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Vogt D, Deiters V, Herold TR, Guenther SR, Kortuem KU, Priglinger SG, Wolf A, Schumann RG. Optimal patient adherence and long-term treatment outcomes of neovascular age-related macular degeneration in real-life. Curr Eye Res 2022; 47:889-896. [PMID: 35179427 DOI: 10.1080/02713683.2022.2044056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To report on long-term real-life outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy in neovascular age-related macular degeneration (nAMD) with optimal patient adherence. METHODS For this retrospective monocenter study, we identified 3217 eyes of 2793 patients that received a minimum of three intravitreal anti-VEGF injections for nAMD therapy between 2006 and 2014 at the University Eye Hospital Munich. From those, we included eyes with treatment-naïve nAMD, follow-up (FU) of ≥60 months and continuous adherence during FU. Primary measures were corrected visual acuity (VA), number of injections and visits as well as treatment regimen. RESULTS We included 161 eyes of 125 patients with a mean FU of 8.0 ± 2.3 years. Mean VA at baseline was 60.1 letters (Snellen equivalent, 20/63). After the third year, mean VA declined constantly by 2-3 letters per year. After 5 and 8 years, 26.1% and 42.1% had lost at least 3 lines from baseline. Mean cumulative number of injections was 5.3 after the first year, and 23.9, 38.1, 48.5 after 5, 8, and 10 years. 'Treat and extent' regimen with higher injection frequency correlated with better function. At time of last FU, 69.8% of eyes were under active treatment. Eyes with ≥70 letters at baseline correlated with better VA at the end of FU. CONCLUSIONS Despite optimal patient adherence, visual function declined progressively in real-life nAMD therapy over long-term. The highest impact on treatment success is given by an early treatment start with individual but intensive anti-VEGF therapy.
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Affiliation(s)
- Denise Vogt
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Viktoria Deiters
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Tina R Herold
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Stefanie R Guenther
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Karsten U Kortuem
- Department of Ophthalmology, University Hospital Ulm, Priettwitzstr. 43, 89075 Ulm, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, University Hospital Ulm, Priettwitzstr. 43, 89075 Ulm, Germany
| | - Ricarda G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany.,Munich Eye Center Brienner Hof, Brienner Str. 12, 80333 Munich, Germany
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Kortuem FC, Ziemssen F, Kortuem KU, Kortuem C. International survey on COVID-19 pandemic: personal protective measures during fundus examination. Acta Ophthalmol 2022; 100:e325-e326. [PMID: 34018695 PMCID: PMC8222869 DOI: 10.1111/aos.14904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Friederike C. Kortuem
- University Eye Hospital Center for Ophthalmology University of Tübingen Tubingen Germany
| | - Focke Ziemssen
- University Eye Hospital Center for Ophthalmology University of Tübingen Tubingen Germany
| | | | - Constanze Kortuem
- University Eye Hospital Center for Ophthalmology University of Tübingen Tubingen Germany
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Kortuem FC, Ziemssen F, Kortuem KU, Kortuem C. The Role and Views of Ophthalmologists During the COVID-19 Pandemic. Clin Ophthalmol 2021; 15:3947-3956. [PMID: 34616139 PMCID: PMC8488052 DOI: 10.2147/opth.s327745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/24/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic forced ophthalmologists to adjust their working conditions to ensure patient and staff safety, while still providing effective and timely treatment. This international survey among ophthalmologists was initiated to capture what actions ophthalmologists were taking and what their opinions were on the risks of infection in their workplace, the delay in treatment, the use of telemedicine and telephone for appointments, and the regional specifications and measures implemented by the respective authorities. Methods An open-source web tool was used to develop an online survey, to which ophthalmologists worldwide were invited via e-mail using international mailing lists (Media Mice, Singapore; Texere Publishing Inc, USA; CGO Gerling) and incentivized using a lottery. The physicians provided their level of agreement relating to the offered statements and gave free answers to the questions regarding the actions taken (conducted November 5th 2020 to December 20th 2020). Results After 91,000 invitations, responses were collected from 1122 ophthalmologists. Despite the use of large international mailing lists, mainly doctors from Europe participated. Half of the participants expressed great concern about possible SARS-CoV-2 infection in their patients. A significant number of younger ophthalmologists (≤50 years: 76.9%, n = 313; >50 years: 69.6%, n = 181) feared the delays that COVID-19 could cause to treatment. Reductions in patient numbers were broadly observed, with more ophthalmologists of younger age reporting greater declines. Nearly all ophthalmologists indicated that they provided disinfectant and the majority also used masks and questionnaires for screening. For 60.3% (n = 412) of ophthalmologists, telephone calls reduced the risk of ‘no-shows’; 71.6% (n = 497) disagreed that telemedical evaluation is possible without slit lamp findings and fundus photos; and 57.0% of participants felt content with the governmental measures during the COVID-19 pandemic. Conclusion The COVID-19 pandemic has significantly influenced the work of ophthalmologists. Based on the limited response rate, certain statements were only possible to evaluate for the European Union: with a noticeable reduction in patient numbers, delay in treatment was a major worry. Measures to protect and reassure patients should be undertaken, especially regarding those with vision-threatening diseases requiring treatment.
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Affiliation(s)
- Friederike C Kortuem
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Focke Ziemssen
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany.,Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | | | - Constanze Kortuem
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
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Kern C, König A, Fu DJ, Schworm B, Wolf A, Priglinger S, Kortuem KU. Big data simulations for capacity improvement in a general ophthalmology clinic. Graefes Arch Clin Exp Ophthalmol 2021; 259:1289-1296. [PMID: 33386963 PMCID: PMC8102441 DOI: 10.1007/s00417-020-05040-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/07/2020] [Accepted: 12/02/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose Long total waiting times (TWT) experienced by patients during a clinic visit have a significant adverse effect on patient’s satisfaction. Our aim was to use big data simulations of a patient scheduling calendar and its effect on TWT in a general ophthalmology clinic. Based on the simulation, we implemented changes to the calendar and verified their effect on TWT in clinical practice. Design and methods For this retrospective simulation study, we generated a discrete event simulation (DES) model based on clinical timepoints of 4.401 visits to our clinic. All data points were exported from our clinical warehouse for further processing. If not available from the electronic health record, manual time measurements of the process were used. Various patient scheduling models were simulated and evaluated based on their reduction of TWT. The most promising model was implemented into clinical practice in 2017. Results During validation of our simulation model, we achieved a high agreement of mean TWT between the real data (229 ± 100 min) and the corresponding simulated data (225 ± 112 min). This indicates a high quality of the simulation model. Following the simulations, a patient scheduling calendar was introduced, which, compared with the old calendar, provided block intervals and extended time windows for patients. The simulated TWT of this model was 153 min. After implementation in clinical practice, TWT per patient in our general ophthalmology clinic has been reduced from 229 ± 100 to 183 ± 89 min. Conclusion By implementing a big data simulation model, we have achieved a cost-neutral reduction of the mean TWT by 21%. Big data simulation enables users to evaluate variations to an existing system before implementation into clinical practice. Various models for improving patient flow or reducing capacity loads can be evaluated cost-effectively. Supplementary Information The online version contains supplementary material available at 10.1007/s00417-020-05040-9.
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Affiliation(s)
- Christoph Kern
- Department of Ophthalmology, University Hospital LMU Munich, Mathildenstraße 8, 80336, Munich, Germany.
| | - André König
- Department of Ophthalmology, University Hospital LMU Munich, Mathildenstraße 8, 80336, Munich, Germany
| | | | - Benedikt Schworm
- Department of Ophthalmology, University Hospital LMU Munich, Mathildenstraße 8, 80336, Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, Ulm University, Ulm, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, University Hospital LMU Munich, Mathildenstraße 8, 80336, Munich, Germany
| | - Karsten U Kortuem
- Department of Ophthalmology, University Hospital LMU Munich, Mathildenstraße 8, 80336, Munich, Germany
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Holmberg OG, Köhler ND, Martins T, Siedlecki J, Herold T, Keidel L, Asani B, Schiefelbein J, Priglinger S, Kortuem KU, Theis FJ. Self-supervised retinal thickness prediction enables deep learning from unlabelled data to boost classification of diabetic retinopathy. NAT MACH INTELL 2020. [DOI: 10.1038/s42256-020-00247-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fasler K, Moraes G, Wagner S, Kortuem KU, Chopra R, Faes L, Preston G, Pontikos N, Fu DJ, Patel P, Tufail A, Lee AY, Balaskas K, Keane PA. One- and two-year visual outcomes from the Moorfields age-related macular degeneration database: a retrospective cohort study and an open science resource. BMJ Open 2019; 9:e027441. [PMID: 31230012 PMCID: PMC6596999 DOI: 10.1136/bmjopen-2018-027441] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To analyse treatment outcomes and share clinical data from a large, single-centre, well-curated database (8174 eyes/6664 patients with 120 756 single entries) of patients with neovascular age-related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (VEGF). By making our depersonalised raw data openly available, we aim to stimulate further research in AMD, as well as set a precedent for future work in this area. SETTING Retrospective, comparative, non-randomised electronic medical record (EMR) database cohort study of the UK Moorfields AMD database with data extracted between 2008 and 2018. PARTICIPANTS Including one eye per patient, 3357 eyes/patients (61% female). Extraction criteria were ≥1 ranibizumab or aflibercept injection, entry of 'AMD' in the diagnosis field of the EMR and a minimum of 1 year of follow-up. Exclusion criteria were unknown date of first injection and treatment outside of routine clinical care at Moorfields before the first recorded injection in the database. MAIN OUTCOME MEASURES Primary outcome measure was change in VA at 1 and 2 years from baseline as measured in Early Treatment Diabetic Retinopathy Study letters. Secondary outcomes were the number of injections and predictive factors for VA gain. RESULTS Mean VA gain at 1 year and 2 years were +5.5 (95% CI 5.0 to 6.0) and +4.9 (95% CI 4.2 to 5.6) letters, respectively. Fifty-four per cent of eyes gained ≥5 letters at 2 years, 63% had stable VA (±≤14 letters), 44% of eyes maintained good VA (≥70 letters). Patients received a mean of 7.7 (95% CI 7.6 to 7.8) injections during year 1 and 13.0 (95% CI 12.8 to 13.2) injections over 2 years. Younger age, lower baseline VA and more injections were associated with higher VA gain at 2 years. CONCLUSION This study benchmarks high quality EMR study results of real life AMD treatment and promotes open science in clinical AMD research by making the underlying data publicly available.
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Affiliation(s)
- Katrin Fasler
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology, UniversitatsSpital Zurich, Zurich, Switzerland
| | - Gabriella Moraes
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Siegfried Wagner
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Karsten U Kortuem
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Augenklinik, Klinikum der Universitat Munchen, Munchen, Bayern, Germany
| | - Reena Chopra
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Livia Faes
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Augenklinik, Luzerner Kantonsspital Zentrumsspital, Luzern, Switzerland
| | - Gabriella Preston
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Nikolas Pontikos
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Dun Jack Fu
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Praveen Patel
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Frohwitter G, Wimmer S, Goetz C, Weitz J, Ulbig M, Kortuem KU, Dangelmaier J, Ritschl L, Doll C, Ristow O, Kesting MR, Koerdt S. Evaluation of a computed-tomography-based assessment scheme in treatment decision-making for isolated orbital floor fractures. J Craniomaxillofac Surg 2018; 46:1550-1554. [DOI: 10.1016/j.jcms.2018.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/17/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022] Open
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Kortuem KU, Vounotrypidis E, Athanasiou A, Müller M, Babenko A, Kern C, Priglinger S, Mayer WJ. Differences in corneal clinical findings after standard and accelerated cross-linking in patients with progressive keratoconus. BMC Ophthalmol 2017; 17:222. [PMID: 29183298 PMCID: PMC5706400 DOI: 10.1186/s12886-017-0610-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 11/16/2017] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to identify differences in clinical corneal findings after standard and accelerated epithelial off cross-linking (CXL) during a long-term follow-up. Methods Two hundred forty-one patients (184 male) were included in this monocentric, retrospective, non-randomized and unmasked study. One hundred forty-eight eyes were treated with the accelerated protocol and 138 with the standard protocol with epithelial off CXL, if diagnosed with keratoconus and a progression in Kmax of more than one dioptre during the preceding 6 months, plus a minimal pachymetry measurement of 400 μm in keratometry (Pentacam, Oculus GmbH, Wetzlar, Germany). Exclusion criteria were previous surgery, other corneal conditions or age above 50 years. Follow-up time was 36 months with clinical examination and keratometry at every visit. Outcome measures were the observed rate of corneal changes, differences between treatment groups and correlation with keratometry measurements. Results In patients with accelerated CXL, significantly more clear corneas were seen at three (p = 0.015) and six (p = 0.002) months after surgery than following the standard protocol. The rate of clear corneas dropped from 52.2% pre-operation (OP) to a minimum of 19.3% after 6 months in the standard protocol group compared with 50.7% clear corneas pre-OP and a minimum of 40.8% in the accelerated group. In the standard protocol group, more striae were found 3 months after intervention than in the accelerated group (p = 0.05). Conclusions In patients with accelerated CXL, fewer morphological corneal changes were observed than after conventional CXL. However, rarely, corneal changes persisted for a long time.
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Affiliation(s)
- Karsten U Kortuem
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstr. 8, 80336, Munich, Germany.
| | - Efstathios Vounotrypidis
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Alexandros Athanasiou
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Michael Müller
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Alexander Babenko
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Christoph Kern
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Wolfgang J Mayer
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstr. 8, 80336, Munich, Germany
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