Alex Mao

Comparison of outcomes after switching treatment from intravitreal bevacizumab to ranibizumab in neovascular age-related macular degeneration

OBJECTIVEnTo compare visual acuity and central retinal thickness in patients initially treated with bevacizumab (Avastin) and switched to ranibizumab (Lucentis) for neovascular age-related macular degeneration (AMD).nnnDESIGNnA retrospective chart review.nnnPARTICIPANTSnThis study included 87 eyes from 80 patients over the age of 65 with neovascular AMD.nnnMETHODSnPatients were initially treated with bevacizumab injections every 6 weeks and then switched to ranibizumab every 4 weeks when it became publicly funded by the Ontario government. Outcomes include comparison of visual acuity and central retinal thickness after bevacizumab treatment, and after switching to ranibizumab.nnnRESULTSnVisual acuity improved significantly versus initial baseline values following a treatment course of 3 or more injections of bevacizumab (0.58 logMar, SD = 0.30 vs 0.73 logMar, SD = 0.41; p = 0.0007). Patients then showed a further significant improvement in visual acuity after switching and receiving a course of ranibizumab (0.51 logMar, SD = 0.32) (p = 0.0122). Mean central retinal thickness as measured by optical coherence tomography significantly decreased after a course of bevacizumab (p = 0.0158), and a further decrease was noted after a subsequent course of ranibizumab (p < 0.0001).nnnCONCLUSIONSnThere was a significant improvement in visual acuity and central retinal thickness in patients with neovascular AMD initially treated with bevacizumab. When these patients were uniformly switched to ranibizumab there was a further significant improvement in visual acuity and a reduction of retinal thickness. It appears that ranibizumab can maintain, or improve the effect achieved after an initial course of bevacizumab.

Intravitreal ranibizumab for the treatment of fibrovascular pigment epithelial detachment in age-related macular degeneration

OBJECTIVEnTo determine the response of predominantly fibrovascular pigment epithelial detachments (PED)-type lesions (secondary to age-related macular degeneration [AMD]) to intravitreal ranibizumab.nnnDESIGNnThis was an open-label prospective study.nnnPARTICIPANTSnThirty-two patients with predominantly fibrovascular PED-type lesions secondary to AMD were included in this study. Three patients were excluded from the final analysis.nnnMETHODSnPatients received monthly intravitreal ranibizumab injections for 6 months (induction). At 6 months, patients not experiencing a visual improvement from baseline Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity or not showing a reduction in PED height (based on optical coherence tomography [OCT]) were deemed ranibizumab nonresponders and received no further injections but underwent re-evaluation at 12 months. Patients deemed responders continued with OCT-guided active treatment on an as-needed basis for an additional 6 months.nnnRESULTSnTwenty-four patients (82.8%) were ranibizumab responders and 5 were (17.2%) nonresponders. For ranibizumab responders, mean ETDRS visual acuity improved by 7.2 ± 9.8 letters at 6 months (p = 0.002) and 6.3 ± 8.6 letters at 12 months (p = 0.002). Ranibizumab nonresponders experienced a decline in mean visual acuity of 8.2 ± 4.6 letters at 6 months (p = 0.02) and 18.2 ± 10.11 letters at 12 months (p = 0.02). At baseline, responders had a mean PED height of 345.8 ± 96.0 μm, which decreased to 111.6 ± 133.2 μm at 6 months (p < 0.001) and had a slight increase at 12 months to 144.8 ± 146.3 μm (p < 0.001). Two responders (8.3%) and 2 nonresponders (40%) developed retinal pigment epithelium tears while on treatment.nnnCONCLUSIONSnIntravitreal ranibizumab appears to be a well-tolerated treatment option for patients with fibrovascular PED. Further large-scale, prospective studies may assist in delineating the best treatment protocol.

Immediately sequential bilateral cataract surgery: a cost-effective procedure

OBJECTIVEnThe objective of this project was to perform a cost-effectiveness analysis (CEA) of immediately sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) to determine whether ISBCS represents an appropriate, cost-effective way to rapidly rehabilitate a patients visual impairment.nnnDESIGNnA systematic review followed by a primary economic analysis with computer-based econometric modeling.nnnPARTICIPANTSnNot applicable.nnnMETHODSnWe constructed a decision analytic model from the perspective of the public third-party payer (i.e., the Ministry of Health) to conduct a CEA of both surgeries, ISBCS and DSBCS. Cost data consisted of the costs of the surgery, intravitreal injections, medications, and drops, all of which were obtained from a comprehensive literature search and from records at St. Josephs Hospital, London, Ont. The effectiveness was measured by the utility values associated with visual acuity in the better seeing eye.nnnRESULTSnISBCS resulted in an incremental effectiveness of 0.08 utility at an incremental cost of

Factors affecting postoperative stereopsis in acquired nonaccommodative esotropia.

1607. Discounting the quality-adjusted life-years (QALYs) gained by an annual interest rate of 3% resulted in 0.932 QALYs gained. The cost-effectiveness of ISBCS was calculated to be

RETROSPECTIVE REVIEW OF LUCENTIS "TREAT AND EXTEND" PATTERNS AND OUTCOMES IN AGE-RELATED MACULAR DEGENERATION.

1431 per QALY gained. A 1-way sensitivity analysis was performed by varying costs, utility values, probabilities, and discounting rates. This analysis varied the incremental cost-effectiveness ratio but did not change the conclusion.nnnCONCLUSIONSnHealth economics assessment showed that, compared with DSBCS, ISBCS is a cost-effective procedure. This finding will be highly useful to policy-makers, decision-makers, clinicians, hospital administrators, and payers in making cost-efficient decisions.

Summary of Glaucoma Diagnostic Testing Accuracy: An Evidence-Based Meta-Analysis.

OBJECTIVEnTo identify and examine factors that affect postoperative binocularity in children diagnosed with acquired nonaccommodative esotropia (ANAET).nnnDESIGNnRetrospective chart review.nnnPARTICIPANTSnThirty-four pediatric patients who received surgery for ANAET by 1 surgeon (I.M.) at the Ivey Eye Institute, University of Western Ontario (London, Ont.).nnnMETHODSnA multivariate logistic regression analysis was performed to evaluate the effect of the following factors on achieving stereopsis postoperatively: age at onset of esotropia (AO), duration of misalignment (DOM), presence of A/V pattern, recent intermittency of esotropia, and presence of dense amblyopia.nnnRESULTSnForty-one percent of all patients achieved stereoacuity of 100 seconds of arc or better. AO was found to be the only factor significantly associated with postoperative stereopsis (adjusted odds ratio = 1.063, P<0.05). None of the children with AO who were younger than 30 months regained bifoveal fixation regardless of their DOM.nnnCONCLUSIONSnAge of onset appears to play a crucial role on postoperative functional outcome in children with ANAET. Delayed surgery in children with an age of onset beyond 30 months did not seem to be detrimental to regaining bifoveal fixation.

Preoperative Factors Affecting Stereopsis after Surgical Alignment of Acquired Partially Accommodative Esotropia

Purpose: To assess patterns and outcomes of a “Treat and Extend” dosing regimen of ranibizumab in patients with age-related macular degeneration. Methods: Three hundred and thirty two treatment-naive age-related macular degeneration patients starting therapy with ranibizumab between January 1, 2011, and June 30, 2012, at the Ivey Eye Institute were reviewed, and 79 met inclusion criteria. Patients on Treat and Extend dosing regimen underwent an induction phase with monthly injections and then moved onto an extension phase. Change in visual acuity and central retinal thickness during the induction and extension phases were recorded. Results: During the induction phase, patients had a significant gain in vision and decrease in central retinal thickness (+8.4 letters, P < 0.001 and −81.3 &mgr;m, P < 0.001). During the extension phase, patients did not have significant change in vision (−0.5 letters, P = 0.81) and did not have significant change in central retinal thickness (−11.5 &mgr;m, P = 0.17). The average extension interval between treatments was 47.7 days, with patients receiving an average of 8.6 injections per year. Cost analysis showed it cost US

Clinical effectiveness of currently available low-vision devices in glaucoma patients with moderate-to-severe vision loss

16,659 to treat 1 patient in the first year on Treat and Extend dosing regimen compared with US

Triamcinolone acetonide as adjunctive treatment to verteporfin in neovascular age-related macular degeneration: a prospective randomized trial.

20,614 on monthly dosing. Conclusion: Treat and Extend dosing regimen allows similar visual outcomes to monthly dosing, while reducing the total number of injections, visits, and overall cost.

Clinical effects of three types of silicone intubations in repairing lacerations of canaliculus

Background New glaucoma diagnostic technologies are penetrating clinical care and are changing rapidly. Having a systematic review of these technologies will help clinicians and decision makers and help identify gaps that need to be addressed. This systematic review studied five glaucoma technologies compared to the gold standard of white on white perimetry for glaucoma detection. Methods OVID® interface: MEDLINE® (In-Process & Other Non-Indexed Citations), EMBASE®, BIOSIS Previews®, CINAHL®, PubMed, and the Cochrane Library were searched. A gray literature search was also performed. A technical expert panel, information specialists, systematic review method experts and biostatisticians were used. A PRISMA flow diagram was created and a random effect meta-analysis was performed. Results A total of 2,474 articles were screened. The greatest accuracy was found with frequency doubling technology (FDT) (diagnostic odds ratio (DOR): 57.7) followed by blue on yellow perimetry (DOR: 46.7), optical coherence tomography (OCT) (DOR: 41.8), GDx (DOR: 32.4) and Heidelberg retina tomography (HRT) (DOR: 17.8). Of greatest concern is that tests for heterogeneity were all above 50%, indicating that cutoffs used in these newer technologies were all very varied and not uniform across studies. Conclusions Glaucoma content experts need to establish uniform cutoffs for these newer technologies, so that studies that compare these technologies can be interpreted more uniformly. Nevertheless, synthesized data at this time demonstrate that amongst the newest technologies, OCT has the highest glaucoma diagnostic accuracy followed by GDx and then HRT.