Robert P. Finger

Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration

Currently available evidence on predictors of anti-vascular endothelial growth factor (VEGF) treatment response in neovascular age-related macular degeneration was reviewed. No meta-analysis of results is possible because of a lack of controlled and randomized trials, varying treatment regimes and outcome measures used, as well as suboptimal reporting. For genetic factors, most evidence to date has been generated for single nucleotide polymorphisms (SNPs) in the complement factor H (CFH), and VEGF-A genes. Just under half of the SNPs assessed in the CFH gene and 15% of the SNPs assessed in the VEGF gene were found to be associated with visual outcomes or the number of injections required during follow-up. Some evidence suggests association of worse treatment outcomes as well as a younger age at treatment onset with an increasing number of risk alleles in known risk genes (CFH and ARMS2/HTRA1) and polymorphisms in the VEGF-A gene. Clinical factors such as higher age, a better visual acuity (VA), a larger choroidal neovascularization (CNV) lesion at baseline, and a delay between symptom onset and initiation of treatment of more than 3 weeks also impact outcomes. Conversely, a worse acuity at baseline predicted more gain in vision. Overall, patients presenting with good acuity at baseline were more likely to have good VA at follow up, but the gain afforded by treatment was impacted by a ceiling effect. Most available evidence suggests a strong association of clinical factors such as age, baseline VA, and CNV lesion size with anti-VEGF treatment outcomes. No behavioral factors such as smoking influence treatment outcomes. Based on the studies conducted so far, the evidence suggests that underlying genotype of known AMD risk associated genes or of the VEGF-A gene have a limited effect, whereas presenting clinical factors appear to be more important in determining treatment outcomes.

Incidence of Blindness and Severe Visual Impairment in Germany: Projections for 2030

PURPOSEnEstimates of the incidences of severe visual impairment and blindness (SVI/B) and their causes are key to good health service planning. Thus, the database of Germanys largest states blind registry was used to estimate current incidence rates (IR) and to project rates for Germany in 2010 and 2030.nnnMETHODSnThe sample consisted of 3328 blind/severely visually impaired individuals newly registered between 2000 and 2008. According to German law, SVI and B were defined as visual acuity equal to or below 20/1000 and 20/400, respectively, in the better seeing eye. Data of the reference population were stratified by age and sex and were used to estimate current IRs. Standardized IRs were estimated for Germany for 2010 and 2030 using national demographic projections.nnnRESULTSnAge-related macular degeneration (AMD) accounted for 50% of all incidence of SVI/B (5.56/100,000 personyears (PY), followed by glaucoma (15%; 1.65/100,000 PY) and diabetic eye disease (10%; 1.16/100,000 PY). All current IRs will rise by 2030, with the most pronounced increase in AMD. By 2030, a national AMD IR of 9.5/100,000 PY is expected, accounting for 57% of all incidence of SVI/B in Germany. The incidence of SVI/B in women will be more than twofold compared to men in 2030 (9187 vs. 3716 incident cases in 2030).nnnCONCLUSIONSnThere will be a dramatic increase of SVI/B by 2030 in Germany, leading to a substantial increase in the need for health and social service provision, with a focus on visually impaired elderly women.

Prevalence and causes of registered blindness in the largest federal state of Germany

Aim As no current estimates for the prevalence and causes of blindness in Germany are available, the database of Germanys largest welfare institution (covering 9.5 million people in the federal state of Northrhine) assessing eligibility for an allowance payable to blind people was used to investigate the prevalence and the specific causes of blindness and visual impairment. Methods Data from a representative sample of 5100 cases out of 20u2008365 cases were extracted, entered into an electronic database and statistically analysed. Blindness and severe vision impairment were defined as visual acuity equal to or below 20/1000 and 20/400, respectively, in the better-seeing eye. Results The mean age of the overall sample was 72±22u2005years and the mean visual acuity of the better seeing eye was 20/800. The prevalence of blindness and severe vision impairment in Northrhine was estimated to be 47.91 per 100u2008000 persons. Most registered visual impairment was due to age-related macular degeneration (AMD; 41%), followed by glaucoma (15%) and diabetic eye disease (10%). Sixty-five per cent of registered blind people were women, 56% of them over the age of 80u2005years. Registered children and teenagers had the relative worst visual acuity (hand movement) and patients with retinal dystrophies had the relative best visual acuity (20/200) within the whole cohort (p<0.001). Standardised prevalence of blindness and severe visual impairment for Germany is estimated to be 44.4/100.000 (57.94 for women and 30.78 for men). Conclusions Prevalence of blindness and severe vision impairment for Germany compare well to other European countries. AMD is the most prevalent cause of registered blindness and severe vision impairment, and prevalence in women is higher. Generally, prevalence increases with age. Provision of support and welfare services need to be organised accordingly.

The economic burden of visual impairment and blindness: a systematic review

Objectives Visual impairment and blindness (VI&B) cause a considerable and increasing economic burden in all high-income countries due to population ageing. Thus, we conducted a review of the literature to better understand all relevant costs associated with VI&B and to develop a multiperspective overview. Design Systematic review: Two independent reviewers searched the relevant literature and assessed the studies for inclusion and exclusion criteria as well as quality. Eligibility criteria for included studies Interventional, non-interventional and cost of illness studies, conducted prior to May 2012, investigating direct and indirect costs as well as intangible effects related to visual impairment and blindness were included. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement approach to identify the relevant studies. A meta-analysis was not performed due to the variability of the reported cost categories and varying definition of visual impairment. Results A total of 22 studies were included. Hospitalisation and use of medical services around diagnosis and treatment at the onset of VI&B were the largest contributor to direct medical costs. The mean annual expenses per patient were found to be US

The Impact of Diabetic Retinopathy and Diabetic Macular Edema on Health-Related Quality of Life in Type 1 and Type 2 Diabetes

purchasing power parities (PPP) 12u2005175–14u2005029 for moderate visual impairment, US

Knowledge, Attitudes and Practice of Diabetes in Rural Bangladesh: The Bangladesh Population Based Diabetes and Eye Study (BPDES)

PPP 13u2005154–16u2005321 for severe visual impairment and US

The impact of vision impairment on vision-specific quality of life in Germany.

PPP 14u2005882–24u2005180 for blindness, almost twofold the costs for non-blind patients. Informal care was the major contributor to other direct costs, with the time spent by caregivers increasing from 5.8u2005h/week (or US

The Impact of Successful Cataract Surgery on Quality of Life, Household Income and Social Status in South India

PPP 263) for persons with vision >20/32 up to 94.1u2005h/week (or US

Monthly Ranibizumab for Nonproliferative Macular Telangiectasia Type 2: A 12-Month Prospective Study

PPP 55u2005062) for persons with vision ≤20/250. VI&B caused considerable indirect costs due to productivity losses, premature mortality and dead-weight losses. Conclusions VI&B cause a considerable economic burden for affected persons, their caregivers and society at large, which increases with the degree of visual impairment. This review provides insight into the distribution of costs and the economic impact of VI&B.

Reticular Pseudodrusen and Their Association with Age-Related Macular Degeneration: The Melbourne Collaborative Cohort Study.

PURPOSEnTo assess the impact of diabetic retinopathy (DR) and diabetic macular edema (DME) on health-related quality of life (HRQoL) in type 1 and type 2 diabetes using the EuroQoL EQ-5D generic multi-attribute utility instrument (MAUI).nnnMETHODSnIn this cross-sectional study, 577 patients with diabetes were recruited from specialized eye clinics in Melbourne, Australia. Each patient underwent clinical, biochemical, and anthropometric assessments. The severity of combined DR and DME (no DR/DME; mild NPDR [nonproliferative DR (NPDR)] and/or mild DME; moderate NPDR and/or moderate DME; and vision-threatening DR (VTDR) (severe NPDR or PDR and/or severe DME) in the worse eye was calculated. EQ-5D utility measures were the main outcome. Because the distribution of the utility measures was skewed, independent associations were explored using multivariate quantile regression models (five quintiles, namely 15th, 30th, 45th, 60th, 75th) ranging from poorest to highest HRQoL.nnnRESULTSnMedian age of the participants was 66 years (range, 26-90 years). Of the 577 participants, 223 (38.7%) had no DR/DME, 35 (6.1%) had mild NPDR/DME, 127 (22.0%) had moderate NPDR/DME, and 192 (33.3%) had VTDR. In adjusted models, neither presence nor severity of DR/DME was significantly associated with any quantile of the EQ-5D. In contrast, the presence of diabetic complications (other than DR) (β = -0.153; SE = 0.052; P < 0.001), other nonocular comorbidities (β = -0.115; SE = 0.038; P < 0.01), and higher body mass index (β = -0.007; SE = 0.002; P < 0.001) were all associated with worse HRQoL.nnnCONCLUSIONSnUsing a generic MAUI, the EQ-5D, the authors found that the presence or severity of DR/DME and concomitant vision loss were not associated with any quantile of HRQoL. These findings suggest that the EQ-5D lacks sensitivity in assessing the impact of the severity of DR/DME on HRQoL parameters and that condition-specific instruments may better capture the full impact of the association.