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1.
Medical Journal of Peking Union Medical College Hospital ; 12(5):755-760, 2021.
Article in Chinese | EMBASE | ID: covidwho-2320863

ABSTRACT

With the development of technology, doctors can diagnose and treat many diseases through telemedicine. At present, teleophthalmology is mainly used in screening and diagnosing some ocular diseases, monitoring chronic ocular diseases, as well as teleconsultation. With the increasing demand and application of teleophthalmology, some problems will gradually become prominent, such as insufficient equipment and staff, medical risks, patient acceptance and satisfaction, network security, privacy, and covering of medical insurance. The global pandemic of COViD-19 has unexpectedly brought telemedicine to the forefront of ophthalmic services, and may continue to change the way of ophthalmic diagnosis and treatment. With the development of artificial intelligence technology, the expansion of 5G communication network coverage, the standardized training of primary medical staff, and the introduction of relevant laws and regulations, teleophthalmology will become more improved, universal, and widely applied, so as to provide patients with sustainable medical services of higher quality.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

2.
Investigative Ophthalmology and Visual Science ; 63(7):341-F0172, 2022.
Article in English | EMBASE | ID: covidwho-2058679

ABSTRACT

Purpose : To assess the visual impact and reasons for treatment delay during the COVID-19 pandemic lockdown in neovascular age-related macular degeneration (nAMD) patients in ongoing anti-VEGF therapy. Methods : Retrospective, national, multicentre, observational study in nAMD patients treated with anti-VEGF therapy and registered in the Fight Retinal Blindness (FRB) Spain platform prior to lockdown. Study cohort was divided in timely treated patients (TTP) and delayed treatment patients (DTP). Mean change in best corrected visual acuity (BCVA, in ETDRS letters) from the last follow-up visit (FUV) before lockdown (BLD) (baseline [BL] visit) to the first FUV after lockdown (ALD) was assessed. A specific questionnaire was distributed to the participant centers to investigate further the reasons for treatment delay in all individual cases. Results : A total of 245 eyes fulfilled the eligibility criteria, from which 39.6% were TTP (n=97) and 60.4% were DTP (n=148). TTP presented greater baseline and final BCVA compared to DTP (64.1 vs 58.7 letters, p=0.023, and 63.6 vs 57.1, p=0.004). BCVA loss was significantly greater for DTP vs TTP (-2.0 vs -0.6 letters, p=0.016). For DTP cohort, the primary reason for visit delay was patient decision (48.2%) followed by limited hospital clinic capacity (42.7%). When patients decided not to attend scheduled visits, the main reason was fear to Covid-19 infection (49.4%). Conclusions : This study provides relevant data about the impact on visual outcomes of Covid-19 pandemic lockdown on nAMD patients and specifically provides new additional information regarding the main reasons for treatment and visits delay from both patients and healthcare service delivery perspectives.

3.
Investigative Ophthalmology and Visual Science ; 63(7):4205-A0133, 2022.
Article in English | EMBASE | ID: covidwho-2058458

ABSTRACT

Purpose : Anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections are efficacious treatments for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), but optimal real-world outcomes require frequent treatment and monitoring that can be burdensome to patients and hinder their ability or willingness to follow their management plan. This study aimed to understand patient treatment experience with anti-VEGF standard of care. Methods : This observational study employed a cross-sectional quantitative survey comprising de novo questions, patient-reported outcome (PRO) measures and medical chart extraction. Adult patients in the USA, UK and Canada with nAMD or DME, and treated with anti-VEGF injections for ≥12 months, were recruited via 21 (9 USA, 6 UK, 6 Canada) clinical sites. Results : Between January and August 2021, 148 (67 USA, 33 UK, 48 Canada) DME and 219 (98 USA, 54 UK, 67 Canada) nAMD patients completed their surveys. While 159 (43%) patients had a study eye visual acuity at most recent reading >70 approxETDRS letters, PRO scores indicated that patients across the two conditions had relatively high visionrelated functioning (NEI-VFQ-25) and were generally satisfied with their current treatment (MacTSQ and RetTSQ). Eighteen DME patients (12%;12% in the US, 27% in the UK, 2% in Canadian samples) and 9 nAMD patients (4%;3% USA, 3% UK, 4% Canada) missed at least 1 injection visit in the past 12 months. Reported barriers were mainly related to treatment, clinic and appointment factors, and the COVID-19 pandemic. Half of the patients reported some level of impairment in their daily activities due to the treatment. Following treatment, the majority recovered within 1 day;however, a sizable portion (24%;21% USA, 31% UK, 22% Canada) needed >1 day to recover. Among the working patients (N = 55), 34 (62%;58% USA, 67% UK, 65% Canada) reported some level of productivity impairment in the form of absenteeism. Conclusions : Despite high adherence and treatment satisfaction levels, patients reported impairment of daily activities, burden, and barriers related to treatment. In general, more DME patients missed at least 1 visit than nAMD patients. More durable treatments with longer intervals could further reduce treatment burden and address the current barriers faced by patients.

4.
Investigative Ophthalmology and Visual Science ; 63(7):2535-A0104, 2022.
Article in English | EMBASE | ID: covidwho-2057970

ABSTRACT

Purpose : During the emergeing COVID-19 pandemic, patient care was delayed due to clinic closures and patient hesitancy in seeking necessary care. We aimed to characterize clinical outcomes of exudative macular degeneration (AMD) patients who had delay in their care. As the uncertainly of the pandemic unfolds, this study aims to inform clinical decision making on future care delay decisions. Methods : Patients with a chart diagnosis of exudative AMD who had an appointment canceled from 3/16/20 through 5/4/20 were selected. This timeframe encompassed the official clinic closure and a time during which many patients self-delayed care. Patients with concurrent macular disease were excluded. Data from each ophthalmology encounter was collected from 3/1/2019 through 7/1/2021. A linear longitudinal multilevel model was used to model best-corrected visual acuity (BCVA) over time. Time varying covariates included injection at visit, presence of subretinal fluid, intraretinal fluid, geographic atrophy, and macular hemorrhage. Baseline covariates included age, race, sex, treatment interval, treatment vs. observation, delay interval, anti-VEGF agent, baseline subretinal fluid, intraretinal fluid, and geographic atrophy, prior PDT, and smoking status. Results : 161 eyes encompassing 2,555 ophthalmology encounters were selected. An initial model without addition of time varying or baseline predictors show a daily change in BCVA of 0.00151 logMAR (p = 0.05) over the study period. The pre-closure BCVA daily change was lower than the post-closure suggesting vision dropped at a faster rate after care delay, however this was not statistically significant (Figure 1). With time varying and baseline covariates added, intraretinal fluid status at baseline was the only statistically significant factor that predicted a larger BCVA slope (p=0.05). Conclusions : Initial data suggests that BCVA fell during the time period, but there was no significant difference between the pre-closure and post-closure data. Patients with intraretinal fluid at baseline may potentially have worse long-term visual outcomes if care is delayed. Further model refinement needs to be undertaken prior to any definite conclusions. (Figure Presented).

5.
Investigative Ophthalmology and Visual Science ; 63(7):209-F0056, 2022.
Article in English | EMBASE | ID: covidwho-2057894

ABSTRACT

Purpose : Age-related macular degeneration (AMD) is projected to affect an average of 1.23 million individuals by the 2050. Whilst anti-VEGF treatment for neovascular AMD (nvAMD) is considered the current gold-standard care, this requires regular monitoring and treatment delivery which causes increased capacity challenges. This, along with the current COVID-19 pandemic, have highlighted the need for efficient and safe ways to diagnose and manage nvAMD. The use of artificial intelligence (AI) in medical care has the potential to alleviate some of this projected pressure facing eye clinics. Previous research has shown that AI has comparable sensitivity and specificity to clinicians in identifying ocular disorders from retinal images. The purpose of the current study was to develop and AI model to identify active from inactive nvAMD disease from retinal SD-OCT images. Methods : Using Google's Vision AutoML software, 1058 Heidelberg SD-OCT images were identified and labelled as either showing nvAMD activity or inactivity. All images were uploaded to Google's cloud storage and automatically assigned two bounding-box labels;1 label capturing the entire Heidelberg SD-OCT image, including the raster and b-scan, with the second capturing the b-scan only. All labels were automatically allocated to either a train, validate or test group based on an 80:10:10 ratio set by the software. Results : Of the 1058 images, a total of 2116 labels were assigned, 1012 showing active and 1104 showing inactive nvAMD. Performance of the AI model revealed an area under the precision recall curve (AUPRC) of 0.84 at a threshold of 0.5, specificity of 40.98% and sensitivity of 95.24%. For the active-only images, the specificity was 34.28% with a sensitivity of 97%. For the inactive-only images, the specificity was 51% with a sensitivity of 92.73%. Conclusions : Utilising Google's AutoML AI software, this model is able to correctly identify active nvAMD from Heidelberg SD-OCT images with a high level of sensitivity and good overall AUPRC.

6.
Investigative Ophthalmology and Visual Science ; 63(7):331-F0162, 2022.
Article in English | EMBASE | ID: covidwho-2057745

ABSTRACT

Purpose : The COVID-19 Pandemic has disrupted the care of patients receiving intravitreal injections for neovascular age-related macular degeneration (nAMD). This study looks at the factors that affected visit adherence for this population of patients during the height of the first pandemic surge. Methods : In this retrospective, observational, case-control study, we included nAMD patients receiving anti-VEGF injections with an appointment scheduled during the target periods of March 11, 2020-May 26, 2020 at either an urban hospital-based or suburban eye clinic. Patients who did not present for their appointment (cases) were compared to patients who did present to their appointment (controls). Medical records were reviewed to collect age, sex, race, presence of appointment attendance, language, marital status, distance from clinic, and area of deprivation index (ADI), which is a measure of socioeconomic health. Multivariate regression models were created with Stata (College Station, Texas) to determine the differences of these factors between no-show and show groups. Results : 115 no-show patients (21% male, mean age 81 years) and 129 controls (26 % male, mean age 80.9 years) were enrolled. The odds of no-show were higher in non-White patients compared to White [(odds ratio (OR) = 2.7, 95% Confidence Interval (CI) = 1.22- 6.17, P = 0.01)], the urban site compared to suburban site (OR = 3.1, 95% CI = 1.70-5.76, P = 0.0001) and single patients compared to married (OR = 2.3, 95% CI = 1.09-4.89, P = 0.02) in univariate analysis. The associations remained significant in multivariate analysis for non-White patients (OR = 3.1, 95% CI = 1.30-6.88, P = 0.01) and urban site (OR = 4.3, 95% CI = 1.78-10.3, P = 0.001) after adjusting for age, gender, language, distance from clinic and ADI. Age, distance from clinic, gender, ADI, and language were not statistically different between the two groups. Conclusions : Visit adherence was lower for non-White patients during the first surge of the COVID-19 pandemic underlying the disparities which can be seen during the pandemic. Patients treated at an urban hospital were less likely to present for their anti-VEGF treatments than those receiving care in a suburban clinic. Further research is needed to determine whether differences in visit adherence effected long-term vision outcomes.

7.
Investigative Ophthalmology and Visual Science ; 63(7):1340-F0174, 2022.
Article in English | EMBASE | ID: covidwho-2057548

ABSTRACT

Purpose : During the COVID-19 pandemic, in line with the UK Royal College of Ophthalmologists' (RCOphth) guidelines, anti-VEGF treatment regimens for Neovascular Age Related Macular degeneration (nAMD) were adjusted to 8 weekly Aflibercept injections with no clinic review. New patients and those who mentioned a significant drop of vision during their injection visits had OCT and their management adjusted to 4 weekly injections. This work audits our practice at a tertiary university hospital during the 2020 pandemic. Methods : Retrospective electronic data was collected from the Medisoft ophthalmology database for patients with nAMD, who received Aflibercept over a 5 month period from 01.03.2020 to 01.08.2020. Best Corrected Visual Acuity (BCVA), Central Macular Thickness (CRT), and number of injections were collected, and compared with our previously published year one data of 225 treatment naïve eyes of 223 patients with nAMD, treated with 8 weekly Aflibercept with mean BCVA of 61 letters & mean CRT of 235 μm at month 5 of therapy. We also assessed the clinical outcomes of our patients who received 4 weekly Aflibercept injections. Statistical analysis was done using SPSS version 24. Results : 1778 eyes of 1427 patients met the inclusion criteria and were included in the study. 1338 patients (93.8%) received 8 weekly injections, their mean BCVA ± SD was 59.7 ± 17.3 with CRT of 239.3 μm ± 67.2 SD at baseline and their latest BCVA ± SD was 59.3 ± 17.4, with CRT of 231.8 μm ± 73.8 SD. More than one third of them 618 (43.3%) received three injections during that period. 89 of our patients (6.2%) received 4 weekly injections during our study period. Their mean BCVA ± SD was 60.5 ± 17.6 with CRT of 276.1 μm ± 96.4 SD at baseline and their latest BCVA ± SD was 62.3 ± 15.1, with CRT of 247.8 μm ± 49.0 SD. Conclusions : Reassuringly, during the COVID-19 pandemic, patients on a fixed 8 weekly Aflibercept pathway maintained their vision. Their mean BCVA & CRT were comparable to our pre-COVID audit outcomes with a treat and extend protocol. Patients on 4 weekly injections also maintained their vision during the pandemic. RCOphth COVID guidelines allowed AMD patients to receive effective therapy whilst minimizing time in hospitals and permitted ophthalmologists to do other COVID related tasks.

8.
Drug Development and Delivery ; 22(4):18-23, 2022.
Article in English | Scopus | ID: covidwho-2012508
9.
Value in Health ; 25(7):S552, 2022.
Article in English | EMBASE | ID: covidwho-1926734

ABSTRACT

Objectives: Optimal real-world outcomes in neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) require frequent and potentially burdensome visits for patients and their caregivers. This study aimed to understand the caregiver perspective on treatment burden, barriers and the impact of caregiving, with a particular focus on the demands of frequent anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection treatment. Methods: Caregivers of adult nAMD/DME patients treated with anti-VEGF injections were enrolled from 21 clinical sites in the USA, UK and Canada. Caregivers completed a cross-sectional survey comprising de novo questions and a self-reported outcome instrument. Results: Overall, 18 DME and 44 nAMD caregivers completed surveys. On average, caregivers provided care 4.3±3.0 days/week, 4.0±4.3 hours/day. Caregivers reported supporting patients on a diverse array of tasks including transportation to doctors' appointments, providing emotional support, and helping with shopping and household chores. Twelve (67%) DME and 30 (68%) nAMD caregivers reported at least one barrier that prevented patients from receiving treatment or attending visits. Barriers were mainly related to the COVID-19 pandemic restrictions, particularly preventing caregivers from accompanying patients to appointments, clinic/appointment factors (distance, difficulty in scheduling appointments, other medical appointments priority, appointment duration), and social/health related factors (caregiver’s availability, care recipient’s reduced mobility/physical limitations). Overall, 13/22 (59%) working caregivers reported an impact on work absenteeism due to helping with treatment appointments. Based on the Caregiver Reaction Assessment scores, caregivers experienced a moderate impact on schedule disruptions, and a milder impact on financial problems, lack of family support, health and self-esteem in relation to their caregiving situation. Conclusions: Caregivers devote significant time to caring for the recipient, with the greatest impact on caregiver schedule disruptions and absenteeism for those working. More durable treatments with longer intervals and fewer appointments may alleviate some of that burden.

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