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Lin Z, Li D, Lin W, Wen L, Wang Y, Lin Z. THE IMPACT OF BILATERAL VISION STATUS ON VISION-RELATED QUALITY OF LIFE IN PEOPLE WITH DIABETES MELLITUS. Retina 2024; 44:1021-1025. [PMID: 38194676 DOI: 10.1097/iae.0000000000004047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
PURPOSE To assess the impact of bilateral vision status on vision-related quality of life (VR-QOL) in patients with Type 2 diabetes in a Chinese cohort. METHODS Patients with presenting visual acuity (PVA) and VR-QOL data from the Fushun Diabetic Retinopathy Cohort Study were included. Vision-related quality of life was assessed using the National Eye Institute Visual Function Questionnaire-25. Monocular PVA (Snellen) was categorized into three levels for both the better-seeing eye and worse-seeing eye: 1) high PVA (H, > 6/18); 2) moderate PVA (M, 6/18-6/60); and 3) low PVA (L, < 6/60). Based on the monocular PVAs, six categories of bilateral vision status were defined (H-H, H-M, H-L, M-M, M-L, and L-L). The parameters of VR-QOL were analyzed between the groups. RESULTS A total of 1,717 patients were enrolled. For better-seeing eyes in the same PVA level, the Visual Function Questionnaire-25 composite score decreased significantly with declining PVA in the worse-seeing eye (H-M vs. H-L: 80.5 ± 17.9 vs. 73.6 ± 22.5, P = 0.01; M-M vs. M-L: 78.7 ± 19.6 vs. 69.1 ± 26.4, P = 0.01). Conversely, for worse-seeing eyes in the same PVA level, there was no significant difference in the Visual Function Questionnaire-25 composite score as PVA changed in the better-seeing eye (H-M vs. M-M, 80.5 ± 17.9 vs. 78.7 ± 19.6, P = 0.30; H-L vs. M-L: 73.6 ± 22.5 vs. 69.1 ± 26.4, P = 0.25). CONCLUSION The PVA of the worse-seeing eye in bilateral vision has a greater impact on VR-QOL in diabetic patients. Priority treatment may be considered for the worse-seeing eye for diabetic patients with different bilateral vision statuses, to better improve VR-QOL.
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Affiliation(s)
- Zushun Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China ; and
| | - Dong Li
- Fushun Eye Hospital, Fushun, Liaoning, China
| | - Wei Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China ; and
| | - Liang Wen
- Fushun Eye Hospital, Fushun, Liaoning, China
| | - Yu Wang
- Fushun Eye Hospital, Fushun, Liaoning, China
| | - Zhong Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China ; and
- Fushun Eye Hospital, Fushun, Liaoning, China
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Vujosevic S, Chew E, Labriola L, Sivaprasad S, Lamoureux E. Measuring Quality of Life in Diabetic Retinal Disease: A Narrative Review of Available Patient-Reported Outcome Measures. OPHTHALMOLOGY SCIENCE 2024; 4:100378. [PMID: 37868790 PMCID: PMC10585645 DOI: 10.1016/j.xops.2023.100378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 10/24/2023]
Abstract
Topic Several patient-reported outcome measures (PROMs) are available to measure health-related quality of life (HRQoL) in patients with late-stage clinical diabetic retinal diseases (DRDs). However, an understanding of the psychometric properties of PROMs is needed to assess how they could relate to severity levels of a revised DRD grading system. This narrative review assessed the available generic-, vision-, and DRD-related PROMs used in DRD research and highlights areas for improvement. Clinical Relevance Diabetic retinal disease is a common complication of diabetes and can lead to sight-threatening complications with a devastating effect on HRQoL. Methods The Quality of Life working group is one of 6 working groups organized for the DRD Staging System Update Effort, a project of the Juvenile Diabetes Research Foundation Mary Tyler Moore Vision Initiative. PubMed, Cochrane Library, Embase, and Google Scholar databases were searched using core keywords to retrieve ophthalmology-related review articles, randomized clinical trials, and prospective, observational, and cross-sectional studies in the English language. A detailed review of 12 PROMs (4 QoL questionnaires and 8 utilities) that met a minimum level of evidence (LOE) was conducted. The relevance of each PROM to DRD disease stage and Biomarker Qualification guidelines (Biomarkers, EndpointS, and other Tools) categories was also defined. Results The National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25), Impact of vision impairment-computerized adaptive testing, and Diabetic Retinopathy and Macular Edema Computerized Adaptive Testing System had a LOE of II in detecting change due to late-stage DRD (diabetic macular edema), although several areas for improvement (e.g., psychometrics and generalizability) were identified. Other PROMs, particularly the utilities, had a LOE of III due to cross-sectional evidence in late-stage clinical DRD. Although the NEI VFQ-25 has been the most widely used PROM in late-stage DRD, more work is required to improve its multidimensional structure and other psychometric limitations. No PROM was deemed relevant for subclinical or early/mid-DRD. Conclusion This narrative review found that the most commonly used PROM is NEI VFQ-25, but none meets the ideal psychometric, responsiveness, and clinical setting digital administration requirements that could be included in an updated DRD staging system for diagnosis and monitoring of DRD progression. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Emily Chew
- Division of Epidemiology and Clinical Applications, Clinical Trials Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Leanne Labriola
- Ophthalmology Department, Carle Foundation Hospital, Urbana, Illinois
- Surgery Department, University of Illinois College of Medicine, Urbana, Illinois
| | - Sobha Sivaprasad
- Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
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Alsaloum P, Russell MW, Blaga V, Kuo BL, Wu AK, Liu BJ, Valentim CCS, Xu CM, Muste JC, Kumar M, Singh RP. Time to fellow eye involvement in patients with unilateral diabetic macular oedema. Eye (Lond) 2023; 37:2761-2767. [PMID: 36732545 PMCID: PMC10482824 DOI: 10.1038/s41433-023-02410-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To examine the time to onset of disease in the fellow eye of patients with unilateral DMO in routine clinical practice and to identify risk factors for development of bilateral DMO. DESIGN Retrospective cohort study. PARTICIPANTS One hundred forty treatment-naive patients 18 years or older with unilateral DMO presenting to Cole Eye Institute between January 2012 and July 2021. METHODS Records of patients with unilateral DMO were reviewed for development of DMO in the fellow eye. Demographic, diabetic, ocular, and systemic characteristics were collected at initial DMO diagnosis date. Bivariate and multivariate analyses were performed and significant factors were modelled using Kaplan-Meier curves. RESULTS Fifty patients with conversion to bilateral DMO and 90 patients without conversion were identified. Average time to bilateral DMO was 15.0 ± 15.7 months. 64% of patients converted within 1 year and 90% converted within 3 years. HbA1c (p = 0.003), diabetic retinopathy duration (p = 0.029), and diabetic foot disease (DFD) (p = 0.002) were identified as significant risk factors for conversion. Patients with better visual acuity at time of initial diagnosis and history of panretinal photocoagulation (PRP) (p = 0.044) or focal laser (p = 0.035) in the primary eye were also more likely to convert. CONCLUSIONS Participants were most likely to develop fellow eye DMO within the first year after initial DMO diagnosis. In routine clinical practice, poor glycaemic control and DFD were risk factors associated with bilateral eye involvement. Clinicians may consider screening the fellow eye of high-risk individuals at each appointment within the first year of diagnosis.
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Affiliation(s)
- Peter Alsaloum
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Matthew W Russell
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Victoria Blaga
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Blanche L Kuo
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Anna K Wu
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Brian J Liu
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Carolina C S Valentim
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Colin M Xu
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Justin C Muste
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Madhukar Kumar
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Rishi P Singh
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Srisubat A, Kittrongsiri K, Sangroongruangsri S, Khemvaranan C, Shreibati JB, Ching J, Hernandez J, Tiwari R, Hersch F, Liu Y, Hanutsaha P, Ruamviboonsuk V, Turongkaravee S, Raman R, Ruamviboonsuk P. Cost-Utility Analysis of Deep Learning and Trained Human Graders for Diabetic Retinopathy Screening in a Nationwide Program. Ophthalmol Ther 2023; 12:1339-1357. [PMID: 36841895 PMCID: PMC10011252 DOI: 10.1007/s40123-023-00688-y] [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: 12/30/2022] [Accepted: 02/10/2023] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION Deep learning (DL) for screening diabetic retinopathy (DR) has the potential to address limited healthcare resources by enabling expanded access to healthcare. However, there is still limited health economic evaluation, particularly in low- and middle-income countries, on this subject to aid decision-making for DL adoption. METHODS In the context of a middle-income country (MIC), using Thailand as a model, we constructed a decision tree-Markov hybrid model to estimate lifetime costs and outcomes of Thailand's national DR screening program via DL and trained human graders (HG). We calculated the incremental cost-effectiveness ratio (ICER) between the two strategies. Sensitivity analyses were performed to probe the influence of modeling parameters. RESULTS From a societal perspective, screening with DL was associated with a reduction in costs of ~ US$ 2.70, similar quality-adjusted life-years (QALY) of + 0.0043, and an incremental net monetary benefit of ~ US$ 24.10 in the base case. In sensitivity analysis, DL remained cost-effective even with a price increase from US$ 1.00 to US$ 4.00 per patient at a Thai willingness-to-pay threshold of ~ US$ 4.997 per QALY gained. When further incorporating recent findings suggesting improved compliance to treatment referral with DL, our analysis models effectiveness benefits of ~ US$ 20 to US$ 50 depending on compliance. CONCLUSION DR screening using DL in an MIC using Thailand as a model may result in societal cost-savings and similar health outcomes compared with HG. This study may provide an economic rationale to expand DL-based DR screening in MICs as an alternative solution for limited availability of skilled human resources for primary screening, particularly in MICs with similar prevalence of diabetes and low compliance to referrals for treatment.
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Affiliation(s)
- Attasit Srisubat
- Department of Medical Services, Ministry of Public Health, Nonthaburi, Thailand
| | - Kankamon Kittrongsiri
- Social, Economic and Administrative Pharmacy (SEAP) Graduate Program, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sermsiri Sangroongruangsri
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
| | - Chalida Khemvaranan
- Department of Research and Technology Assessment, Lerdsin Hospital, Bangkok, Thailand
| | | | | | | | | | | | - Yun Liu
- Google LLC, Mountain View, CA, USA
| | - Prut Hanutsaha
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Saowalak Turongkaravee
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Rajiv Raman
- Sri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand.
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INCIDENCE OF NEW DIABETIC MACULAR EDEMA IN FELLOW EYES OF PATIENTS IN THE VISTA AND VIVID STUDIES. Retina 2023; 43:254-262. [PMID: 36265076 DOI: 10.1097/iae.0000000000003658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To characterize diabetic macular edema (DME) incidence in fellow eyes of patients treated for DME in the study eye. METHODS This post hoc analysis of VISTA/VIVID data evaluated fellow eyes without DME at baseline through Week 100. Diabetic macular edema presence in the fellow eye was inferred by investigator-reported DME adverse events and use of DME treatments. RESULTS Over 100 weeks, 44.9%, 44.2%, and 42.9% of fellow eyes developed DME in the intravitreal aflibercept injection 2 mg every 4 weeks (n = 245), intravitreal aflibercept injection 2 mg every 8 weeks (n = 258), and laser control (n = 252) groups, respectively. Mean time to DME development in combined treatment groups was ∼6 months. Multivariable regression analysis confirmed patients with shorter diabetes duration (hazard ratio per 10-year decrease, 1.16; 95% confidence interval, 1.03-1.30; P = 0.0160) and thicker baseline study eye central subfield thickness (hazard ratio per 10- µ m increase, 1.01; 95% confidence interval, 1.01-1.02; P = 0.0002) were at higher risk of developing DME in the fellow eye. CONCLUSION Among patients with DME in one eye at baseline, almost half developed DME in the fellow eye over 2 years. Shorter duration of diabetes and thicker study eye central subfield thickness were predictors of DME development in the fellow eye.
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Statement of the German Ophthalmological Society, the German Retina Society, and the Professional Association of Ophthalmologists in Germany on treatment of diabetic macular edema : Dated August 2019. Ophthalmologe 2021; 118:40-67. [PMID: 33033871 DOI: 10.1007/s00347-020-01244-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Liao KM, Wu WC, Jang Y, Su FY, Tsai LT. Impacts of monocular, binocular, and functional visual acuity on vision-related quality of life in patients with type 2 diabetes. Sci Rep 2021; 11:298. [PMID: 33431910 PMCID: PMC7801718 DOI: 10.1038/s41598-020-79483-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022] Open
Abstract
Although the association between visual acuity (VA) and vision-related quality of life (VRQoL) has been well reported in patients with type 2 diabetes mellitus (T2DM), little is known about how unilateral and bilateral VA affects daily performance in such patients. For this cross-sectional study, patients were recruited from the Diabetes Shared Care Network of the Division of Endocrinology and Metabolism, Zhong-Xiao Branch, Taipei City Hospital in Taiwan. Ninety patients with T2DM (51 men and 39 women) with a mean age of 60.3 ± 10.5 (standard deviation) years, 47% of whom had diabetic retinopathy, were included. The purposes were to compare the impacts of VA in the better eye, both eyes, and three forms of functional acuity scores (FAS) on VRQoL in patients with T2DM. VRQoL and corrected VA were assessed with the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Early Treatment Diabetic Retinopathy Study (ETDRS) chart, respectively. Three FAS algorithms proposed by Colenbrander and the American Medical Association were used to assess FAS. Regression analyses were performed to determine the correlations among the five types of VA, the original composite scores, and the Rasch-calibrated composite scores of the NEI VFQ-25 on all patients with T2DM and on the same patients stratified by diabetic retinopathy (DR) and no-DR. The VA of both eyes had a higher impact on VRQoL and revealed a lower reduction estimated by the two forms of composite scores than did the VA of the better eye and three FAS algorithms (compared with binocular VA β estimates, − 14.5%, − 15.8%, − 29.3%, and − 11.8% for original composite scores, and − 16.1%, − 14.0%, − 24.6%, and 10.3% for Rasch-calibrated composite scores). When the T2DM group was stratified into DR and no-DR groups, significant associations between VA and VRQoL were observed only in the DR group. The VA of both eyes also had the greatest impact and reduction after stratification. The results indicated that unilateral better-eye VA and VA estimated by the three FAS algorithms seems to underestimate the impact of visual impairment on self-report VRQoL in patients with T2DM. This study provides empirical support for the importance of binocular VA assessment in regular clinical diabetes eye care.
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Affiliation(s)
- Kuo-Meng Liao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Zhong-Xiao Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taoyuan, Taiwan
| | - Yuh Jang
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei, 100, Taiwan
| | - Fan-Ya Su
- Department of Psychiatry, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Li-Ting Tsai
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei, 100, Taiwan.
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Choovuthayakorn J, Phinyo P, Tantraworasin A, Kunavisarut P, Patikulsila D, Chaikitmongkol V, Watanachai N, Pathanapitoon K. Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema in Clinical Practice of Single Center: Three-Year Outcomes. Ophthalmic Res 2020; 64:483-493. [PMID: 33053556 DOI: 10.1159/000512300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/10/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of this study was to explore visual and anatomical outcomes in patients who underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for visual impairment from center-involved diabetic macular edema (CI-DME) in clinical practice. METHODS Medical records of consecutive CI-DME patients who initiated treatment with intravitreal bevacizumab injection between January 2012 and December 2016 and were followed for at least 12 months were retrospectively reviewed. Visual and anatomical changes after treatment over a 36-month period were evaluated. RESULTS There were 286 patients (423 eyes) with a mean (standard deviation, SD) age of 56.8 (8.5) years included in this study. One hundred and forty-six (51%) patients were female, and 137 (47.9%) patients received bilateral eye treatment. Mean (SD) presenting visual acuity (VA) of overall eyes was 50.2 (19.6) letter scores. Stratified by baseline vision, eyes with initial VA worse than 20/40 achieved a statistically significant VA improvement, compared to baseline, by +8.4, +6.9, and +5.4 letters at 12, 24, and 36 months, respectively, with all p values <0.001. However, when initial VA was 20/40 and better, a non-statistically significant change in mean VA by +2.0, -3.5, and -3.6 letters were noted at the same time point (p value between 0.078 and 0.273). Unlike visual changes, a statistically significant decline in central subfield thickness compared to baseline was noted at the end of months 12, 24, and 36 in both initial VA subgroups (all p values <0.001). Nevertheless, even though the median number of given injections considerably decreased from 6 in the first 12 months to 2 in the second 12-month period and 1 in the final 12-month interval, required ophthalmic clinic visits decreased in frequency with median numbers of 10, 7, and 6 appointments in each consecutive 12-month duration. CONCLUSION This study supports the benefits of practical intravitreal anti-VEGF utilization to manage CI-DME in real-world settings. The improvement of vision in eyes presenting with poor baseline VA and maintenance of vision in eyes with better baseline VA were demonstrated through the 3-year review of each case. However, the burden of frequent monitoring warrants further evaluation of long-term compliance and efficacy.
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Affiliation(s)
- Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Tantraworasin
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kessara Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Lai K, Huang C, Li L, Gong Y, Xu F, Zhong X, Lu L, Jin C. Anatomical and functional responses in eyes with diabetic macular edema treated with "1 + PRN" ranibizumab: one-year outcomes in population of mainland China. BMC Ophthalmol 2020; 20:229. [PMID: 32539744 PMCID: PMC7296700 DOI: 10.1186/s12886-020-01510-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/09/2020] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND To evaluate the anatomical and functional responses in eyes with diabetic macular edema (DME) treated with ranibizumab under "1 + pro re nata (PRN)" regimen. METHODS This prospective interventional case series included 69 eyes of 69 patients with DME treated with intravitreal injections of 0.5 mg ranibizumab followed by repeated injections as needed. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), subfoveal choroidal thickness (SFCT), and predictive factors for final visual outcomes were assessed. RESULTS Logarithm of minimal angle of resolution (logMAR) BCVA improved from 0.64 ± 0.23 at baseline to 0.56 ± 0.27, 0.53 ± 0.26, 0.47 ± 0.25, 0.44 ± 0.32, 0.47 ± 0.26 and 0.46 ± 0.26 at time-point of months 1, 2, 3, 6, 9, and 12, respectively (P < 0.05 for any follow-up time-point except month 1). CFT decreased from 478.23 ± 172.31 μm at baseline to 349.74 ± 82.21 μm, 313.52 ± 69.62 μm, 292.59 ± 61.07 μm, 284.67 ± 69.85 μm, 268.33 ± 43.03 μm, and 270.39 ± 49.27 μm at above time-points, respectively (P < 0.05). The number of injections was 6.83 times over 12 months' follow-up under "1 + PRN" regimen. Multivariate analysis showed that the factors including age, BCVA at baseline, disruption of ellipsoid zone, posterior vitreous detachment (PVD), and vitreomacular traction (VMT) were correlated with the final BCVA. CONCLUSIONS Intravitreal injections of ranibizumab under "1 + PRN" regimen is a not only effective but also safe way to improve visual acuity of DME patients. And older age, lower baseline BCVA, VMT, and disruption of ellipsoid zone are predictors for final poor BCVA while PVD is a positive predictive factor for good final BCVA. TRIAL REGISTRATION The trial was registered retrospectively in ClinicalTrials.gov on 2 June 2019 (NCT03973138).
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Affiliation(s)
- Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Xiaojing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China.
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Cooper OAE, Taylor DJ, Crabb DP, Sim DA, McBain H. Psychological, social and everyday visual impact of diabetic macular oedema and diabetic retinopathy: a systematic review. Diabet Med 2020; 37:924-933. [PMID: 31479552 DOI: 10.1111/dme.14125] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 01/11/2023]
Abstract
AIMS To synthesize the evidence on the impact of diabetic retinopathy and diabetic macular oedema from the patient perspective. METHODS A systematic literature review was conducted using MEDLINE Complete, PsycINFO, EMBASE and AMED. We included articles investigating the impact of the condition on quality of life, symptoms, visual functioning, activities of daily living, well-being, social functioning, and financial status. The studies evaluated were observational, including cross-sectional, prospective cohort and retrospective cohort designs. Outcome data were extracted and synthesized. RESULTS Searches yielded 5114 publications. After screening, 85 studies were included, measuring the following outcomes: visual functioning (n=46); quality of life (n=22); well-being (n=16); functional status (n=5); work (n=4); and visual task performance (n=2). Diabetic retinopathy has a considerable impact on visual functioning and this is greater in people with greater disease severity. Diabetic retinopathy significantly limits activities including working, driving, walking and reading, and has the potential to have a negative impact on psychological well-being. CONCLUSIONS Diabetic retinopathy is associated with poor self-reported visual functioning, well-being, and health-related quality of life. Ability to perform basic everyday tasks appears to diminish with disease severity. Some studies suggest impaired mobility and problems with work, but there are gaps in this evidence.
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Affiliation(s)
- O A E Cooper
- School of Health Sciences, City, University of London, London, UK
| | - D J Taylor
- School of Health Sciences, City, University of London, London, UK
| | - D P Crabb
- School of Health Sciences, City, University of London, London, UK
| | - D A Sim
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - H McBain
- School of Health Sciences, City, University of London, London, UK
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11
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Stellungnahme der DOG, der RG und des BVA zur Therapie des diabetischen Makulaödems. Ophthalmologe 2020; 117:218-247. [DOI: 10.1007/s00347-019-01015-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Granado-Casas M, Castelblanco E, Ramírez-Morros A, Martín M, Alcubierre N, Martínez-Alonso M, Valldeperas X, Traveset A, Rubinat E, Lucas-Martin A, Hernández M, Alonso N, Mauricio D. Poorer Quality of Life and Treatment Satisfaction is Associated with Diabetic Retinopathy in Patients with Type 1 Diabetes without Other Advanced Late Complications. J Clin Med 2019; 8:jcm8030377. [PMID: 30889868 PMCID: PMC6462963 DOI: 10.3390/jcm8030377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/10/2019] [Accepted: 03/14/2019] [Indexed: 01/27/2023] Open
Abstract
Diabetic retinopathy (DR) may potentially cause vision loss and affect the patient’s quality of life (QoL) and treatment satisfaction (TS). Using specific tools, we aimed to assess the impact of DR and clinical factors on the QoL and TS in patients with type 1 diabetes. This was a cross-sectional, two-centre study. A sample of 102 patients with DR and 140 non-DR patients were compared. The Audit of Diabetes-Dependent Quality of Life (ADDQoL-19) and Diabetes Treatment Satisfaction Questionnaire (DTSQ-s) were administered. Data analysis included bivariate and multivariable analysis. Patients with DR showed a poorer perception of present QoL (p = 0.039), work life (p = 0.037), dependence (p = 0.010), and had a lower average weighted impact (AWI) score (p = 0.045). The multivariable analysis showed that DR was associated with a lower present QoL (p = 0.040), work life (p = 0.036) and dependence (p = 0.016). With regards to TS, DR was associated with a higher perceived frequency of hypoglycaemia (p = 0.019). In patients with type 1 diabetes, the presence of DR is associated with a poorer perception of their QoL. With regard to TS, these subjects also show a higher perceived frequency of hypoglycaemia.
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Affiliation(s)
- Minerva Granado-Casas
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
| | - Esmeralda Castelblanco
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain.
| | - Anna Ramírez-Morros
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Mariona Martín
- Department of Endocrinology & Nutrition, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Nuria Alcubierre
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
| | - Montserrat Martínez-Alonso
- Systems Biology and Statistical Methods for Biomedical Research, IRBLleida, University of Lleida, 25198 Lleida, Spain.
| | - Xavier Valldeperas
- Department of Ophthalmology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Alicia Traveset
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain.
| | - Esther Rubinat
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain.
| | - Ana Lucas-Martin
- Department of Endocrinology & Nutrition, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Marta Hernández
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
- Department of Endocrinology & Nutrition, University Hospital Arnau de Vilanova, 25198 Lleida, Spain.
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain.
| | - Didac Mauricio
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain.
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain.
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13
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Fajnkuchen F, Pieramici D, Hrarat L, Best AL, Cohen SY, Delahaye-Mazza C, Grenet T, Nghiem-Buffet S, Quentel G, Bodaghi B, Giocanti-Aurégan A. Impact of ranibizumab on visual impairment in patients with bilateral diabetic macular edema. Acta Diabetol 2019; 56:67-71. [PMID: 30167869 DOI: 10.1007/s00592-018-1210-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
AIMS Diabetic macular edema (DME) frequently presents bilaterally. In case of bilateral retinal disease, the visual impairment (VI) and the visual acuity (VA) are strongly correlated to the better eye. The aim of this study was to assess the impact of ranibizumab intravitreal injections (IVR) on VI in patients with simultaneous VA loss due to DME. METHODS This was a retrospective two-center study including consecutive DME patients with visual loss treated with ranibizumab since November 2011 and with a minimum follow-up of 6 months. Patients with bilateral visual decrease from DME undergoing IVR within 6 months of each other were included. RESULTS Twenty-nine DME patients who received bilateral IVR within a 6-month interval in the second eye were included. At baseline, 82.8% (n = 24) of patients had a VA < 20/40 in their better eye versus 44.8% (n = 13) of patients at the end of follow-up, i.e. a reduction by 45.9% of VI. In the better eye, the mean VA was 57.3, 65.0 and 65.5 ETDRS letters, respectively, at baseline, month 3 and month 6 (mean VA gain +8.2 letters). In the worse eye, the mean VA was 44.2, 53.5 and 53.8 ETDRS letters, respectively, at baseline, M3 and M6 (mean VA gain +9.6 letters). CONCLUSIONS In patients with bilateral DME, subsequent ranibizumab IVR reduced VI frequency.
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Affiliation(s)
- Franck Fajnkuchen
- Ophthalmology, Centre d'Imagerie et de Laser, Paris, France
- Ophthalmology Department, Avicenne Hospital, Bobigny, France
| | - Dante Pieramici
- Partner California Retina Consultants, Director California Retina Research Foundation, Santa Barbara, USA
| | - Linda Hrarat
- Ophthalmology Department, Avicenne Hospital, Bobigny, France
| | | | - Salomon Y Cohen
- Ophthalmology, Centre d'Imagerie et de Laser, Paris, France
- Centre Hospitalier Intercommunal Créteil, Créteil, France
| | | | - Typhaine Grenet
- Ophthalmology, Centre d'Imagerie et de Laser, Paris, France
- Ophthalmology Department, Avicenne Hospital, Bobigny, France
| | - Sylvia Nghiem-Buffet
- Ophthalmology, Centre d'Imagerie et de Laser, Paris, France
- Ophthalmology Department, Avicenne Hospital, Bobigny, France
| | | | - Bahram Bodaghi
- Ophthalmology Department, Avicenne Hospital, Bobigny, France
- Ophthalmology Department, Pitié Salpétrière Hospital, Paris, France
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14
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Ziemssen F, Marahrens L, Roeck D, Agostini H. Klinische Stadieneinteilung der diabetischen Retinopathie. DIABETOLOGE 2018. [DOI: 10.1007/s11428-018-0417-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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15
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Chua J, Chia AR, Chee ML, Man REK, Tan GSW, Lamoureux EL, Wong TY, Chong MFF, Schmetterer L. The relationship of dietary fish intake to diabetic retinopathy and retinal vascular caliber in patients with type 2 diabetes. Sci Rep 2018; 8:730. [PMID: 29335432 PMCID: PMC5768794 DOI: 10.1038/s41598-017-18930-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/18/2017] [Indexed: 12/29/2022] Open
Abstract
In this cross-sectional study, we evaluated the association of dietary fish intake with varying severity of diabetic retinopathy (DR) and retinal vascular caliber in Asians with type 2 diabetes mellitus. 357 Asians (median age: 58 years; 31% women; 78% Chinese) were recruited from a tertiary eye care institution in Singapore. Fish consumption was evaluated using a validated food frequency questionnaire. Digital retinal photographs assessed for DR severity and retinal vascular caliber. Ordered logistic and linear regression models were used to investigate the association of fish intake with DR severity and vascular caliber. Increasing frequency of fish consumption was significantly associated with lower odds of having severe DR (odds ratio [OR] = 0.91, 95% CI: 0.84–0.99 per 1-unit increase of fish intake; P = 0.038). Among those with no retinopathy, persons in quartile 4 fish intake had a wider retinal vascular caliber for arteriolar (β = 22.27 µm, 95% CI: 12.64–31.90; P-trend < 0.001) and venular (β = 32.00 µm, 95% CI: 17.56–46.43; P-trend < 0.001), than those in quartile 1 fish intake. Persons with higher fish intake had a decreased likelihood of having severe DR. In diabetics without retinopathy, higher fish intake was associated with wider retinal vascular caliber. Future research is needed to reinforce the direction of the casualty.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ai-Ru Chia
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Miao Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria. .,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Wien, Austria.
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