49 results on '"Squirrell, David"'
Search Results
2. Nurse specialists for the administration of antivascular endothelial growth factor intravitreal injections
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Samalia, Priya, Garland, David, and Squirrell, David
- Published
- 2016
3. One-Year Anti-VEGF Therapy Outcomes in Diabetic Macular Edema Based on Treatment Intensity: Data from the Fight Retinal Blindness! Registry
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Miri, Admir, Fung, Adrian, Higueras, Alejandro, Invernizzi, Alessandro, Hamilton, Alex, Cohn, Amy, Vanderschueren, Ann, Wolff, Benjamin, Walid, Bougamha, Hennings, Charles, Chung, Charmaine, Hornsby, Chris, Rethati, Cinthia, Barthelmes, Daniel, Villoria, Daniel Velazquez, Squirrell, David, Chan, Derek, Chong, Elaine, Mangelschots, Els, Carreño, Ester, Baudin, Florian, Viola, Francesco, Lavid, Francisco Javier, Kok, Gerhard, Furness, Graham, Michel, Guillaume, Mack, Heather, Steiner, Helen, Mehta, Hemal, Reddie, Ian, Acton, James, Wells, Jane, Arnold, Jennifer, Suarez, Joel, Gilhotra, Jolly, Oday, Justin, Ceklic, Lala, Sararols, Laura, Manning, Les, Chow, Li Ping, OToole, Louise, Cordoves, Luis, Arrazola, Maite, Tena Sempere, María Eugenia, Navarro, Maria Pilar, Gillies, Mark, Morgan, Mark, Núñez, Marta Rodriguez, Weber, Michel, Castilla Marti, Miguel, de la Fuente, Miguel, Asencio Duran, Monica, Jaross, Nandor, Muñoz, Pablo Catalán, Carnota, Pablo, Lockie, Patrick, Beaumont, Paul, Hinchcliffe, Peter, Gabrielle, Pierre-Henry, Calvo, Pilar, Barnes, Rachel, Chalasani, Raj, Barry, Richard, Chong, Robert, Gallego-Pinazo, Roberto, Ferrier, Ross, Fraser-Bell, Samantha, Allieu, Sandrine, Wickremasinghe, Sanjeev, Tick, Sarah, Welch, Sarah, Moreno, Saturnino Manuel Gismero, Nothling, Simon, Aparicio-Sanchis, Sonia, Vujosevic, Stela, Young, Stephanie, Wan, Sue, Tan, Terence, Guillaumie, Tremeur, Daien, Vincent, Kheir, Wajiha, Valldeperas, Xavier, Louw, Zanne, Bashshur, Ziad, Hashimoto, Yohei, Kibret, Getiye Dejenu, Kheir, Wajiha Jurdi, O'Toole, Louise, and Creuzot-Garcher, Catherine
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- 2024
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4. Development and validation of a deep-learning model to predict 10-year atherosclerotic cardiovascular disease risk from retinal images using the UK Biobank and EyePACS 10K datasets
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Vaghefi, Ehsan, Squirrell, David, Yang, Song, An, Songyang, Xie, Li, Durbin, Mary K., Hou, Huiyuan, Marshall, John, Shreibati, Jacqueline, McConnell, Michael V., and Budoff, Matthew
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- 2024
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5. A multi-centre prospective evaluation of THEIA™ to detect diabetic retinopathy (DR) and diabetic macular oedema (DMO) in the New Zealand screening program
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Vaghefi, Ehsan, Yang, Song, Xie, Li, Han, David, Yap, Aaron, Schmeidel, Ole, Marshall, John, and Squirrell, David
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- 2023
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6. Changes in 12-month outcomes over time for age-related macular degeneration, diabetic macular oedema and retinal vein occlusion
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Bhandari, Sanjeeb, Nguyen, Vuong, Hunt, Adrian, Gabrielle, Pierre-Henry, Viola, Francesco, Mehta, Hemal, Manning, Les, Squirrell, David, Arnold, Jennifer, McAllister, Ian L., Barthelmes, Daniel, and Gillies, Mark
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- 2023
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7. Bevacizumab for diabetic macular oedema: one-year treatment outcomes from the Fight Retinal Blindness! Registry
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Bhandari, Sanjeeb, Squirrell, David, Nguyen, Vuong, Wang, Nancy, Wells, Jane M., Tan, Terence, Barnes, Rachel, Barry, Richard, Barthelmes, Daniel, and Gillies, Mark
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- 2022
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8. Ethnic differences on long term outcomes of polypoidal choroidal vasculopathy after predominantly bevacizumab monotherapy
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Yap, Aaron, Wang, Nancy, and Squirrell, David
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- 2022
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9. Validation of neuron activation patterns for artificial intelligence models in oculomics.
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An, Songyang and Squirrell, David
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SYSTOLIC blood pressure , *ARTIFICIAL intelligence , *RESEARCH personnel , *RETINA , *PHENOTYPES - Abstract
Recent advancements in artificial intelligence (AI) have prompted researchers to expand into the field of oculomics; the association between the retina and systemic health. Unlike conventional AI models trained on well-recognized retinal features, the retinal phenotypes that most oculomics models use are more subtle. Consequently, applying conventional tools, such as saliency maps, to understand how oculomics models arrive at their inference is problematic and open to bias. We hypothesized that neuron activation patterns (NAPs) could be an alternative way to interpret oculomics models, but currently, most existing implementations focus on failure diagnosis. In this study, we designed a novel NAP framework to interpret an oculomics model. We then applied our framework to an AI model predicting systolic blood pressure from fundus images in the United Kingdom Biobank dataset. We found that the NAP generated from our framework was correlated to the clinically relevant endpoint of cardiovascular risk. Our NAP was also able to discern two biologically distinct groups among participants who were assigned the same predicted systolic blood pressure. These results demonstrate the feasibility of our proposed NAP framework for gaining deeper insights into the functioning of oculomics models. Further work is required to validate these results on external datasets. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Association of retinal image-based, deep learning cardiac BioAge with telomere length and cardiovascular biomarkers.
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Vaghefi, Ehsan, SongyangAn, Corbett, Rini, and Squirrell, David
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- 2024
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11. A Multicountry Comparison of Real-World Management and Outcomes of Polypoidal Choroidal Vasculopathy: Fight Retinal Blindness! Cohort
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Chong Teo, Kelvin Yi, Squirrell, David M., Nguyen, Vuong, Banerjee, Gayatri, Cohn, Amy, Barthelmes, Daniel, Gemmy Cheung, Chui Ming, and Gillies, Mark
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- 2019
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12. Connexin43 hemichannel block protects against the development of diabetic retinopathy signs in a mouse model of the disease
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Mugisho, Odunayo O., Green, Colin R., Squirrell, David M., Bould, Sarah, Danesh-Meyer, Helen V., Zhang, Jie, Acosta, Monica L., and Rupenthal, Ilva D.
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- 2019
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13. Examination of alternative eGFR definitions on the performance of deep learning models for detection of chronic kidney disease from fundus photographs.
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An, Songyang, Vaghefi, Ehsan, Yang, Song, Xie, Li, and Squirrell, David
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CHRONIC kidney failure ,EPIDERMAL growth factor receptors ,DEEP learning ,CYSTATIN C - Abstract
Deep learning (DL) models have shown promise in detecting chronic kidney disease (CKD) from fundus photographs. However, previous studies have utilized a serum creatinine-only estimated glomerular rate (eGFR) equation to measure kidney function despite the development of more up-to-date methods. In this study, we developed two sets of DL models using fundus images from the UK Biobank to ascertain the effects of using a creatinine and cystatin-C eGFR equation over the baseline creatinine-only eGFR equation on fundus image-based DL CKD predictors. Our results show that a creatinine and cystatin-C eGFR significantly improved classification performance over the baseline creatinine-only eGFR when the models were evaluated conventionally. However, these differences were no longer significant when the models were assessed on clinical labels based on ICD10. Furthermore, we also observed variations in model performance and systemic condition incidence between our study and the ones conducted previously. We hypothesize that limitations in existing eGFR equations and the paucity of retinal features uniquely indicative of CKD may contribute to these inconsistencies. These findings emphasize the need for developing more transparent models to facilitate a better understanding of the mechanisms underpinning the ability of DL models to detect CKD from fundus images. [ABSTRACT FROM AUTHOR]
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- 2023
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14. Hyper‐reflective dots in optical coherence tomography imaging and inflammation markers in diabetic retinopathy.
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Mat Nor, Mohd N., Guo, Cindy X., Green, Colin R., Squirrell, David, and Acosta, Monica L.
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DIABETIC retinopathy ,OPTICAL coherence tomography ,GLIAL fibrillary acidic protein ,RETINAL imaging - Abstract
The aim of this study is to correlate small dot hyper‐reflective foci (HRF) observed in spectral domain optical coherence tomography (SD‐OCT) scans of an animal model of hyperglycaemia with focal electroretinography (fERG) response and immunolabelling of retinal markers. The eyes of an animal model of hyperglycaemia showing signs of diabetic retinopathy (DR) were imaged using SD‐OCT. Areas showing dot HRF were further evaluated using fERG. Retinal areas enclosing the HRF were dissected and serially sectioned, stained and labelled for glial fibrillary acidic protein (GFAP) and a microglial marker (Iba‐1). Small dot HRF were frequently seen in OCT scans in all retinal quadrants in the inner nuclear layer or outer nuclear layer in the DR rat model. Retinal function in the HRF and adjacent areas was reduced compared with normal control rats. Microglial activation was detected by Iba‐1 labelling and retinal stress identified by GFAP expression in Müller cells observed in discrete areas around small dot HRF. Small dot HRF seen in OCT images of the retina are associated with a local microglial response. This study provides the first evidence of dot HRF correlating with microglial activation, which may allow clinicians to better evaluate the microglia‐mediated inflammatory component of progressive diseases showing HRF. [ABSTRACT FROM AUTHOR]
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- 2023
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15. Quantification of Optical Coherence Tomography Angiography in Age and Age-Related Macular Degeneration Using Vessel Density Analysis
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Vaghefi, Ehsan, Hill, Sophie, Kersten, Hannah M., and Squirrell, David
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- 2020
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16. Detection of smoking status from retinal images; a Convolutional Neural Network study
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Vaghefi, Ehsan, Yang, Song, Hill, Sophie, Humphrey, Gayl, Walker, Natalie, and Squirrell, David
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- 2019
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17. Incidence, risk factors and outcomes of submacular haemorrhage with loss of vision in neovascular age-related macular degeneration in daily clinical practice: data from the FRB! registry
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Gabrielle, Pierre-Henry, Maitrias, Samuel, Nguyen, Vuong, Arnold, Jennifer J, Squirrell, David, Arnould, Louis, Sanchez-Monroy, Jorge, Viola, Francesco, O'Toole, Louise, Barthelmes, Daniel, Creuzot-Garcher, Catherine, Gillies, Mark, University of Zurich, and Gabrielle, Pierre-Henry
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10018 Ophthalmology Clinic ,610 Medicine & health ,2731 Ophthalmology - Published
- 2022
18. Use of public sector diabetes eye services in New Zealand 2006–2019: Analysis of national routinely collected datasets.
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Silwal, Pushkar Raj, Lee, Arier C., Squirrell, David, Zhao, Jinfeng, Harwood, Matire, Vincent, Andrea L., Murphy, Rinki, Ameratunga, Shanthi, and Ramke, Jacqueline
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PUBLIC sector ,EYE care ,MEDICAL screening ,DIABETES ,AGE groups ,MOSAIC viruses - Abstract
Objective: To assess diabetes eye service use in New Zealand among people aged ≥15 years by estimating service attendance, biennial screening rate, and disparities in the use of screening and treatment services. Methods: We obtained Ministry of Health data from the National Non-Admitted Patient Collection on diabetes eye service events between 1 July 2006 and 31 December 2019 and sociodemographic and mortality data from the Virtual Diabetes Register and linked these using a unique patient identifier (encrypted National Health Index). We 1) summarized attendance at retinal screening and ophthalmology services, 2) calculated biennial and triennial screening rate, 3) summarized treatment with laser and anti-VEGF and used log-binomial regression to examine associations of all of these with age group, ethnicity, and area-level deprivation. Results: In total, 245,844 people aged ≥15 years had at least one diabetes eye service appointment attended or scheduled; half of these (n = 125,821, 51.2%) attended only retinal screening, one-sixth attended only ophthalmology (n = 35,883, 14.6%) and one-third attended both (n = 78,300, 31.8%). The biennial retinal screening rate was 62.1%, with large regional variation (73.9% in Southern District to 29.2% in West Coast). Compared with NZ Europeans, Māori were approximately twice as likely to never receive diabetes eye care or to access ophthalmology when referred from retinal screening, 9% relatively less likely to receive biennial screening and received the fewest anti-VEGF injections when treatment was commenced. Disparities in service access were also present for Pacific Peoples compared to NZ Europeans, younger and older age groups compared to those aged 50–59 years and those living in areas with higher deprivation. Conclusions: Access to diabetes eye care is suboptimal, with substantial disparity between age groups, ethnicity groups, area level deprivation quintile and across districts. Efforts to improve access to and quality of diabetes eye care services must include strengthening data collection and monitoring. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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19. Three-year treatment outcomes of Aflibercept versus Ranibizumab for diabetic macular edema:: Data from the Fight Retinal Blindness! Registry
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Gabrielle, Pierre-Henry, Nguyen, Vuong, Creuzot-Garcher, Catherine, Arnold, Jennifer J, Mehta, Hemal, Duran, Mónica Asencio, Bougamha, Walid, Carreño, Ester, Viola, Francesco, Squirrell, David, Barthelmes, Daniel, Gillies, Mark, and University of Zurich
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10018 Ophthalmology Clinic ,Diabetic Retinopathy ,Recombinant Fusion Proteins ,Angiogenesis Inhibitors ,610 Medicine & health ,General Medicine ,Blindness ,2731 Ophthalmology ,Macular Edema ,Ophthalmology ,Receptors, Vascular Endothelial Growth Factor ,Treatment Outcome ,Ranibizumab ,Intravitreal Injections ,Diabetes Mellitus ,Humans ,Registries ,Retrospective Studies - Abstract
Compare the 3-year outcomes of ranibizumab versus aflibercept in eyes with diabetic macular edema in daily practice.This was a retrospective analysis of naive diabetic macular edema eyes starting intravitreal injections of ranibizumab (0.5 mg) or aflibercept (2 mg) from January 1, 2013 to December 31, 2017 that were collected in the Fight Retinal Blindness! Registry.We identified 534 eyes (ranibizumab-267 and aflibercept-267) of 402 patients. The adjusted mean (95% confidence interval) visual acuity change of +1.3 (-0.1 to 4.2) letters in the ranibizumab group and +2.4 (-0.2 to 5.1) letters (P = 0.001) in the aflibercept group at 3 years was not clinically different. However, the adjusted mean CST change seemed to remain significantly different throughout the 3-year period with higher reductions in favor of aflibercept (-87.8 [-108.3 to -67.4] µm for ranibizumab vs. -114.4 [-134.4 to -94.3] for aflibercept; P0.01). When baseline visual impairment was moderate (visual acuity ≤68 Early Treatment Diabetic Retinopathy Study letters), we found a faster improvement in visual acuity in eyes treated with aflibercept up until 18 months of treatment than eyes treated with ranibizumab, which then stayed similar until 36 months of treatment, whereas there was no apparent difference when baseline visual impairment was mild (visual acuity ≥69 Early Treatment Diabetic Retinopathy Study letters). The rate of serious adverse events was low.Aflibercept and ranibizumab were both effective and safe for diabetic macular edema over 3 years.
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- 2022
20. Incidence, Risk Factors and Outcomes of Submacular Hemorrhage with Loss of Vision in Neovascular Age-Related Macular Degeneration in Daily Clinical Practice: the Fight Retinal Blindness! Registry
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Gabrielle, Pierre-Henry, Nguyen, Vuong, Arnold, Jennifer, Squirrell, David, Arnould, Louis, Sanchez-Monroy, Jorge, Viola, Francesco, O'Toole, Louise, Barthelmes, Daniel, Creuzot Garcher, Catherine, Gillies, Mark C., and Julien, Sabine
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[SDV] Life Sciences [q-bio] ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,[SDV.MHEP.OS] Life Sciences [q-bio]/Human health and pathology/Sensory Organs - Published
- 2022
21. Automation of Macular Degeneration Classification in the AREDS Dataset, Using a Novel Neural Network Design.
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Xie, Li, Vaghefi, Ehsan, Yang, Song, Han, David, Marshall, John, and Squirrell, David
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MACULAR degeneration ,DISEASE risk factors ,CONVOLUTIONAL neural networks ,AUTOMATION ,RETINAL imaging - Abstract
Purpose: To create an ensemble of Convolutional Neural Networks (CNNs), capable of detecting and stratifying the risk of progressive age-related macular degeneration (AMD) from retinal photographs. Design: Retrospective cohort study. Methods: Three individual CNNs are trained to accurately detect 1) advanced AMD, 2) drusen size and 3) the presence or otherwise of pigmentary abnormalities, from macular centered retinal images were developed. The CNNs were then arranged in a "cascading" architecture to calculate the Age-related Eye Disease Study (AREDS) Simplified 5-level risk Severity score (Risk Score 0 – Risk Score 4), for test images. The process was repeated creating a simplified binary "low risk" (Scores 0– 2) and "high risk" (Risk Score 3– 4) classification. Participants: There were a total of 188,006 images, of which 118,254 images were deemed gradable, representing 4591 patients, from the AREDS1 dataset. The gradable images were split into 50%/25%/25% ratios for training, validation and test purposes. Main Outcome Measures: The ability of the ensemble of CNNs using retinal images to predict an individual's risk of experiencing progression of their AMD based on the AREDS 5-step Simplified Severity Scale. Results: When assessed against the 5-step Simplified Severity Scale, the results generated by the ensemble of CNN's achieved an accuracy of 80.43% (quadratic kappa 0.870). When assessed against a simplified binary (Low Risk/High Risk) classification, an accuracy of 98.08%, sensitivity of ≥ 85% and specificity of ≥ 99% was achieved. Conclusion: We have created an ensemble of neural networks, trained on the AREDS 1 dataset, that is able to accurately calculate an individual's score on the AREDS 5-step Simplified Severity Scale for AMD. If the results presented were replicated, then this ensemble of CNNs could be used as a screening tool that has the potential to significantly improve health outcomes by identifying asymptomatic individuals who would benefit from AREDS2 macular supplements. [ABSTRACT FROM AUTHOR]
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- 2023
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22. Neovascular age-related macular degeneration at treatment intervals of 14 weeks or greater
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Cornish, Elisa E, Nguyen, Vuong, Young, Stephanie, Fraser-Bell, Samantha, Guymer, Robyn, Squirrell, David, Barthelmes, Daniel, Gillies, Mark C, University of Zurich, and Cornish, Elisa E
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10018 Ophthalmology Clinic ,610 Medicine & health ,2731 Ophthalmology - Published
- 2021
23. One‐year real‐world outcomes of bevacizumab for the treatment of macular oedema secondary to retinal vein occlusion.
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Wang, Nancy, Hunt, Adrian, Nguyen, Vuong, Shah, Janika, Fraser‐Bell, Samantha, McAllister, Ian, Barthelmes, Daniel, Gillies, Mark, and Squirrell, David
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RETINAL vein occlusion ,MACULAR edema ,TREATMENT effectiveness ,BEVACIZUMAB ,VISUAL acuity - Abstract
Background: Bevacizumab is the only agent that many people can afford, yet there are only limited data on whether it improves macular oedema (MO) secondary to retinal vein occlusion (RVO) in real‐world clinical practice. Here we studied 12‐month real‐world treatment outcomes of bevacizumab for RVO‐related MO. Methods: This was a multicentre, observational study analysing 12‐month data from the Fight Retinal Blindness! (FRB) database. We studied treatment‐naïve eyes with MO secondary to RVO commencing bevacizumab therapy between June 2009 and June 2019. Visual acuity (VA) and central subfield thickness (CST) were measured at baseline, 6 and 12 months. The primary outcome was a change in VA from baseline to 12 months. Results: Two hundred and twenty treatment naive eyes were analyzed. The baseline VA for BRVO was better than CRVO (55.8 vs. 42.6 LogMAR letters) and this gap widened over the 12‐month period, with a 12‐month VA change of +14.0 (95% CI 11.1, 16.8) letters for BRVO and + 11.9 (95% CI 6.4, 17.4) for CRVO. The mean CST at baseline was 511 μm for BRVO and 627 μm for CRVO, falling at 12 months by −155 μm (−190, −121) in BRVO and −198 μm (−252, −145) in CRVO. The median number of injections for BRVO and CRVO completers was 7 (5, 9). Conclusions: Bevacizumab can be an effective treatment of RVO‐MO in a real‐world setting with outcomes approaching those reported by the seminal clinical trials. The functional and anatomical outcomes of intravitreal therapy were better for BRVO than CRVO. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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24. Incidence, risk factors and outcomes of submacular haemorrhage with loss of vision in neovascular age‐related macular degeneration in daily clinical practice: data from the FRB! registry.
- Author
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Gabrielle, Pierre‐Henry, Maitrias, Samuel, Nguyen, Vuong, Arnold, Jennifer J, Squirrell, David, Arnould, Louis, Sanchez‐Monroy, Jorge, Viola, Francesco, O'Toole, Louise, Barthelmes, Daniel, Creuzot‐Garcher, Catherine, and Gillies, Mark
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MACULAR degeneration ,POLYPOIDAL choroidal vasculopathy ,VISION disorders ,VASCULAR endothelial growth factors ,PROPORTIONAL hazards models ,HEMORRHAGE - Abstract
Purpose: The main purpose of the study was to report the estimated incidence, cumulative rate, risk factors and outcomes of submacular haemorrhage (SMH) with loss of vision in neovascular age‐related macular degeneration (nAMD) receiving intravitreal injections (IVT) of vascular endothelial growth factor (VEGF) inhibitor in routine clinical practice. Methods: Retrospective analysis of treatment‐naïve eyes receiving IVTs of VEGF inhibitors (ranibizumab, aflibercept or bevacizumab) for nAMD from 1 January 2010 to 31 December 2020 that were tracked the Fight Retinal Blindness! registry. Estimated incidence, cumulative rate and hazard ratios (HR) of SMH with loss of vision during treatment were measured using the Poisson regression, Kaplan–Meier survival curves and Cox proportional hazard models. Results: We identified 7642 eyes (6425 patients) with a total of 135 095 IVT over a 10‐year period. One hundred five eyes developed SMH with loss of vision with a rate of 1 per 1283 injections (0.08% 95% confidence interval [95% CI] [0.06; 0.09]). The estimated incidence [95% CI] was 4.6 [3.8; 5.7] SMH with loss of vision per year per 1000 treated patients during the study. The cumulative [95% CI] rate of SMH per patient did not increase significantly with each successive injection (p = 0.947). SMH cases had a mean VA drop of around 6 lines at diagnosis, which then improved moderately to a 4‐line loss at 1 year. Conclusions: Submacular haemorrhage (SMH) with loss of vision is an uncommon complication that can occur at any time in eyes treated for nAMD in routine clinical practice, with only limited recovery of vision 1 year later. [ABSTRACT FROM AUTHOR]
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- 2022
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25. A multi-center prospective evaluation of THEIA to detect diabetic retinopathy (DR) and diabetic macular edema (DME) in the New Zealand screening program
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Vaghefi, Ehsan, Yang, Song, Xie, Li, Han, David, and Squirrell, David
- Subjects
Image and Video Processing (eess.IV) ,FOS: Electrical engineering, electronic engineering, information engineering ,FOS: Physical sciences ,Medical Physics (physics.med-ph) ,Electrical Engineering and Systems Science - Image and Video Processing ,Physics - Medical Physics - Abstract
Purpose: to assess the efficacy of THEIA, an artificial intelligence for screening diabetic retinopathy in a multi-center prospective study. To validate the potential application of THEIA as clinical decision making assistant in a national screening program. Methods: 902 patients were recruited from either an urban large eye hospital, or a semi-rural optometrist led screening provider, as they were attending their appointment as part of New Zealand Diabetic Screening programme. These clinics used a variety of retinal cameras and a range of operators. The de-identified images were then graded independently by three senior retinal specialists, and final results were aggregated using New Zealand grading scheme, which is then converted to referable\non-referable and Healthy\mild\more than mild\vision threatening categories. Results: compared to ground truth, THEIA achieved 100% sensitivity and [95.35%-97.44%] specificity, and negative predictive value of 100%. THEIA also did not miss any patients with more than mild or vision threatening disease. The level of agreement between the clinicians and the aggregated results was (k value: 0.9881, 0.9557, and 0.9175), and the level of agreement between THEIA and the aggregated labels was (k value: 0.9515). Conclusion: Our multi-centre prospective trial showed that THEIA does not miss referable disease when screening for diabetic retinopathy and maculopathy. It also has a very high level of granularity in reporting the disease level. Since THEIA is being tested on a variety of cameras, operating in a range of clinics (rural\urban, ophthalmologist-led\optometrist-led), we believe that it will be a suitable addition to a public diabetic screening program., Word count: 3623 Figures: 3 Tables: 6 Supplementary Tables: 7
- Published
- 2021
26. COVID-19 pandemic lockdown international impact on nAMD, DME and RVO intravitreal therapy outcomes: Fight Retinal Blindness International registry
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Javier Zarranz-Ventura, Vuong Nguyen, Garcher, Catherine, Verbraak, Frank, Otoole, Louise, Invernizzi, Alessandro, Viola, Francesco, Squirrell, David, Barthelmes, Daniel, Gillies, Mark, Institut d'Investigacions Biomèdiques August Pi I Sunyer [Barcelona, Spain] (Hospital Clinic ), University of New South Wales [Sydney] (UNSW), Service d'Ophtalmologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Amsterdam UMC, Mater Private Healthcare Group, Luigi Sacco University Hospital [Milan], Greenlane Clinical Centre, University hospital of Zurich [Zurich], and Assoc Research Vision Ophthalmology Inc., Rockville (United States)
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genetic structures ,[SDV.MHEP.OS]Life Sciences [q-bio]/Human health and pathology/Sensory Organs ,eye diseases - Abstract
International audience; Purpose : To evaluate the impact of COVID-19 pandemic lockdown on the clinical outcomes of an international cohort of neovascular AMD (nAMD), diabetic macular edema (DME) and retinal vein occlusion (RVO) treated eyes in eight countries: Australia, France, Ireland, Italy, Netherlands, New Zealand, Spain and Switzerland.Methods : Multicenter international nAMD, DME and RVO database observational study. Data was internationally collected using a validated web-based tool (Fight Retinal Blindness! Project). Baseline visit was defined as the closest visit prior (up to 3 months) to the initial lockdown date, which differed by country. Pre- and post-lockdown periods were defined as 6 months prior and post-baseline visit. Data collected included: demographics, visual acuity (VA) in logarithm of the minimum angle of resolution (logMAR) ETDRS letters at baseline and pre- and post-baseline visits, number of injections and visits.Results : 5271 eyes of 4288 patients were included. In nAMD eyes (n=4240), mean VA change post-lockdown ranged from -0.3 to -3.3 letters, and the median number of injections/visits decreased from a pre-lockdown range of 4-5/4-7 to a range of 2-4/2-4 post-lockdown, respectively. In DME eyes (n=605), mean VA change ranged from -4 to +2.3 letters, and the median number of injections/visits decreased from a pre-lockdown range of 2-5/4-6.5 to 1-3/2-3. In RVO eyes (n=426), mean VA change ranged from -2.4 to +3 letters, and the median number of injections/visits decreased from a range of 3-7/4-7.5 to 1-6/2.5-6 post-lockdown. The dropout rates for the 6 months post-lockdown period were 34% for nAMD (n=1458), 43% for DME (n=264) and 44% for RVO (n=188). Study drugs included ranibizumab (33.5%,), aflibercept (50.9%) and bevacizumab (15.5%).Conclusions : This study provides accurate estimates of the impact of COVID-19 pandemic lockdown on the visual outcomes of an international cohort of eyes treated with intravitreal therapy. The data reported in this study may serve clinicians to prepare strategies to mitigate vision loss in future scenarios of the COVID-19 pandemic evolution.
- Published
- 2021
27. Outcomes of cataract surgery in eyes with diabetic macular oedema: Data from the Fight Retinal Blindness! Registry
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Bhandari, Sanjeeb, Biechl, Anne C, Nguyen, Vuong, Squirrell, David, Mehta, Hemal, Barthelmes, Daniel, Gillies, Mark C, University of Zurich, and Bhandari, Sanjeeb
- Subjects
10018 Ophthalmology Clinic ,610 Medicine & health ,2731 Ophthalmology - Published
- 2020
28. Assessing the accuracy of a large observational registry of neovascular age-related macular degeneration
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Nguyen, Vuong, Leung, King Fai Calvin, Nguyen, Chu Luan, Squirrell, David, Essex, Rohan, Arnold, Jennifer, Young, Stephanie, Barthelmes, Daniel, Gillies, Mark, and University of Zurich
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10018 Ophthalmology Clinic ,610 Medicine & health - Published
- 2020
29. Essentials of a Robust Deep Learning System for Diabetic Retinopathy Screening: A Systematic Literature Review
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Chu, Aan, Squirrell, David, Phillips, Andelka M., and Vaghefi, Ehsan
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Article Subject ,education - Abstract
This systematic review was performed to identify the specifics of an optimal diabetic retinopathy deep learning algorithm, by identifying the best exemplar research studies of the field, whilst highlighting potential barriers to clinical implementation of such an algorithm. Searching five electronic databases (Embase, MEDLINE, Scopus, PubMed, and the Cochrane Library) returned 747 unique records on 20 December 2019. Predetermined inclusion and exclusion criteria were applied to the search results, resulting in 15 highest-quality publications. A manual search through the reference lists of relevant review articles found from the database search was conducted, yielding no additional records. A validation dataset of the trained deep learning algorithms was used for creating a set of optimal properties for an ideal diabetic retinopathy classification algorithm. Potential limitations to the clinical implementation of such systems were identified as lack of generalizability, limited screening scope, and data sovereignty issues. It is concluded that deep learning algorithms in the context of diabetic retinopathy screening have reported impressive results. Despite this, the potential sources of limitations in such systems must be evaluated carefully. An ideal deep learning algorithm should be clinic-, clinician-, and camera-agnostic; complying with the local regulation for data sovereignty, storage, privacy, and reporting; whilst requiring minimum human input.
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- 2020
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30. Type 3 neovascularisation (retinal angiomatous proliferation) treated with antivascular endothelial growth factor: real-world outcomes at 24 months
- Author
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Invernizzi, Alessandro, Teo, Kelvin, Nguyen, Vuong, Daniell, Mark, Squirrell, David, Barthelmes, Daniel, Gillies, Mark C, University of Zurich, and Invernizzi, Alessandro
- Subjects
10018 Ophthalmology Clinic ,2809 Sensory Systems ,2804 Cellular and Molecular Neuroscience ,610 Medicine & health ,2731 Ophthalmology - Published
- 2019
31. Neovascular age‐related macular degeneration at treatment intervals of 14 weeks or greater.
- Author
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Cornish, Elisa E., Nguyen, Vuong, Young, Stephanie, Fraser‐Bell, Samantha, Guymer, Robyn, Squirrell, David, Barthelmes, Daniel, and Gillies, Mark C.
- Subjects
MACULAR degeneration ,VASCULAR endothelial growth factors ,POLYPOIDAL choroidal vasculopathy ,VASCULAR endothelial growth factor antagonists ,TREATMENT effectiveness ,INJECTIONS - Abstract
Background: We assessed the proportion of eyes with neovascular age‐related macular degeneration (nAMD) in routine clinical practice that reach ≥14 week treatment intervals and their outcomes. Method: We analysed data from the Fight Retinal Blindness! (FRB!) Project database, a prospectively designed registry of 'real‐world' outcomes. Treatment‐naive eyes starting vascular endothelial growth factor (VEGF) inhibitors for nAMD from 1st January 2006 were included. Eyes were defined to have reached the ≥14 week treatment interval if they received ≥2 consecutive injections at treatment intervals of ≥14 week but not exceeding 26 weeks. Outcomes were reported in a subgroup of eyes that had 12 months of follow‐up from reaching this interval. Results: Of the 3907 treatment‐naïve eyes that started treatment during the identified periods on a treat‐and‐extend regimen and received at least 8 injections over the first 2 years, 402 (10%) eyes received at least 2 consecutive injections at an interval of ≥14 week during their follow‐up. Fifty‐two percent of these eyes maintained vision to 12 months, however only 40% stayed at this interval and 25% of the lesions reactivated. Conclusion: We found that only 10% of eyes with nAMD were extended beyond a 13‐week injection interval and that over half had returned to a shorter interval by 12 months. Eyes that stayed at this extended treatment interval maintained stable vision. More data on the outcomes of eyes treated with intervals longer than 3 months are required to establish whether emerging VEGF inhibitors provide a more sustained effect than the currently available drugs. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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32. Proof‐of‐concept calculations to determine the health‐adjusted life‐year trade‐off between intravitreal anti‐VEGF injections and transmission of COVID‐19.
- Author
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Boyd, Matt J., Scott, Daniel A. R., Squirrell, David M., and Wilson, Graham A.
- Subjects
COVID-19 ,COVID-19 pandemic ,HEALTH care teams ,CHOROID diseases ,VISION disorders ,INFECTIOUS disease transmission ,LASER photocoagulation ,PROLIFERATIVE vitreoretinopathy - Abstract
Background: Clinical ophthalmological guidelines encourage the assessment of potential benefits and harms when deciding whether to perform elective ophthalmology procedures during the COVID‐19 pandemic, in order to minimize the risk of disease transmission. Method: We performed probability calculations to estimate COVID‐19 infection status and likelihood of disease transmission among neovascular age‐related macular degeneration patients and health‐care workers during anti‐VEGF procedures, at various community prevalence levels of COVID‐19. We then applied the expected burden of COVID‐19 illness and death expressed through health‐adjusted life‐years (HALYs) lost. We compared these results to the expected disease burden of severe visual impairment if sight protecting anti‐VEGF injections were not performed. Results: Our calculations suggest a wide range of contexts where the benefits of treatment to prevent progression to severe visual impairment or blindness are greater than the expected harms to the patient and immediate health care team due to COVID‐19. For example, with appropriate protective equipment the benefits of treatment outweigh harms when the chance of progression to severe visual impairment is >0.044% for all scenarios where COVID‐19 prevalence was 1/1000, even when the attack rate in the clinical setting is very high (5‐43%). Conclusion: Unless COVID‐19 prevalence is very high, the reduced disease burden from avoiding visual impairment outweighs the expected HALYs lost from COVID‐19 transmission. This finding is driven by the fact that HALYs lost when someone suffers severe visual impairment for 5 years are equivalent to nearly 400 moderate cases of infectious disease lasting 2 weeks each. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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33. Towards implementation of AI in New Zealand national diabetic screening program: Cloud-based, robust, and bespoke.
- Author
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Xie, Li, Yang, Song, Squirrell, David, and Vaghefi, Ehsan
- Subjects
ARTIFICIAL neural networks ,DIABETIC retinopathy ,MEDICAL coding ,PEOPLE with diabetes ,QUALITY assurance - Abstract
Convolutional Neural Networks (CNNs) have become a prominent method of AI implementation in medical classification tasks. Grading Diabetic Retinopathy (DR) has been at the forefront of the development of AI for ophthalmology. However, major obstacles remain in the generalization of these CNNs onto real-world DR screening programs. We believe these difficulties are due to use of 1) small training datasets (<5,000 images), 2) private and 'curated' repositories, 3) locally implemented CNN implementation methods, while 4) relying on measured Area Under the Curve (AUC) as the sole measure of CNN performance. To address these issues, the public EyePACS Kaggle Diabetic Retinopathy dataset was uploaded onto Microsoft Azure
™ cloud platform. Two CNNs were trained; 1 a "Quality Assurance", and 2. a "Classifier". The Diabetic Retinopathy classifier CNN (DRCNN) performance was then tested both on 'un-curated' as well as the 'curated' test set created by the "Quality Assessment" CNN model. Finally, the sensitivity of the DRCNNs was boosted using two post-training techniques. Our DRCNN proved to be robust, as its performance was similar on 'curated' and 'un-curated' test sets. The implementation of 'cascading thresholds' and 'max margin' techniques led to significant improvements in the DRCNN's sensitivity, while also enhancing the specificity of other grades. [ABSTRACT FROM AUTHOR]- Published
- 2020
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34. Multimodal Retinal Image Analysis via Deep Learning for the Diagnosis of Intermediate Dry Age-Related Macular Degeneration: A Feasibility Study.
- Author
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Vaghefi, Ehsan, Hill, Sophie, Kersten, Hannah M., and Squirrell, David
- Subjects
AGING ,ANGIOGRAPHY ,CLINICAL trials ,COMBINED modality therapy ,DIGITAL image processing ,PHOTOGRAPHY ,RETINA ,RETINAL degeneration ,PILOT projects ,OPTICAL coherence tomography ,DEEP learning - Abstract
Background and Objective. To determine if using a multi-input deep learning approach in the image analysis of optical coherence tomography (OCT), OCT angiography (OCT-A), and colour fundus photographs increases the accuracy of a CNN to diagnose intermediate dry age-related macular degeneration (AMD). Patients and Methods. Seventy-five participants were recruited and divided into three cohorts: young healthy (YH), old healthy (OH), and patients with intermediate dry AMD. Colour fundus photography, OCT, and OCT-A scans were performed. The convolutional neural network (CNN) was trained on multiple image modalities at the same time. Results. The CNN trained using OCT alone showed a diagnostic accuracy of 94%, whilst the OCT-A trained CNN resulted in an accuracy of 91%. When multiple modalities were combined, the CNN accuracy increased to 96% in the AMD cohort. Conclusions. Here we demonstrate that superior diagnostic accuracy can be achieved when deep learning is combined with multimodal image analysis. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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35. Cystoid macular oedema following cataract surgery: A review.
- Author
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Han, Jina V., Patel, Dipika V., Squirrell, David, and McGhee, Charles NJ.
- Subjects
CATARACT surgery ,RETINAL vein occlusion ,SURGICAL complications ,RETINAL surgery ,ETIOLOGY of diseases ,META-analysis ,VITRECTOMY - Abstract
Pseudophakic cystoid macular oedema (PCMO) remains a significant cause of compromised postoperative vision in contemporary cataract surgery. Well‐established risk factors include intraoperative complications such as posterior capsule rupture and preoperative factors including: diabetes mellitus, uveitis, retinal vein occlusion, epiretinal membrane. The role of topical glaucoma medications in PCMO continues to be debated. Current treatment strategies largely target suppression of inflammation. Topical NSAIDs remain the mainstay in prophylaxis and treatment of PCMO. Topical corticosteroids are commonly used as monotherapy or in combination with NSAIDs. Unfortunately, high‐quality trials are notably lacking for other PCMO treatment modalities such as: periocular corticosteroids, orbital floor triamcinolone, intravitreal triamcinolone, corticosteroid implants, intravitreal bevacizumab and pars‐plana vitrectomy. A lack of consistency in defining PCMO and resolution of PCMO explains why even large systematic reviews may come to contradictory conclusions. This review explores the varied contemporary evidence‐base in relation to the aetiology, diagnosis, prophylaxis and treatment of PCMO. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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36. Intravitreal pro-inflammatory cytokines in non-obese diabetic mice: Modelling signs of diabetic retinopathy.
- Author
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Mugisho, Odunayo O., Rupenthal, Ilva D., Squirrell, David M., Bould, Sarah J., Danesh-Meyer, Helen V., Zhang, Jie, Green, Colin R., and Acosta, Monica L.
- Subjects
DIABETIC retinopathy ,CYTOKINES ,HYPERGLYCEMIA treatment ,LABORATORY mice ,PEOPLE with diabetes ,HEALTH - Abstract
Diabetic retinopathy is a vascular disease of the retina characterised by hyperglycaemic and inflammatory processes. Most animal models of diabetic retinopathy are hyperglycaemia-only models that do not account for the significant role that inflammation plays in the development of the disease. In the present study, we present data on the establishment of a new animal model of diabetic retinopathy that incorporates both hyperglycaemia and inflammation. We hypothesized that inflammation may trigger and worsen the development of diabetic retinopathy in a hyperglycaemic environment. Pro-inflammatory cytokines, IL-1β and TNF-α, were therefore injected into the vitreous of non-obese diabetic (NOD) mice. CD1 mice were used as same genetic background controls. Fundus and optical coherence tomography images were obtained before (day 0) as well as on days 2 and 7 after intravitreal cytokine injection to assess vessel dilation and beading, retinal and vitreous hyper-reflective foci and retinal thickness. Astrogliosis and microgliosis were assessed using immunohistochemistry. Results showed that intravitreal cytokines induced vessel dilation, beading, severe vitreous hyper-reflective foci, retinal oedema, increased astrogliosis and microglia upregulation in diabetic NOD mice. Intravitreal injection of inflammatory cytokines into the eyes of diabetic mice therefore appears to provide a new model of diabetic retinopathy that could be used for the study of disease progression and treatment strategies. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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37. Nurse specialists for the administration of anti-vascular endothelial growth factor intravitreal injections.
- Author
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Samalia, Priya, Garland, David, and Squirrell, David
- Published
- 2016
38. Topical non‐steroidal anti‐inflammatory drugs are not the mainstay of prophylaxis and treatment for pseudophakic cystoid macular oedema: Response.
- Author
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Han, Jina V., Patel, Dipika V., Squirrell, David, and McGhee, Charles N. J.
- Subjects
ANTI-inflammatory agents ,EDEMA ,THERAPEUTICS ,EYE drops ,META-analysis - Abstract
Topical non-steroidal anti-inflammatory drugs are not the mainstay of prophylaxis and treatment for pseudophakic cystoid macular oedema: Response We thank Levitz, Lim, Grzybowski and Kim, well-known and prolific correspondents on scientific publications, for their interest in, and kind comments upon, our recent publication[1] on pseudophakic cystoid macular oedema (PCMO); "The review article does allude to the challenges faced in providing advice on prophylaxis of PCMO" and "The authors have provided a significant review of a complex topic".[2] However, in relation to other comments, we feel the correspondents may have confused the semantics of what we believe is a balanced review, stating they would "Like to highlight several aspects of the quoted literature which may be misconstrued". Topical NSAIDs are not the mainstay of prophylaxis and treatment for pseudophakic cystoid macular oedema. [Extracted from the article]
- Published
- 2019
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39. One-Year Anti-VEGF Therapy Outcomes in Diabetic Macular Edema Based on Treatment Intensity: Data from the Fight Retinal Blindness! Registry.
- Author
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Mehta H, Gabrielle PH, Hashimoto Y, Kibret GD, Arnold J, Guillaumie T, Kheir WJ, Kok G, Vujosevic S, O'Toole L, Mangelschots E, Jaross N, Ceklic L, Daien V, Viola F, Squirrell D, Lavid FJ, Creuzot-Garcher C, Barthelmes D, and Gillies M
- Subjects
- Humans, Male, Female, Middle Aged, Follow-Up Studies, Treatment Outcome, Aged, Bevacizumab administration & dosage, Receptors, Vascular Endothelial Growth Factor administration & dosage, Receptors, Vascular Endothelial Growth Factor antagonists & inhibitors, Time Factors, Retrospective Studies, Recombinant Fusion Proteins administration & dosage, Macular Edema drug therapy, Macular Edema diagnosis, Macular Edema etiology, Diabetic Retinopathy drug therapy, Diabetic Retinopathy diagnosis, Diabetic Retinopathy complications, Angiogenesis Inhibitors administration & dosage, Intravitreal Injections, Visual Acuity, Registries, Vascular Endothelial Growth Factor A antagonists & inhibitors, Tomography, Optical Coherence methods, Ranibizumab administration & dosage
- Abstract
Purpose: To compare 1-year outcomes of eyes with diabetic macular edema (DME) treated in routine clinical practice based on the proportion of visits where intravitreal VEGF inhibitor injections were delivered., Design: Cohort study., Participants: There were 2288 treatment-naive eyes with DME starting intravitreal VEGF inhibitor therapy from October 31, 2015 to October 31, 2021 from the Fight Retinal Blindness! international outcomes registry., Methods: Eyes were grouped according to the proportion of visits at which an injection was received, Group A with less than the median of 67% (n = 1172) versus Group B with greater than the median (n = 1116)., Main Outcome Measures: Mean visual acuity (VA) change after 12 months of treatment., Results: The mean (95% confidence interval [CI]) VA change after 12 months of treatment was 3.6 (2.8-4.4) letters for eyes in Group A versus 5.2 (4.4-5.9) letters for eyes in Group B (P = 0.005). The mean (95% CI) central subfield thickness (CST) change was -69 (-76 to -61) μm and -85 (-92 to -78) μm for eyes in Group A versus Group B, respectively (P = 0.002). A moderate positive correlation was observed between the number of injections received over 12 months of treatment and the change in VA (P < 0.001). Additionally, eyes that received more injections had a moderately greater CST reduction., Conclusions: This registry analysis found that overall VA and anatomic outcomes tended to be better in DME eyes treated at a greater proportion of visits in the first year of intravitreal VEGF inhibitor therapy., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. All rights reserved.)
- Published
- 2024
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40. Three-Year Outcomes of VEGF Inhibitors in Naive Branch Retinal Vein Occlusion: Fight Retinal Blindness!
- Author
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Alforja S, Hunt A, Nguyen V, O'Toole L, Gabrielle PH, Invernizzi A, Mehta H, Ponsioen TL, Squirrell D, Casaroli-Marano RP, Barthelmes D, Gillies MC, and Zarranz-Ventura J
- Abstract
Purpose: To evaluate the 3-year outcomes of VEGF inhibitors in the treatment of cystoid macular edema due to branch retinal vein occlusion (BRVO) in an international multicenter cohort of eyes., Design: Multicenter, international, BRVO database study., Subjects: Seven hundred forty-seven patients (760 eyes) undergoing intravitreal therapy for BRVO for 3 years in a multicenter international setting., Methods: Demographics, visual acuity (VA) in logarithm of the minimum angle of resolution letters, central subfield thickness (CST), treatments, number of injections, and visits data was collected using a validated web-based tool., Main Outcome Measures: Visual acuity gain at 3 years in logarithm of the minimum angle of resolution letters. Secondary outcome measures included anatomical results, treatment pattern, and percentage of completers. A subgroup analysis by study drug was conducted for clinical outcomes., Results: Mean adjusted VA change was +11 letters (95% confidence interval 9-13), mean adjusted change in CST was -176 μm (-193, -159). Median number of injections/visits was 16 of 24 at 3 years of follow-up. Most eyes received VEGF inhibitors exclusively (89%, n = 677) and as a monotherapy in 71% (n = 538). Few eyes were switched to steroids (11%, n = 83). Suspensions in treatment >180 days occurred in 26% of study eyes. Aflibercept showed greater CST reductions (-147 vs. -128 vs. -114 μm; P < 0.001) and significantly lower switching rates (14% vs. 38% vs. 33%; P < 0.001) compared with ranibizumab and bevacizumab, respectively., Conclusions: This international study of 3-year BRVO outcomes after starting treatment with VEGF inhibitors found adequate visual and anatomical results in routine clinical care. Visual outcomes were similar among the different initiating VEGF inhibitors, although eyes starting with aflibercept had better anatomical outcomes and a lower switching rate., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024. Published by Elsevier Inc.)
- Published
- 2024
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41. THREE-YEAR TREATMENT OUTCOMES OF AFLIBERCEPT VERSUS RANIBIZUMAB FOR DIABETIC MACULAR EDEMA: Data from the Fight Retinal Blindness! Registry.
- Author
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Gabrielle PH, Nguyen V, Creuzot-Garcher C, Arnold JJ, Mehta H, Duran MA, Bougamha W, Carreño E, Viola F, Squirrell D, Barthelmes D, and Gillies M
- Subjects
- Angiogenesis Inhibitors therapeutic use, Blindness chemically induced, Humans, Intravitreal Injections, Ranibizumab therapeutic use, Receptors, Vascular Endothelial Growth Factor therapeutic use, Recombinant Fusion Proteins therapeutic use, Registries, Retrospective Studies, Treatment Outcome, Diabetes Mellitus, Diabetic Retinopathy complications, Diabetic Retinopathy diagnosis, Diabetic Retinopathy drug therapy, Macular Edema diagnosis, Macular Edema drug therapy, Macular Edema etiology
- Abstract
Purpose: Compare the 3-year outcomes of ranibizumab versus aflibercept in eyes with diabetic macular edema in daily practice., Methods: This was a retrospective analysis of naive diabetic macular edema eyes starting intravitreal injections of ranibizumab (0.5 mg) or aflibercept (2 mg) from January 1, 2013 to December 31, 2017 that were collected in the Fight Retinal Blindness! Registry., Results: We identified 534 eyes (ranibizumab-267 and aflibercept-267) of 402 patients. The adjusted mean (95% confidence interval) visual acuity change of +1.3 (-0.1 to 4.2) letters in the ranibizumab group and +2.4 (-0.2 to 5.1) letters (P = 0.001) in the aflibercept group at 3 years was not clinically different. However, the adjusted mean CST change seemed to remain significantly different throughout the 3-year period with higher reductions in favor of aflibercept (-87.8 [-108.3 to -67.4] µm for ranibizumab vs. -114.4 [-134.4 to -94.3] for aflibercept; P < 0.01). When baseline visual impairment was moderate (visual acuity ≤68 Early Treatment Diabetic Retinopathy Study letters), we found a faster improvement in visual acuity in eyes treated with aflibercept up until 18 months of treatment than eyes treated with ranibizumab, which then stayed similar until 36 months of treatment, whereas there was no apparent difference when baseline visual impairment was mild (visual acuity ≥69 Early Treatment Diabetic Retinopathy Study letters). The rate of serious adverse events was low., Conclusion: Aflibercept and ranibizumab were both effective and safe for diabetic macular edema over 3 years., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)
- Published
- 2022
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42. Patients Perceptions of Artificial Intelligence in Diabetic Eye Screening.
- Author
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Yap A, Wilkinson B, Chen E, Han L, Vaghefi E, Galloway C, and Squirrell D
- Subjects
- Artificial Intelligence, Delivery of Health Care, Humans, Mass Screening, Middle Aged, Surveys and Questionnaires, Diabetes Mellitus, Diabetic Retinopathy diagnosis
- Abstract
Purpose: Artificial intelligence (AI) technology is poised to revolutionize modern delivery of health care services. We set to evaluate the patient perspective of AI use in diabetic retinal screening., Design: Survey., Methods: Four hundred thirty-eight patients undergoing diabetic retinal screening across New Zealand participated in a survey about their opinion of AI technology in retinal screening. The survey consisted of 13 questions covering topics of awareness, trust, and receptivity toward AI systems., Results: The mean age was 59 years. The majority of participants identified as New Zealand European (50%), followed by Asian (31%), Pacific Islander (10%), and Maori (5%). Whilst 73% of participants were aware of AI, only 58% have heard of it being implemented in health care. Overall, 78% of respondents were comfortable with AI use in their care, with 53% saying they would trust an AI-assisted screening program as much as a health professional. Despite having a higher awareness of AI, younger participants had lower trust in AI systems. A higher proportion of Maori and Pacific participants indicated a preference toward human-led screening. The main perceived benefits of AI included faster diagnostic speeds and greater accuracy., Conclusions: There is low awareness of clinical AI applications among our participants. Despite this, most are receptive toward the implementation of AI in diabetic eye screening. Overall, there was a strong preference toward continual involvement of clinicians in the screening process. There are key recommendations to enhance the receptivity of the public toward incorporation of AI into retinal screening programs., Competing Interests: The authors have no other or conflicts of interest to declare., (Copyright © 2022 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.)
- Published
- 2022
- Full Text
- View/download PDF
43. Evaluation of the prevalence of non-diabetic eye disease detected at first screen from a single region diabetic retinopathy screening program: a cross-sectional cohort study in Auckland, New Zealand.
- Author
-
Ramachandran N, Schmiedel O, Vaghefi E, Hill S, Wilson G, and Squirrell D
- Subjects
- Aged, Cohort Studies, Cross-Sectional Studies, Humans, Mass Screening, Middle Aged, New Zealand epidemiology, Prevalence, Diabetes Mellitus, Diabetic Retinopathy diagnosis, Diabetic Retinopathy epidemiology
- Abstract
Objectives: To evaluate the prevalence of incidental non-diabetic ocular comorbidities detected at first screen in a large diabetic retinopathy (DR) screening programme., Design: Cross-sectional cohort study., Setting: Single large metropolitan diabetic eye screening programme in Auckland, New Zealand., Participants: Twenty-two thousand seven hundred and seventy-one participants who attended screening from September 2008 to August 2018., Results: Hypertensive retinopathy (HTR) was observed in 14.2% (3236/22 771) participants. Drusen were present in 14.0% participants under the age of 55 years, increasing to 20.5% in those 55 years and older. The prevalence of neovascular age-related macular degeneration (AMD) was 0.5% in participants aged<55 years, 2.4% in participants aged 55-75 years and 16% in participants aged>75 years. Retinal vein occlusion and retinal arterial embolus were prevalent in 0.7% and 0.02%, respectively, in participants aged<55 years, increasing to 2.2% and 0.4%, respectively, in those >75 years. Cataracts were common being present in 37.1% of participants over the age of 75 years. Only 386 individuals (1.7%) were labelled as glaucoma suspects. Geographic atrophy, epiretinal membrane, choroidal nevi and posterior capsular opacification had an increased prevalence in older individuals., Conclusions: Our data suggest that AMD, HTR and cataracts are routinely detected during DR screening. The incorporation of the detection of these ocular comorbidities during DR screening provide opportunities for patients to modify risk factors (smoking cessation and diet for AMD, blood pressure for HTR) and allow access to cataract surgery., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
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44. Risk Factors for Progression to Referable Diabetic Eye Disease in People With Diabetes Mellitus in Auckland, New Zealand: A 12-Year Retrospective Cohort Analysis.
- Author
-
Hill S, Mullins P, Murphy R, Schmiedel O, Vaghefi E, Ramke J, and Squirrell D
- Subjects
- Cohort Studies, Disease Progression, Humans, Mass Screening, New Zealand epidemiology, Retrospective Studies, Risk Factors, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 epidemiology, Diabetic Retinopathy epidemiology, Eye Diseases
- Abstract
Purpose: To evaluate the prevalence and risk factors for the development of any and referable diabetic eye disease in a multi-ethnic New Zealand population with diabetes mellitus attending a regional retinal screening service., Methods: Retrospective observational cohort study of people living with diabetes who attended the Auckland Regional Diabetic Retinal Screening Programme 2006-2018 inclusive (n = 41,786)., Results: Any retinopathy/maculopathy was present at first screening for 48.2% [95% confidence interval (CI): 45.8%-50.6%] / 37.8% (95% CI: 35.5%- 40.1%) of people with Type 1 and 25% (95% CI: 24.6%-25.4%) / 21.9% (95% CI: 21.5%-22.3%) with Type 2 diabetes. Referable retinopathy at baseline screening was 4.4% (95% CI: 3.6%-5.3%) and 1.6% (95% CI: 1.5%-1.7%) among people with Type 1 and Type 2 diabetes mellitus, respectively. After 4 years, cumulative incidence for referable retinopathy /referable maculopathy was 12/36 per 1000 people with Type 1 and 2.4/16 per 1000 people with Type 2 diabetes. Independent hazards for disease progression varied for the diabetes cohort types but baseline grade, duration of diabetes, and HbA1c were common to all., Conclusions: Referable diabetic eye disease at the first screening and after 4 years of follow-up is uncommon. Lengthening of the screening intervals for people with no or mild diabetic eye disease at first screening assessment could be considered., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.)
- Published
- 2021
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45. ASSESSING THE ACCURACY OF A LARGE OBSERVATIONAL REGISTRY OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.
- Author
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Nguyen V, Leung KFC, Nguyen CL, Squirrell D, Essex R, Arnold J, Young S, Barthelmes D, and Gillies M
- Subjects
- Aged, Australia epidemiology, Blindness etiology, Female, Humans, Male, Morbidity trends, Retrospective Studies, Wet Macular Degeneration complications, Blindness epidemiology, Registries, Wet Macular Degeneration epidemiology
- Abstract
Purpose: To evaluate the accuracy of an observational database that tracks real-world treatment outcomes for neovascular age-related macular degeneration., Methods: We audited 245 randomly sampled eyes from 189 patients with 3,356 visits from 11 doctors in the Fight Retinal Blindness!, Database: Sex, birth year, previous treatments received, treatment, and visual acuity were validated against the clinical notes. Error rates, the proportion of missed visits (the number of visits present in the patient record but not entered into Fight Retinal Blindness!), the level of agreement using Cohen's kappa (κ) and intraclass correlation coefficients, and positive and negative predictive values were calculated. A visual acuity error was defined as an absolute difference of ≥5 letters., Results: The overall error rate was 3.5% (95% confidence interval: 3.1-3.9). The error rate for visual acuity was 5.1% (95% confidence interval: 4.2-5.9) and <5% for the remaining fields. The level of agreement for each field ranged from good to excellent (κ or intraclass correlation ≥ 0.75). The positive predictive value and negative predictive value for visits were 99% and 89%, respectively. The proportion of missed visits was 10.2%., Conclusion: Accuracy of the Fight Retinal Blindness! database was good (>95%). The rate of missed visits was high, possibly due to the high burden of retrospective data entry or patients switching practitioners during treatment.
- Published
- 2020
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46. Outcomes of cataract surgery in eyes with diabetic macular oedema: Data from the Fight Retinal Blindness! Registry.
- Author
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Bhandari S, Biechl AC, Nguyen V, Squirrell D, Mehta H, Barthelmes D, and Gillies MC
- Subjects
- Angiogenesis Inhibitors therapeutic use, Blindness drug therapy, Humans, Intravitreal Injections, Registries, Retrospective Studies, Treatment Outcome, Cataract complications, Diabetes Mellitus, Diabetic Retinopathy complications, Diabetic Retinopathy diagnosis, Diabetic Retinopathy drug therapy, Macular Edema diagnosis, Macular Edema drug therapy, Macular Edema etiology
- Abstract
Importance: There are limited data on real-world outcomes of cataract surgery in eyes receiving intravitreal treatments for diabetic macular oedema (DMO)., Background: Cataract surgery may exacerbate oedema in some eyes with DMO resulting in inferior outcomes., Design: Matched, case-controlled retrospective study of observational data in routine clinical practice., Participants: Eyes receiving intravitreal treatments for DMO tracked in the Fight Retinal Blindness! Registry., Methods: Eyes that underwent cataract surgery were identified and matched 1:1 with phakic controls also receiving intravitreal injections for DMO. We also assessed potential factors that were associated with better visual acuity (VA) outcomes., Main Outcome Measures: Change in VA 6 months after cataract surgery., Results: Cataract surgery was identified in 208 eyes of 156 patients of which 147 eyes had 6 months of observations before and after surgery. The mean VA 6 months after surgery improved by 10.6 letters and was similar to their matched phakic controls (68.8 vs 69.2 letters; P = 0.8). Mean CST both 6 months before (341 μm) and after (360 μm) surgery were similar (P = 0.08). However, these eyes had thicker maculae and they received more injections than their matched phakic controls both before and after surgery. Eyes with worse VA before surgery and those that had received intravitreal treatment in the 4 weeks preceding surgery were more likely to gain vision., Conclusions and Relevance: Visual outcomes of cataract surgery in eyes receiving intravitreal therapy for DMO were reasonably better. Their maculae were thicker and required more injections in the 6 months before and after surgery than their phakic controls., (© 2019 Royal Australian and New Zealand College of Ophthalmologists.)
- Published
- 2020
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47. Ten-Year Treatment Outcomes of Neovascular Age-Related Macular Degeneration from Two Regions.
- Author
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Gillies M, Arnold J, Bhandari S, Essex RW, Young S, Squirrell D, Nguyen V, and Barthelmes D
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Intravitreal Injections, Macular Degeneration physiopathology, Male, Retrospective Studies, Vascular Endothelial Growth Factor A antagonists & inhibitors, Visual Acuity physiology, Angiogenesis Inhibitors therapeutic use, Bevacizumab therapeutic use, Macular Degeneration drug therapy, Ranibizumab therapeutic use
- Abstract
Purpose: To report and compare 10-year treatment outcomes of vascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration (nAMD) from Australia and New Zealand (ANZ) and Switzerland., Design: Retrospective, comparative, interventional case series., Methods: We analyzed 712 treatment-naive eyes (ANZ, n = 474; Switzerland, n = 321) starting anti-VEGF for nAMD in routine clinical practice between January 1, 2006, and December 31, 2008, tracked in the prospectively designed observational database, the Fight Retinal Blindness! registry. The primary outcome was mean change in visual acuity (VA [in logMAR letters]) in eyes that completed 10 years of treatment., Results: The mean VA in 132 eyes (28%) from ANZ patients who completed 10 years of treatment dropped by 0.9 letters from baseline (95% confidence interval [CI], -4.9 to 3.1; P = 0.7) with 42% achieving ≥20/40, whereas the 37 eyes (12%) from Swiss subjects lost 14.9 letters (95% CI, -24 to -5.7; P < 0.001) with 35% achieving ≥20/40. Eyes from ANZ patients received more injections than eyes from Swiss subjects over 10 years (a median of 53 vs 42, respectively) from fewer visits with better disease control (proportion of visits with active disease: 38% vs 69%, respectively), suggesting a treat-and-extend regimen versus a pro re nata regimen (treatment given only when the lesion is active). Macular atrophy and subretinal fibrosis were the main reasons for 10 letter loss in the subset of eyes analyzed retrospectively. The mean VA of eyes from both regions that discontinued treatment within 10 years had fallen below the baseline at their final visit., Conclusions: Eyes with nAMD may achieve satisfactory long-term visual outcomes if they receive adequate treatment. Central macular atrophy does not develop universally in eyes receiving long-term treatment with VEGF inhibitors as previously feared. Visual outcomes were better in eyes from ANZ patients, likely because they received more injections., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
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48. Type 3 neovascularisation (retinal angiomatous proliferation) treated with antivascular endothelial growth factor: real-world outcomes at 24 months.
- Author
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Invernizzi A, Teo K, Nguyen V, Daniell M, Squirrell D, Barthelmes D, and Gillies MC
- Subjects
- Aged, Aged, 80 and over, Case-Control Studies, Female, Fluorescein Angiography, Humans, Intravitreal Injections, Male, Middle Aged, Tomography, Optical Coherence, Visual Acuity, Angiogenesis Inhibitors therapeutic use, Choroidal Neovascularization drug therapy, Macular Degeneration complications, Ranibizumab therapeutic use
- Abstract
Aims: To compare 24 months outcomes of eyes with retinal angiomatous proliferations (RAPs) treated with antivascular endothelial growth factor (anti-VEGF) with a group of controls diagnosed with other neovascular age-related macular degeneration (nAMD) subtypes in a real-world setting., Methods: Treatment-naïve nAMD eyes that commenced anti-VEGF between January 2006 and November 2015 were identified from a registry of nAMD treatment outcomes. Cases were defined as eyes diagnosed with RAP. Three controls per case were selected among nAMD eyes with non-RAP lesions and matched on baseline visual acuity (VA), year of treatment initiation, anti-VEGF agent first injected and follow-up. Baseline VA was compared with 12 and 24 months VA. Change in VA, number of injections received, proportion of visits with active nAMD and time to first inactivation were compared between RAPs and controls., Results: 157 RAPs and 469 controls were included. Baseline VA (mean (SD)) increased at 12 months (61.4 (15.5) vs 68.7 (14.7) letters, p<0.001) and remained higher (66.6 (17.3) letters) at 24 months (p<0.001) in RAPs. The change from baseline VA (mean(95% CI)) was significantly higher in RAPs than in controls at 12 months (7.3 (5.4 to 9.1) vs 4.1 (2.8 to 5.4) letters, p=0.01) and at 24 months (5.1 (2.8 to 7.3) vs 2.5 (1 to 4) letters, p=0.056). Both groups received a median of 13 injections. RAPs inactivated earlier and were less active than controls (both p<0.001)., Conclusions: RAPs responded well to anti-VEGF, with a significant improvement in VA persisting at 24 months. RAPs had better visual outcomes than controls at 12 and 24 months, tended to inactivate earlier and were less active throughout 2 years follow-up., Competing Interests: Competing interests: Gillies and Barthelmes are inventors of the software used to collect the data for this analysis., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
- Full Text
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49. Application of Arterial Spin Labelling in Detecting Retinal Ischemia.
- Author
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Vaghefi E, Kauv K, Pan W, and Squirrell D
- Abstract
Purpose: Here, we have tried to quantify the chorioretinal blood perfusion in patients who are clinically identified to be suffering from retinal ischemia using arterial spin labelling (ASL) MRI., Method: Four participants, diagnosed with retinal ischemia based on their structural OCT and angiography test, were then scanned using anatomical MRI as well as ASL. We optimized MR parameters to maximize resolution and target fixation, blinking, and breathing ques to minimize motion artifacts., Results: Participants had a maximum of ∼50 mL/100 mL/min of blood perfusion, which is below the normal values of ∼200 mL/100 mL/min. It also appeared that thinning of the choroid contributes more to the measured decreased chorioretinal perfusion, compared to slowed arterial filling time., Conclusion: Decreased chorioretinal perfusion is a multifactorial event and has been implicated in several posterior eye pathologies. Based on our current results, it seems that ischemia of the eye could be due to anatomy (tissue volume) and/or functionality (arterial flow).
- Published
- 2017
- Full Text
- View/download PDF
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