DELAYED FOLLOW-UP IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION TREATED UNDER UNIVERSAL HEALTH COVERAGE: Risk Factors and Visual Outcomes.
Angiogenesis Inhibitors
/ therapeutic use
Follow-Up Studies
Humans
Intravitreal Injections
Macular Degeneration
/ drug therapy
Ranibizumab
Retrospective Studies
Risk Factors
Tomography, Optical Coherence
/ methods
Universal Health Insurance
Vascular Endothelial Growth Factor A
Wet Macular Degeneration
/ diagnosis
Journal
Retina (Philadelphia, Pa.)
ISSN: 1539-2864
Titre abrégé: Retina
Pays: United States
ID NLM: 8309919
Informations de publication
Date de publication:
01 09 2022
01 09 2022
Historique:
pubmed:
4
5
2022
medline:
25
8
2022
entrez:
3
5
2022
Statut:
ppublish
Résumé
To report the rate of delayed follow-up visits (DFU), to identify risk factors of DFU, and to assess the impact of DFU on outcomes in neovascular age-related macular degeneration. This retrospective study included all patients with neovascular age-related macular degeneration (n = 1,291) treated with antivascular endothelial growth factor injections between January 2013 and December 2020 in 2 centers in Quebec, Canada. A DFU was defined as a delay of ≥4 weeks than scheduled. Visual outcomes, especially ≥15 letters loss, were reported. A total of 351 patients (27.2%) experienced ≥1 DFU. Odds were greater among older patients ( P = 0.005), patients treated at the hospital rather than the clinic ( P < 0.001), and patients with worse initial visual acuity ( P = 0.024). A DFU was associated with a mean visual acuity loss of 4.2 ± 13.4 letters ( P < 0.001) and an increased incidence of intraretinal fluid and subretinal fluid ( P = 0.001, P = 0.005) at 6 months despite resumption of injections. Central foveal thickness increased after DFU but returned to pre-DFU visit at 6 months. The DFU rate in patients with neovascular age-related macular degeneration treated under a universal health care system was around 27%. Delayed follow-up visits caused significant decreases in visual acuity and increases in intraretinal fluid and subretinal fluid on optical coherence tomography that did not recover after injections resumption despite normalization of central foveal thickness.
Sections du résumé
BACKGROUND/PURPOSE
To report the rate of delayed follow-up visits (DFU), to identify risk factors of DFU, and to assess the impact of DFU on outcomes in neovascular age-related macular degeneration.
METHODS
This retrospective study included all patients with neovascular age-related macular degeneration (n = 1,291) treated with antivascular endothelial growth factor injections between January 2013 and December 2020 in 2 centers in Quebec, Canada. A DFU was defined as a delay of ≥4 weeks than scheduled. Visual outcomes, especially ≥15 letters loss, were reported.
RESULTS
A total of 351 patients (27.2%) experienced ≥1 DFU. Odds were greater among older patients ( P = 0.005), patients treated at the hospital rather than the clinic ( P < 0.001), and patients with worse initial visual acuity ( P = 0.024). A DFU was associated with a mean visual acuity loss of 4.2 ± 13.4 letters ( P < 0.001) and an increased incidence of intraretinal fluid and subretinal fluid ( P = 0.001, P = 0.005) at 6 months despite resumption of injections. Central foveal thickness increased after DFU but returned to pre-DFU visit at 6 months.
CONCLUSION
The DFU rate in patients with neovascular age-related macular degeneration treated under a universal health care system was around 27%. Delayed follow-up visits caused significant decreases in visual acuity and increases in intraretinal fluid and subretinal fluid on optical coherence tomography that did not recover after injections resumption despite normalization of central foveal thickness.
Identifiants
pubmed: 35504012
doi: 10.1097/IAE.0000000000003512
pii: 00006982-202209000-00008
doi:
Substances chimiques
Angiogenesis Inhibitors
0
Vascular Endothelial Growth Factor A
0
Ranibizumab
ZL1R02VT79
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1693-1701Références
Congdon N, O'Colmain B, Klaver CC, et al. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004;122:477–485.
Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006;355:1419–1431.
Brown DM, Regillo CD. Anti-VEGF agents in the treatment of neovascular age-related macular degeneration: applying clinical trial results to the treatment of everyday patients. Am J Ophthalmol 2007;144:627–637.
Soares RR, Mellen P, Garrigan H, et al. Outcomes of eyes lost to follow-up with neovascular age-related macular degeneration receiving intravitreal anti-vascular endothelial growth factor. Ophthalmol Retina 2020;4:134–140.
Patel S, Sternberg P Jr. Association between visit adherence and visual acuity in neovascular age-related macular degeneration. JAMA Ophthalmol 2020;138:242–243.
Ramakrishnan MS, Yu Y, VanderBeek BL. Association of visit adherence and visual acuity in patients with neovascular age-related macular degeneration: secondary analysis of the comparison of age-related macular degeneration treatment trial. JAMA Ophthalmol 2020;138:237–242.
Obeid A, Gao X, Ali FS, et al. Loss to follow-up among patients with neovascular age-related macular degeneration who received intravitreal anti-vascular endothelial growth factor injections. JAMA Ophthalmol 2018;136:1251–1259.
Angermann R, Rauchegger T, Nowosielski Y, et al. Treatment compliance and adherence among patients with diabetic retinopathy and age-related macular degeneration treated by anti-vascular endothelial growth factor under universal health coverage. Graefes Arch Clin Exp Ophthalmol 2019;257:2119–2125.
Institut national de santé publique du Québec. Indice de défavorisation matérielle et sociale. 2021. Available at: https://www.inspq.qc.ca/defavorisation/indice-de-defavorisation-materielle-et-sociale . Accessed September 9, 2021.
Spaide R. Ranibizumab according to need: a treatment for age-related macular degeneration. Am J Ophthalmol 2007;143:679–680.
Cucinotta D, Vanelli M. Who declares COVID-19 a pandemic. Acta Biomed 2020;91:157–160.
Mehrotra A, Chernew ME, Linetsky D, et al. The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound Emerges. To the Point (Blog). Commonwealth Fund. 2020. Available at: https://doi.org/10.26099/ds9e-jm36 . Accessed May 19, 2020.
Ehlken C, Helms M, Böhringer D, et al. Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients. Clin Ophthalmol 2017;12:13–20.
Boulanger-Scemama E, Querques G, About F, et al. Ranibizumab for exudative age-related macular degeneration: a five year study of adherence to follow-up in a real-life setting. J Fr Ophtalmol 2015;38:620–627.
Droege KM, Muether PS, Hermann MM, et al. Adherence to ranibizumab treatment for neovascular age-related macular degeneration in real life. Graefes Arch Clin Exp Ophthalmol 2013;251:1281–1284.
Salive ME. Multimorbidity in older adults. Epidemiol Rev 2013;35:75–83.
Keisler-Starkey K, Bunch LN. Health Insurance Coverage in the United States: 2019. Washington, DC: Census U.S. Department of Commerce; 2021. Available at: https://www.census.gov/content/dam/Census/library/publications/2020/demo/p60-271.pdf . Accessed September 20, 2020.
Kim JH, Chang YS, Kim JW. Natural course of patients discontinuing treatment for age-related macular degeneration and factors associated with visual prognosis. Retina 2017;37:2254–2261.
Gianniou C, Dirani A, Jang L, Mantel I. Refractory intraretinal or subretinal fluid in neovascular age-related macular degeneration treated with intravitreal ranizubimab: functional and Structural Outcome. Retina 2015;35:1195–1201.
Schmidt-Erfurth U, Waldstein SM. A paradigm shift in imaging biomarkers in neovascular age-related macular degeneration. Prog Retin Eye Res 2016;50:1–24.
Waldstein SM, Wright J, Warburton J, et al. Predictive value of retinal morphology for visual acuity outcomes of different ranibizumab treatment regimens for neovascular AMD. Ophthalmology 2016;123:60–69.
Grunwald JE, Daniel E, Huang J, et al. Risk of geographic atrophy in the comparison of age-related macular degeneration treatments trials. Ophthalmology 2014;121:150–161.
Guymer RH, Markey CM, McAllister IL, et al. Tolerating subretinal fluid in neovascular age-related macular degeneration treated with ranibizumab using a treat-and-extend regimen: FLUID study 24-month results. Ophthalmology 2019;126:723–734.
Nguyen CL, Gillies MC, Nguyen V, et al. Characterization of poor visual outcomes of neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents. Ophthalmology 2019;126:735–742.
Westborg I, Albrecht S, Rosso A. Risk for low visual acuity after 1 and 2 years of treatment with ranibizumab or bevacizumab for patients with neovascular age-related macular degeneration. Retina 2017;37:2035–2046.
Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group; Martin DF, Martin DF, Maguire MG, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 2012;119:1388–1398.
Schmidt-Erfurth U, Kaiser PK, Korobelnik JF, et al. Intravitreal aibercept injection for neovascular age-related macular degeneration: ninety-six-week results of the VIEW studies. Ophthalmology 2014;121:193–201.
Sarwar S, Clearfield E, Soliman MK, et al. Aflibercept for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2016;2:CD011346.
Gamache P, Hamel D, Blaser C. L'indice de défavorisation matérielle et sociale: en bref. Institut national de santé publique du Québec. 2019. Available at: https://www.inspq.qc.ca/sites/default/files/santescope/indice-defavorisation/guidemethodologiquefr.pdf . Accessed September 12, 2021.