Economic burden of age-related macular degeneration in routine clinical practice: the RAMDEBURS study

Purpose: To describe and evaluate the main direct health costs, in routine clinical practice, of age-related macular degeneration (AMD) patients, from hospital perspective, in Spain. Methods: Retrospective, multicenter, and observational study conducted on five third-level Spanish hospitals, between December 2018 and December 2019. The study included patients who were diagnosed of AMD before December 2018. Direct healthcare costs were obtained from a Spanish database. Study variables included demographic and clinical variables, and resources, such as treatment, diagnostic tests, medical examination, and surgery. Among the 1414 screened AMD patients, 1164 patients were included. In the overall study patients, the total cost was €5,386,511.0, with a mean cost per patient of €4627.6 ± 2383.9. The largest cost items were diagnostic examinations (€2.832.902,0) and vascular endothelial growth factor inhibitors (anti-VEGF) treatment (€2.038.257,2). Bevacizumab was administered to 325 (27.9%) patients, ranibizumab to 328 (28.2%), and aflibercept to 626 (53.8%); 115 (10.7%) patients received two anti-VEGF treatments, while 90 (7.7%) did not receive any. Over the course of the study, a total of 6,057 anti-VEGF injections were administered, with a mean (95% confidence interval) of 4.8 (4.4-5.2) injections per patient. Regarding safety, 29 patients experience injection-related adverse events, among them 12 patients had cataract and 11 ones elevated intraocular pressure (IOP). The incidence of endophthalmitis was 0.5% (6/1164). Conclusions: AMD was associated with considerable healthcare costs for regional healthcare systems. Diagnostic examinations, particularly OCT examinations, and anti-VEGF treatment represented the largest cost items

A Randomized Study of Nutritional Supplementation in Patients with Unilateral Wet Age-Related Macular Degeneration

Carotenoides; Marcadors inflamatoris; Àcids grassos poliinsaturatsCarotenoides; Marcadores inflamatorios; Ácidos grasos poliinsaturadosCarotenoids; Inflammatory markers; Polyunsaturated fatty acidsThe purpose of this study is evaluate the efficacy and safety of medicinal products containing the original Age-Related Eye Disease group (AREDS) formulation at doses approved in Europe (EU, control group; n = 59) with a product that adds DHA, lutein, zeaxanthin, resveratrol and hydroxytyrosol to the formula (intervention group; n = 50). This was a multicenter, randomized, observer-blinded trial conducted in patients aged 50 years or older diagnosed with unilateral exudative Age related Macular Degeneration AMD. At month 12, the intervention did not have a significant differential effect on visual acuity compared with the control group, with an estimated treatment difference in Early Treatment Diabetic Retinopathy Study (ETDRS) of −1.63 (95% CI −0.83 to 4.09; p = 0.192). The intervention exhibited a significant and, in most cases, relevant effect in terms of a reduction in some inflammatory cytokines and a greater improvement in the fatty acid profile and serum lutein and zeaxantin concentration. In patients with unilateral wet AMD, the addition of lutein, zeaxanthin, resveratrol, hydroxytyrosol and DHA to the AREDS EU recommended doses in the short-term did not have a differential effect on visual acuity compared to a standard AREDS EU formula but, in addition to improving the fatty acid profile and increasing carotenoid serum levels, may provide a beneficial effect in improving the proinflammatory and proangiogenic profile of patients with AMD.The research was funded by Laboratorios Théa (Barcelona, Spain) and by research grants from the “Instituto de Salud Carlos III/European Regional Development Fund (ERDF)” and RD16/0008/0011, OFTARED: Enfermedades oculares: “Prevención, detección precoz, tratamiento y rehabilitación de las patologías oculares”

Improvement of Retinal Images Affected by Cataracts

Eye fundus images are used in clinical diagnosis for the detection and assessment of retinal disorders. When retinal images are degraded by scattering due to opacities of the eye tissues, the precise detection of abnormalities is complicated depending on the grading of the opacity. This paper presents a concept proof study on the use of the contrast limited adaptive histogram equalization (CLAHE) technique for better visualization of eye fundus images for different levels of blurring due to different stages of cataracts. Processing is performed in three different color spaces: RGB, CIELAB and HSV, with the aim of finding which one better enhances the missed diagnostic features due to blur. The experimental results show that some fundus features not observable by naked eye can be detected in some of the space color processed with the proposed method. In this work, we also develop and provide an online image process, which allows clinicians to tune the default parameters of the algorithm for a better visualization of the characteristics of fundus images. It also allows the choice of a region of interest (ROI) within the images that provide better visualization of some features than those enhanced by the processing of the full picture

Síndrome de toxicidad al nylon en la cirugía de la catarata: influencia en el astigmatismo postquirúrgico

Purpose: We want to analyze an infrequently complication of extracapsular cataract extractions (EEC) and insertions of posterior chamber IOL, characterized by limbus inflammation by nylon suture. Methods: We report 3 patients who underwent EEC (one person with both eyes) in our hospital. All the cases were connected with a nylon's monofilament suture and we realized the incision at the capilar cornea. Results: We observed a limbus inflammation in the area adjacent to the suture and the presence of a exudation around of the suture path. One of the patient (the person with both eyes) had more inflammation in the second eye. This process formed a relaxation of the suture and subsequent against-the-rule astigmatism was observed after the healing process. Culture and smear results were negative and the process finished with the usual therapy.Objetivo: Analizar una complicación poco frecuente tras la cirugía extracapsular de la catarata (EEC), como es la inflamación postoperatoria inducida por la sutura de nylon. Material y método: Presentamos tres casos de pacientes intervenidos de cataratas (uno de ellos bilateral) en los que se empleó Nylon 10/0 para suturar la incisión quirúrgica. En todos los casos la incisión se realizó en córnea capilar. Resultados: En el postoperatorio, observamos la aparición de una intensa reacción inflamatoria localizada en la zona adyacente a la sutura, con afectación de la misma. En el caso del paciente en el que se realizó una cirugía bilateral, la intensidad de la inflamación fue mayor y más temprana en el segundo ojo, como ya se ha descrito en la literatura consultada. Esto ocasionó un reblandecimiento de la herida que conllevó un astigmatismo en contra de la regla en todos los casos tratados. Los cultivos realizados (frotis y cultivos de las secreciones) fueron negativos, y el cuadro inflamatorio cedió con la instauración de corticoides tópicos, no siendo necesario retirar la sutura en ningún paciente

Relationships between Patient-Reported Outcome Measures and Clinical Measures in Naïve Neovascular Age-Related Macular Degeneration Patients Treated with Intravitreal Ranibizumab

Our objective was to evaluate changes in patient-reported outcome measures using the NEI-VFQ 25 questionnaire during a treat and extend regimen in naive neovascular Age-Related Macular Degeneration patients, and its correlation with anatomical and functional data. We conducted a prospective observational study. Patients underwent a treat and extend regimen with intravitreal ranibizumab for neovascular Age-Related Macular Degeneration. Initial response was evaluated at 4th month, and subsequently in every follow-up visit. If a clinical response was achieved, the injection interval was extended in two-week increments, up to a maximum of 12 weeks. Quality of life was assessed using the NEI-VFQ 25 questionnaire at baseline, 4th months, and 12th months. Patients were categorized as good or poor responders based on Best corrected visual acuity, central foveal thickness, intraretinal fluid, or subretinal fluid. Treatment with ranibizumab led to a significant improvement in quality of life, with a mean increase in NEI-VFQ 25 score of 4.27 points in the 12th month. No significant differences in improvement were observed between good and poor responders. Quality of life scores in neovascular Age-Related Macular Degeneration patients improved with intravitreal treatment regardless of the clinical response. The early response following the loading phase could indicate better quality of life after one year of treatment, with Best corrected visual acuity being the clinical parameter with the greatest influence on quality of life

A randomized study of nutritional supplementation in patients with unilateral wet age-related macular degeneration

The purpose of this study is evaluate the efficacy and safety of medicinal products containing the original Age-Related Eye Disease group (AREDS) formulation at doses approved in Europe (EU, control group; n = 59) with a product that adds DHA, lutein, zeaxanthin, resveratrol and hydroxytyrosol to the formula (intervention group; n = 50). This was a multicenter, randomized, observer-blinded trial conducted in patients aged 50 years or older diagnosed with unilateral exudative Age related Macular Degeneration AMD. At month 12, the intervention did not have a significant differential effect on visual acuity compared with the control group, with an estimated treatment difference in Early Treatment Diabetic Retinopathy Study (ETDRS) of −1.63 (95% CI −0.83 to 4.09; p = 0.192). The intervention exhibited a significant and, in most cases, relevant effect in terms of a reduction in some inflammatory cytokines and a greater improvement in the fatty acid profile and serum lutein and zeaxantin concentration. In patients with unilateral wet AMD, the addition of lutein, zeaxanthin, resveratrol, hydroxytyrosol and DHA to the AREDS EU recommended doses in the short-term did not have a differential effect on visual acuity compared to a standard AREDS EU formula but, in addition to improving the fatty acid profile and increasing carotenoid serum levels, may provide a beneficial effect in improving the proinflammatory and proangiogenic profile of patients with AMD.The research was funded by Laboratorios Théa (Barcelona, Spain) and by research grants from the “Instituto de Salud Carlos III/European Regional Development Fund (ERDF)” and RD16/0008/0011, OFTARED: Enfermedades oculares: “Prevención, detección precoz, tratamiento y rehabilitación de las patologías oculares”.Peer reviewe