Assessment of visual acuity improvement in patients with AMD referred to the low vision department / Avaliação da melhora da acuidade visual em pacientes com DMRI encaminhados ao setor de visão subnormal

Abstract Purpose: To evaluate the vision improvement through the use of visual aids of patients with Age-Related Macular Degeneration (AMD) those were examined in the low vision department. Methods: A retrospective study was conducted by reviewing medical records of 61 patients with AMD who were referred to the Low Vision Department from January 2012 to December 2014. The data collected included age, sex, diagnosis of the type of AMD and previous use of vascular endothelium growth factor inhibitor or antioxidants. In addition, far acuity, with and without optical aid, was indicated as well as which aid was prescribed. Results: In this study with 61 patients, 54.1% were male and 45.9% female. The most prevalent age group was 71-80 years old (44.3%) and most of the patients had the dry form of AMD (70.5%). With the use of visual aids, 73.8% of the patients improved visual acuity for far vision. The most prescribed optical aid was the Galileu 2.8x telescope (50.8%). Conclusion: Patients with visual impairment and AMD can benefit significantly from the visual aids if they are properly prescribed and fitted. Most patients in the study were fitted with at least one of the indicated visual aids, resulting in a significant improvement in far acuity.

Resumo Objetivo: Avaliar a melhora da visão através de auxílios visuais em pacientes portadores de Degeneração Macular Relacionada a Idade (DMRI) encaminhados ao serviço de visão subnormal. Métodos: Foi realizado um estudo retrospectivo, através da revisão 61 prontuários de pacientes com diagnóstico de DMRI que foram encaminhados ao departamento de Visão Subnormal (VSN), no período de janeiro 2012 a dezembro de 2014. Foram coletados dados sobre idade, sexo, diagnóstico do tipo de DMRI e uso prévio de inibidor do fator de crescimento do endotélio vascular (anti-VEGF) ou antioxidante. Além disso, outras informações foram colhidas como acuidade visual para longe sem auxílio e com auxílio óptico, indicando o(s) auxílio(s) óptico(s) prescrito(s). Resultados: Dos 61 pacientes avaliados, 54,1% eram do sexo masculino e 45,9% do sexo feminino. A faixa etária mais prevalente foi de 71-80 anos (44,3%) e a maioria (70,5%) apresentava a forma seca de DMRI. Com o uso de recursos visuais, 73,8% dos tiveram melhora da acuidade visual para longe. O auxilio óptico mais prescrito foi o telescópio do tipo Galileu 2,8x (50,8%). Conclusão: Pacientes com deficiência visual e DMRI podem se beneficiar significativamente dos recursos visuais se esses forem devidamente indicados e adaptados. A maioria dos pacientes aceitou pelo menos um dos recursos visuais indicados resultando numa melhora importante da acuidade visual de longe.

Capacidad funcional y calidad de vida en los ancianos con degeneración macular y baja visión / Functional capacity and quality of life in elderly patients with macular degeneration and low vision

OBJETIVO: caracterizar la capacidad funcional y la calidad de vida en los ancianos con degeneración macular y baja visión, atendidos en el Instituto Cubano de Oftalmología “Ramón Pando Ferrer” en el período comprendido de enero a junio de 2013. MÉTODOS: se realizó un estudio descriptivo, de corte transversal. Fueron estudiadas las siguientes variables: edad, sexo, color de la piel, agudeza visual mejor corregida de cerca con cartilla Zeiss, antes y después de la rehabilitación visual, discapacidad visual, capacidad funcional para las actividades de la vida diaria, tipo clínico de degeneración macular, factores de riesgo de la enfermedad, motivación para la rehabilitación visual y ayudas ópticas y no ópticas prescritas. RESULTADOS: existió un predominio de la enfermedad en las mujeres (55,2 %), entre los 75-79 años de edad y en el color de la piel blanca. La discapacidad visual que prevaleció fue la baja visión ligera a moderada; la capacidad funcional mayormente encontrada fue la independencia con alguna limitación. La degeneración macular seca se presentó en el 82,7 % de los casos; el factor de riesgo más frecuente fue el tabaquismo (82,7 %); la lectoescritura fue la motivación principal y el mayor número de pacientes mejoró la agudeza visual después de la rehabilitación visual. Las ayudas ópticas y no ópticas que más se prescribieron fueron los microscopios y la iluminación. CONCLUSIONES: el grupo de edades entre 75 y 79 años, el sexo femenino y la piel blanca o caucasiana son los factores que aportan un mayor número de casos de degeneración macular y baja visión. La discapacidad visual que prevalece es la de los clasificados como baja visión ligera a moderada. La degeneración macular seca se presenta en casi la totalidad de los casos. Los factores de riesgo más frecuentes son el tabaquismo, la herencia y las enfermedades cardiovasculares. El mayor número de pacientes mejora después de la rehabilitación visual.

OBJECTIVE: to characterize the functional capacity and the quality of life of the elderly people with macular degeneration and low vision who were seen at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology from January to June 2013. METHODS: cross-sectional and descriptive study that included the following variables: age, sex, race, best corrected near visual acuity using Zeiss chart before and after visual rehabilitation, visual disability, functional capacity for daily life activities, clinical type of macular degeneration, risk factors for the disease, reason for visual rehabilitation and prescribed optical and non-optical aids. RESULTS: the disease prevailed in females (55,2 %), 75-79 years-old age group and Caucasians. Predominant visual disability was mild to moderate low vision; the mostly found functional capacity was independence with some limitations. Dry macular degeneration was present in 82,7 % of cases; the most frequent risk factor was smoking (82,7 %); reading and writing was the main motivation and a large number of patients improved their visual acuity after rehabilitation. The optical and non-optical aids that were mostly prescribed included microscopes and lighting. CONCLUSIONS: females, 75-79 years-old age group and Caucasians are the risk factors that cause the highest number of cases with macular degeneration and low vision. Visual disability prevailed among those classified as mild to moderate low vision patients. Dry macular degeneration was present in almost all the cases. The most frequent risk factors were smoking, heredity and cardiovascular diseases. Most of the patients improved their condition after visual rehabilitation.

Critical evaluation of the off-label indication and of the risks associated to the use of multi-dose vials on the treatment of age-related macular degeneration

Age-related macular degeneration (AMD) is an ocular inflammatory diseases treated mainly by means of a bevacizumab (Avastin®) or ranibizumab (Lucentis®) intravitreal injection. Among these drugs, only ranibizumab has a specific therapeutic indication for AMD. Considering that, the off-label use on ophthalmic therapy seems to become a rule when it should be an exception. Furthermore, bevacizumab presentation consists of multi-dose vials although it does not contain preservatives in its formula. The current literature review aimed at assessing the risks for the patient related to the use of off-label indication and multi-dose vials on AMD treatment. Considering this, the proposal related to the Brazilian Public Consultation no.10, dated September 12, 2012, which proposes the Clinical Protocol and Therapeutic Guidelines for AMD treatment, was evaluated. This systematic review allowed to conclude that the bevacizumab off-label indication results in increased risks for the patient when compared to the product with specific therapeutic indication for AMD treatment (ranibizumab), especially referring to the significant raise in the adverse events. The risks for the patient related to the multi-dose vial use, referring to the microbiological stability and dose precision, were also made clear.

A degeneração macular relacionada à idade (DMRI) é uma doença ocular inflamatória tratada principalmente por injeção intravítrea de bevacizumabe (Avastin®) ou de ranibizumabe (Lucentis®). Entre os medicamentos citados, apenas o ranibizumabe tem indicação terapêutica específica para uso oftálmico. Considerando essa realidade, o uso off-label na terapia oftálmica parece constituir regra quando deveria ser exceção. Ademais, a apresentação do bevacizumabe consiste em frascos de múltipla-dose, embora esse medicamento não contenha conservante em sua fórmula. A presente revisão da literatura avaliou os riscos ao paciente relativos ao uso indicado off-label e de frascos de múltipla-dose no tratamento de DMRI. Nesse sentido, avaliou-se a proposta relativa à Consulta Pública Brasileira nº 10, de 12 de setembro de 2012, que propõe o Protocolo Clínico e Diretrizes Terapêuticas para o tratamento de DMRI. O levantamento sistemático de trabalhos científicos e de informações relevantes de banco de dados eletrônicos permitiu concluir que a indicação off-label do bevacizumabe acarreta riscos maiores ao paciente, quando comparado ao produto com indicação terapêutica específica para o tratamento de DMRI (ranibizumabe), especialmente quanto ao aumento significativo de eventos adversos. Evidenciaram-se, também, os riscos ao paciente relativos ao uso de frascos de múltipla-dose, quanto à estabilidade microbiológica e à precisão da dose.

Rehabilitación visual en pacientes con degeneración macular asociada con la edad en el adulto mayor de la consulta provincial de baja visión de Ciego de Ávila / Visual rehabilitation in patients with macular degeneration associated with the age in elderly person from the provincial consultation of low vision in Ciego de Avila

La rehabilitación visual en pacientes con degeneración macular asociada con la edad mejora la calidad de vida y adquiere relevancia porque devuelve la independencia a pacientes con agudezas visuales muy bajas.En la presente investigación se aplicó un sistema para la rehabilitación visual en gerontes con este padecimiento en la consulta de baja visión de la provincia de Ciego de Ávila. Se realizó un estudio observacional retrospectivo en 32 adultos mayores con degeneración macular asociada con la edad. Se calcularon las frecuencias y el porciento; se obtuvo una muestra de 29 pacientes y de ellos los de 75 años ó más y los de sexo femenino tuvieron un mayor por ciento de rehabilitación. La lectoescritura fue la motivación más prescrita, así como los microscopios para cerca.

The visual rehabilitation in patients with macular degeneration associate with the age it improves the quality of life and it acquires relevance because it gives back independence to patients with very low visual acuity. In the present investigation a system for the visual rehabilitation was applied in elderly people with this condition in the low vision consultation of Ciego de Avila province. A retrospective and observational study was carried out in 32 elderly people with macular degeneration associate with the age. Frequencies and percent were calculated. A sample of 29 patients was obtained, and 75 years and the feminine sex had a greater percent of rehabilitation. The literacy was the most prescribed motivation, as well as the microscopes for close.

Adaptaçäo de auxílios em pacientes com degeneraçäo macular relacionada à idade / Using optical aids in patients with age-related macular degeneration

Auxílios ópticos de perto e de longe foram testados e adaptados em pacientes com Degeneraçäo Macular Relacionada à Idade. A acuidade visual melhorou utilizando-se os auxílios na maioria dos pacientes (78,12 por cento). Os auxílios ópticos mais prescritos para perto foram os óculos com lentes esferoprismáticas e para longe, os mais prescritos foram os telescópios binoculares. Após os testes iniciais e após ter estabelecido o auxílio adequado foram realizados programas de treinamento de aprendizagem do manuseio dos mesmos, antes da prescriçäo final. Verificou-se que a utilizaçäo dos auxílios ópticos possibilitou a realizaçäo