Subretinal hemorrhages associated with age-related macular degeneration in patients receiving anticoagulation or antiplatelet therapy.

PURPOSE: To evaluate the incidence of and risk factors for subretinal hemorrhages in age-related macular degeneration (AMD) patients on anticoagulation or antiplatelet therapy. DESIGN: Retrospective, observational case series. METHODS: We retrospectively reviewed the medical and photographic records of 71 consecutive patients who sought treatment at our institution with acute subretinal hemorrhages complicating age-related macular degeneration. The size of the subretinal hemorrhage was measured in standardized Macular Photocoagulation Study disc areas. Data on the use of medications and medical indications for anticoagulation and antiplatelet therapy were obtained. RESULTS: Overall, patients receiving antithrombotic therapy had a significantly larger subretinal hemorrhage size (mean, 9.71 disc areas) than patients not receiving anticoagulant or antiplatelet therapy (mean, 2.99 disc areas). Subgroup analysis revealed that both antiplatelet (P < .0001) and anticoagulant therapy (P = .003) were associated with a significantly larger bleeding size. Moreover, subgroup analysis among patients with arterial hypertension revealed that individuals receiving antithrombotic therapy had a statistically significantly larger hemorrhage size than hypertensive patients who did not receive anticoagulants or antiplatelet agents (P < .0001). CONCLUSIONS: Our results indicate that anticoagulants and antiplatelet agents are strongly associated with the development of large subretinal hemorrhages in AMD patients. Moreover, arterial hypertension is a strong risk factor for large subretinal hemorrhages in AMD patients receiving anticoagulants or antiplatelet agents. Physicians should be aware of an increased risk of extensive subretinal hemorrhage in AMD patients when deciding on the initiation and duration of anticoagulant and antiplatelet therapy.

Time between symptom onset and assessment in age-related macular degeneration with subfoveal choroidal neovascularization.

BACKGROUND: Therapy delay in neovascular age-related macular degeneration (NV-AMD) is associated with risk of visual deterioration. METHODS: Retrospective cross section analysis including patients with NV-AMD who received fluorescein angiography (FA). The time elapsed from symptom onset to assessment was analysed in relation to different factors. Inclusion criteria were: age >50 years, symptom onset within 6 months before assessment, no previous AMD therapy, indication for vascular endothelial growth factor inhibitor treatment. RESULTS: Mean duration of symptoms was 2.272 +/- 1.683 months (n = 220); percentiles 25, 50, 75 and 90 corresponded to 1, 2, 3 and 5.383 months. A significant increase (p = 0.033) in mean symptom duration was found between age groups 65-74, 75-84 and over 84 years. Privately insured persons (assessment 1.242 +/- 1.060 months after symptom onset; n = 14) received FA 1.083 months earlier (p = 0.0089) than patients with a statutory health insurance (assessment 2.325 +/- 1.661 months after symptom onset; n = 194). CONCLUSION: In order to avoid progressive visual deterioration in patients with NV-AMD earlier assessment of these individuals should be aimed for.

Content quality of ophthalmic information on the internet.

PURPOSE: Little is known whether information about eye conditions on the Internet is complete and accurate to support patient or layman decision making. METHODS: Quality of content modules about age-related macular degeneration (AMD) was analyzed on 20 web sites. Content analysis covered 72 criteria in 11 groups. Each single criterion was rated with '1' or '0' (yes/no answer). RESULTS: The interrater reliability between two observers was almost perfect (kappa = 0.86). On average, 25.6% (+/-15.6) of the criteria were fulfilled. In the categories diagnostic procedures, therapy, preventive checkups, prevention and prognosis of AMD, only 12.7, 18.3, 20.0, 25.0 and 30.0%, respectively, of the required content was given. CONCLUSION: Our study shows, based upon the example of university eye hospitals, that the full potential to provide laymen with firsthand and up-to-date information has by far not yet been achieved. Further research is needed on how the Internet influences the communication between patient and ophthalmologist.

Transparency of information on eye diseases on the internet.

BACKGROUND: Transparency is an indicator of trustworthiness and quality of health information about eye diseases on the Internet. METHODS: 20 websites that contained information about eye diseases aimed at the general public were evaluated. A modified Afgis (Aktionsforum Gesundheitsinformationssystem/action forum health information system) project transparency checklist was used. RESULTS: On average, 6.15 +/- 1.68 criteria were fulfilled. All websites maintained separation between advertising and editorial content. Between 80 and 90% of the websites studied contained complete information about the provider, aims and target audience, and feedback from users. The criteria for privacy were met by 70% of websites, 40% met those for currency of content and data, 35% those for methods of quality assurance, 15% those for financing and sponsoring and 0% met the requirements for authors and sources of information. CONCLUSION: Visually impaired people benefit from transparency, because this facilitates accessibility to web-based health information. Hence, websites containing health information related to eye diseases should meet the demands of transparency.

Accessibility of health information on the internet to the visually impaired user.

PURPOSE: Web sites containing health information should be accessible to visually impaired persons. METHODS: 139 web sites containing medical information addressing laymen or patients were evaluated with respect to their accessibility. A quantitative checklist which is based upon the Web Content Accessibility Guidelines of the World Wide Web Consortium (W3C) was used. RESULTS: Only 18% (15 sites) achieved WAI (Web Accessibility Initiative) level A or AA. WAI level AA was reached by only 1% (1 site) of the web sites. None of the web sites reached level AAA; 82% of the assessed web sites offering consumer health information are not fully accessible to visually impaired persons. CONCLUSION: The accessibility of web-based health content to visually impaired users should be improved. Health information on the web should at least meet the requirements of priority 1 (level A), preferably priority 2 (level AA) of the W3C guidelines.

Topical nonsteroidal anti-inflammatory therapy in ophthalmology.

Topically applied nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in the management and prevention of ocular inflammation and cystoid macular edema related to cataract surgery and the maintenance of mydriasis during cataract surgery. Other common uses are the reduction of discomfort after refractive surgery or in allergic conjunctivitis. NSAIDs primarily act as cyclooxygenase inhibitors and thus reduce the formation of endogenous PGs. Today, several NSAIDs are commercially available: diclofenac, flurbiprofen, indomethacin, ketorolac and suprofen. At present the ophthalmologist has to make a decision between the use of topical corticosteroids, with their potential adverse effects, or of topical NSAIDs, with their possibly increased benefit, unknown effect on ocular pressure, wound healing and corneal tissue, higher costs and limited track record. However, the improvement of surgical techniques might support an increasing use of NSAIDs in the future. Preoperative anti-inflammatory treatment should be considered in eyes at a higher risk of developing severe postoperative inflammatory reactions. This decision has to be made carefully and has to be guided by the clinical circumstances, the spectrum of diagnosis and the individual benefit-risk ratio of each patient.

Functional magnetic resonance imaging in acute unilateral optic neuritis.

Despite good clinical criteria for diagnosing optic neuritis (ON), only a few techniques can precisely assess its impact on visual brain function. The authors studied whether functional magnetic resonance imaging (fMRI) of visual activation reliably reflects the cerebral consequences of acute unilateral ON, and how fMRI correlates with clinical function and visual evoked potentials (VEPs). Twenty ON patients, before and after steroid treatment, were compared to 20 controls. Each eye was stimulated separately with a checkerboard pattern reversing at 1, 2, 4, and 8 Hz. VEPs were recorded the same day. Initially, affected eye responses differed significantly from those of unaffected counterparts and controls in 12 patients. Post hoc classification by fMRI criteria was correct in approximately 85%. fMRI and VEP response parameters (as well as visual acuity) correlated significantly. The higher stimulation frequencies yielded greater fMRI responses from unaffected eyes, but not from affected eyes, in controls. The fMRI responses were quantifiable in every subject, whereas in 11 ON eyes, no VEPs were obtained during the acute stage. The authors conclude that fMRI is sensitive to the cerebral response alteration during ON and might therefore contribute to evaluating the temporal evolution of the visual functional deficit during recovery or therapy.