for total anti-VEGF injections ranged from 9.6 to 21.1 (median 13.3) per 1000 citizens between hospital districts and for aflibercept injections from 0.8 to 4.0 (median 1.9). According to the primary protocol for wet AMD, during 2015-2017, the number of total anti-VEGF injections increased from 10.9 to 15.2 per 1000 citizens with the pro re nata (PRN) protocol and from 11.3 to 18.9 with the treat-and-extend regimen (TER). The 3-year average of aflibercept injections as a second-line treatment, but not the total number of anti-VEGF or bevacizumab injections, inversely correlated with new onset visual impairments (R = -0.505, P = 0.027) in the hospital districts. The number of visual impairments did not differ between the hospital districts according to the PRN and TER protocols (1.23 ± 0.41 and 1.14 ± 0.67, respectively, per 1000 citizens aged ≥64 years, P = 0.713). CONCLUSION These results emphasize that the use of aflibercept injections as a second-line treatment may decrease new onset visual impairments.
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Affiliation(s)
- Petteri Karesvuo
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Laura Hakkala
- Department of Ophthalmology, Turunmaa Regional Hospital, Turku, Finland
| | - Kai Kaarniranta
- Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Ophthalmology, University Hospital, Kuopio, Finland
| | - Hannu Uusitalo
- SILK, Department of Ophthalmology, Tampere University and Tays Eye Center, Tampere, Finland.,The Finnish Register of Visual Impairment, Helsinki, Finland.,The National Institute for Health and Welfare, Helsinki, Finland
| | - Matti Ojamo
- The Finnish Register of Visual Impairment, Helsinki, Finland.,The National Institute for Health and Welfare, Helsinki, Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Kymenlaakso Central Hospital, Eye Centre, Kotka, Finland
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Bro T, Derebecka M, Jørstad ØK, Grzybowski A. Off-label use of bevacizumab for wet age-related macular degeneration in Europe. Graefes Arch Clin Exp Ophthalmol 2019; 258:503-511. [PMID: 31889214 DOI: 10.1007/s00417-019-04569-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/27/2019] [Accepted: 12/12/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To analyse current off-label use of bevacizumab for wet age-related macular degeneration (AMD) in Europe. METHODS The study was conducted as a combined survey and literature review. It included the 22 most populous countries in Europe. In each country, ophthalmologists with particular knowledge about off-label treatment responded to a questionnaire. RESULTS Answers were obtained from twenty European countries. The off-label use of bevacizumab for wet AMD greatly differed between nations; the bevacizumab proportion varied from non-existent (0%) to very high (97%). There were also large disparities within single countries (e.g. 0-80%), which were attributable to differences in regional decision-making. Both governmental institutions and national ophthalmological societies expressed highly diverging opinions on the use of off-label treatment. Intravitreal administration of bevacizumab had been a matter of legal dispute in several countries. The question about responsibility for off-label therapy mainly remained unanswered. CONCLUSIONS There was a highly varying utilization of bevacizumab between European countries. Despite an intention of a consistent approach to medical regulations, Europe has not yet reached a professional or political consensus on the ophthalmic off-label use of bevacizumab.
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Affiliation(s)
- Tomas Bro
- Futurum, the Academy for Health and Care in Region Jönköping, Jönköping, Sweden. .,Ögonmottagningen, Höglandssjukhuset, 575 81, Eksjö, Sweden.
| | | | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Andrzej Grzybowski
- University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
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10
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Blasiak J, Watala C, Tuuminen R, Kivinen N, Koskela A, Uusitalo-Järvinen H, Tuulonen A, Winiarczyk M, Mackiewicz J, Zmorzyński S, Filip A, Kaarniranta K. Expression of VEGFA-regulating miRNAs and mortality in wet AMD. J Cell Mol Med 2019; 23:8464-8471. [PMID: 31633290 PMCID: PMC6850949 DOI: 10.1111/jcmm.14731] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/12/2019] [Accepted: 09/23/2019] [Indexed: 12/31/2022] Open
Abstract
MicroRNAs (miRNAs) regulate gene expression; many of them act in the retinal pigment epithelium (RPE), and RPE degeneration is known to be a critical factor in age‐related macular degeneration (AMD). Repeated injections with anti‐VEGFA (vascular endothelial growth factor A) are the only effective therapy in wet AMD. We investigated the correlation between the expression of 18 miRNAs involved in the regulation of the VEGFA gene in serum of 76 wet AMD patients and 70 controls. Efficacy of anti‐VEGFA treatment was evaluated by counting the number of injections delivered up to 12 years. In addition, we compared the relative numbers of deaths in patient with AMD and control groups. We observed a decreased expression of miR‐34‐5p, miR‐126‐3p, miR‐145‐5p and miR‐205‐5p in wet AMD patients as compared with controls. These miRNAs are involved in the regulation of angiogenesis, cytoprotection and protein clearance. No miRNA was significantly correlated with the treatment outcome. Wet AMD patients had greater mortality than controls, and their survival was inversely associated with the number of anti‐VEGFA injections per year. No association was observed between miRNA expression and mortality. Our study emphasizes the need to clarify the role of miRNA regulation in AMD pathogenesis.
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Affiliation(s)
- Janusz Blasiak
- Department of Molecular Genetics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Cezary Watala
- Department of Haemostatic Disorders, Medical University, Lodz, Poland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
| | - Niko Kivinen
- Department of Ophthalmology, University of Eastern Finland, Kuopio, Finland
| | - Ali Koskela
- Department of Ophthalmology, University of Eastern Finland, Kuopio, Finland
| | | | - Anja Tuulonen
- Department of Ophthalmology, Tampere University Hospital, Tampere, Finland
| | - Mateusz Winiarczyk
- Department of Vitreoretinal Surgery, Medical University of Lublin, Lublin, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, Lublin, Poland
| | - Szymon Zmorzyński
- Department of Cancer Genetics, Medical University of Lublin, Lublin, Poland
| | - Agata Filip
- Department of Cancer Genetics, Medical University of Lublin, Lublin, Poland
| | - Kai Kaarniranta
- Department of Ophthalmology, University of Eastern Finland, Kuopio, Finland.,Department of Ophthalmology, Kuopio University Hospital, Kuopio, Finland
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11
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Hujanen P, Tuulonen A, Uusitalo‐Järvinen H. Real-world efficacy and safety of dividing aflibercept into three syringes in the treatment of wet age-related macular degeneration. Acta Ophthalmol 2019; 97:e812-e813. [PMID: 30762298 DOI: 10.1111/aos.14051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Pekko Hujanen
- Tays Eye Centre Tampere University Hospital Tampere Finland
| | - Anja Tuulonen
- Tays Eye Centre Tampere University Hospital Tampere Finland
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