Prevalence of Age-Related Macular Degeneration in Europe: The Past and the Future

Purpose Age-related macular degeneration (AMD) is a frequent, complex disorder in elderly of European ancestry. Risk profiles and treatment options have changed considerably over the years, which may have affected disease prevalence and outcome. We determined the prevalence of early and late AMD in Europe from 1990 to 2013 using the European Eye Epidemiology (E3) consortium, and made projections for the future. Design Meta-analysis of prevalence data. Participants A total of 42 080 individuals 40 years of age and older participating in 14 population-based cohorts from 10 countries in Europe. Methods AMD was diagnosed based on fundus photographs using the Rotterdam Classification. Prevalence of early and late AMD was calculated using random-effects meta-analysis stratified for age, birth cohort, gender, geographic region, and time period of the study. Best-corrected visual acuity (BCVA) was compared between late AMD subtypes; geographic atrophy (GA) and choroidal neovascularization (CNV). Main Outcome Measures Prevalence of early and late AMD, BCVA, and number of AMD cases. Results Prevalence of early AMD increased from 3.5% (95% confidence interval [CI] 2.1%–5.0%) in those aged 55–59 years to 17.6% (95%

HYPERREFLECTIVE RETINAL SPOTS AND VISUAL FUNCTION AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN CENTER-INVOLVING DIABETIC MACULAR EDEMA.

To assess and correlate early modifications in hyperreflective retinal spots (HRS), retinal sensitivity (RS), fixation stability, and best-corrected visual acuity (BCVA) after anti-vascular endothelial growth factor treatment in naive center-involving diabetic macular edema. METHODS: Cross-sectional comparative case-control series. Twenty diabetic patients underwent 3 consecutive intravitreal anti-vascular endothelial growth factor injections in the study eye (20 fellow eyes served as control), full ophthalmologic examination including spectral domain optical coherence tomography (Retinascan RS-3000; Nidek, Gamagori, Japan), and microperimetry (MP1; Nidek) at baseline (Visit-V1), 1 month after each injection (V2, V3, V4), and at 6 months (V5). Central retinal thickness, inner and outer retinal thickness, number of HRS, BCVA, RS, and bivariate contour ellipse area were evaluated by analysis of variance test with Bonferroni post hoc test. Correlation analyses were performed by Spearman correlation. RESULTS: In treated eyes, central retinal thickness and inner retinal thickness significantly decreased at V2, V3, V4 versus V1 (P < 0.03 at least for all); the mean number of HRS significantly decreased in both inner and outer retina at all follow-up visits versus V1 (P < 0.008 at least for all); mean RS and bivariate contour ellipse area remained statistically unchanged during the follow-up; BCVA significantly improved at V3, V4, and V5 versus V1 (P = 0.009 at least for all). In fellow eyes, central retinal thickness, HRS, RS, and BCVA did not change at any follow-up. The number of HRS correlated inversely with RS, directly with bivariate contour ellipse area, and not significantly with BCVA. CONCLUSION: A significant decrease in HRS in the retina after anti-vascular endothelial growth factor treatment is documented. A decrease in HRS correlates with functional parameters, specifically RS. New parameters may be used for treatment evaluation in center-involving diabetic macular edema

Autofluorescence Imaging in Age-Related Macular Degeneration Complicated by Choroidal Neovascularization. A Prospective Study

PURPOSE: To determine if integrity of the retinal pigment epithelium (RPE)/photoreceptor complex as assessed by autofluorescence imaging can be predicted on the basis of visual acuity (VA), size, or fluorescein angiographic characteristics of the lesion in the early stage of choroidal neovascularization in age-related macular degeneration (AMD). DESIGN: Prospective, observational, consecutive case series. PARTICIPANTS: Seventy-nine eyes of 78 patients with untreated early-stage subfoveal neovascular AMD. METHODS: Digital color fundus photography and fluorescein angiography were carried out by certified photographers using the same camera throughout the study. Confocal scanning laser ophthalmoscopy images were obtained using a retinal angiograph. Autofluorescence images were compared with digital fluorescein angiography and fundus color photographs using IMAGEnet. MAIN OUTCOME MEASURES: Autofluorescence at the macula was correlated with VA, angiographic lesion characteristics, lesion size, and length of symptoms. RESULTS: Of the 79 eyes studied, 40 had classic and predominantly classic choroidal neovascularization, 10 had minimally classic, 29 had occult, 75 were subfoveal, and 4 were juxtafoveal. In 54 eyes, autofluorescence was continuous at the central macula, and this correlated significantly with VA, lesion size, and symptom length but not choroidal neovascularization type. However, there was considerable overlap between the 2 groups such that the integrity of RPE autofluorescence could not be predicted on the basis of these criteria. CONCLUSION: Intact autofluorescence at the macula in early choroidal neovascularization correlates with VA, lesion size, and symptom length but not lesion type. None predict with any certainty the integrity of the outer retina. Our data suggest that the RPE/photoreceptor complex may be intact at the macula for several months in the presence of choroidal neovascularization, suggesting that VA might be rescued if treatment were effective in suppressing neovascular growth without damaging the RPE/retina complex, although this remains to be tested. It would be sensible to assess autofluorescence in treatment protocols to test this concept because it may be a marker for earlier disease and predict outcomes of treatment

Confocal scanning laser ophthalmoscope in the retromode imaging modality in exudative age-related macular degeneration.

Abstract PURPOSE: To evaluate the ability of confocal scanning laser ophthalmoscope (cSLO) in the retromode imaging modality in detecting retinal changes secondary to exudative age-related macular degeneration (AMD). METHODS: Seventeen eyes of 13 consecutive patients affected by CNV secondary to AMD were evaluated with optical coherence tomography (OCT) to detect neuroretinal detachment (NRD), pigment epithelial detachment (PED), cystoid macular edema (CME), and epiretinal membranes (ERM). All eyes were examined with a cSLO equipped with infrared retromode (RM) imaging modality. Infrared and fundus autofluorescence images were also obtained (IR and FAF). The intermethod agreement between OCT and cSLO was evaluated considering single cSLO imaging modality separately (IR, FAF, and RM), and all imaging modalities together. RESULTS: Eight eyes (47 %) had NRD at OCT; intermethod agreement was poor for any single cSLO imaging modality considered separately (k: 0.14, 0.01, and 0.29 for cSLO IR, FAF, and RM, respectively). Four eyes had PED at OCT (24 %); intermethod agreement was mild for cSLO RM, poor for IR and FAF (k: 0.51, 0.16, and 0.00, respectively). CME was present in eight eyes (47 %); intermethod agreement was excellent for cSLO RM, poor for IR and FAF (k: 0.88, 0.38, and 0.26, respectively). ERM was present in three eyes (18 %); intermethod agreement was mild for cSLO IR, poor for FAF, and excellent for RM (k: 0.59, 0.00, and 0.76, respectively). CONCLUSIONS: cSLO RM imaging is a useful and reproducible technique in detecting retinal features associated with CNV, particularly CME

Short wavelenght fundus autofluorescence versus near-infrared fundus autofluorescence, with microperimetric correspondance, in patients with geographic atrophy due to age-related macular degeneration

Abstract AIM: To compare standard short-wavelength fundus autofluorescence (SW-FAF) and near infrared-wavelength fundus autofluorescence (NIR-FAF) in detecting geographic atrophy (GA) secondary to age-related macular degeneration, and its retinal sensitivity impairment. METHODS: Twenty-five consecutive patients (36 eyes) affected by GA were studied by means of fundus autofluorescence imaging, using both SW-FAF (excitation: 488 nm, emission >500 nm) and NIR-FAF (excitation: 787 nm, emission >800 nm). All patients underwent microperimetry to assess fixation characteristics and retinal sensitivity. RESULTS: In the extrafoveal region, the total hypoautofluorescent (hypo-FAF) area was significantly wider with NIR-FAF than with SW-FAF (8.03\ub16.68 mm(2) vs 7.37\ub16.34 mm(2) respectively; p=0.005). In the foveal area, the total hypo-FAF area was smaller with NIR-FAF than with SW-FAF (0.19\ub10.03 mm(2) versus 0.42\ub10.12 mm(2) respectively; p=0.008). Foveal sparing was larger at NIR-FAF compared with SW-FAF (p=0.021). In nine cases (25%) the site of fixation was hypoautofluorescent on SW-FAF, but normal on NIR-FAF with preserved retinal sensitivity. CONCLUSIONS: Standard SW-FAF may overestimate GA in the foveal area, correctly detected by NIR-FAF. In the extrafoveal area, SW-FAF may underestimate GA. Standard SW-FAF should be integrated with NIR FAF when detecting and following GA to avoid inconsistent results and misinterpretation, from both a morphological and functional perspective. Microperimetry helps to quantify retinal sensitivity in GA

Diabetic Retinopathy Screening Using an Expert System with an Operator-Free Nidek Orion Fundus Camera

Worldwide, 240 million people have diabetes with 50% unaware of their condition. An estimated 2.5 million have diabetic retinopathy (DR), which is the leading cause of adult blindness. Fundus photography reading centers are overwhelmed by the growing number of DR cases to review. This study describes an automated artificial intelligence (AI) system that screens for DR. Subjects were recruited from the patient population at a medical university diabetes clinic. Dilated eyes (359 non- DR & 18 DR) and undilated eyes (130 non-DR & 11 DR) were used. Non-DR included normal and diabetic subjects with normal retinas or non-visually threatening (VT) disease. DR included only cases of VT disease. Cases in which retinal imaging was impossible (e.g., severe cataracts) were excluded from the study. A Nidek Orion non-mydriatic automated fundus camera (Nidek Technologies, srl, Padova, Italy) recorded 5 overlapping fundus fields that were combined into a single 45\ub0 mosaic image. Canon fundus photographs were also acquired at the same clinic visit using a 3-field modified ETDRS pattern. The Canon images were later screened by a human expert at a major fundus photography reading center to serve as a comparative gold standard. The Orion mosaic images were processed for contrast enhancement and passed through an analysis routine that extracted the location, size, and shape of bright and dark blobs. This information was passed to an Expert System that determined if DR was present and if it was VT or non-VT based on location and size. Only VT results were flagged for DR output. Results of the Expert System were then compared to the gold standard using the same criteria. Dilated eyes had 78.6% accuracy, 94.4% sensitivity, and 78.8% specificity, while undilated eyes had 98.2% accuracy, 90.9% sensitivity, and 98.7% specificity in screening. Additional tuning is needed to reduce VT-like artifacts seen with pupil dilation. This Expert System is an effective step toward mass screening of undilated subjects with a risk for VT DR. The AI software can be contained within the Orion, providing rapid analysis and avoiding concerns about data integrity and patient privacy that are associated with telemedicine methods. The expert system distinguishes the referable VT DR from non-VT cases, thus saving time and improving the management of this blinding eye disease