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Background We aimed to assess feasibility of self-completion of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) by head and neck cancer patients, and to assess self-reported increased awareness regarding malnutrition risk after self-completion.Methods Participants were randomized to complete the PG-SGA SF by paper or app. Feasibility was assessed by time needed to complete the PG-SGA SF, perceived difficulty, and help needed during completion. Participants were asked if they knew what malnutrition was (yes/no) and if they could define "malnutrition." They were also asked 9 questions on whether they perceived increased awareness of malnutrition risk after having completed the PG-SGA SF and 2 on their intention to change lifestyle habits.Results Of all participants (n = 59; 65.9 +/- 12.6 years; 73% male), 55% completed the PG-SGA SF paper version and 46% the Pt-Global app. Median time needed for self-completion of the PG-SGA SF was 2 minutes 41 seconds (interquartile range: 1 minute 49 seconds-3 minutes 50 seconds). Forty-eight percent needed help with completion, indicating acceptable feasibility. Participants who completed the Pt-Global app needed help significantly more often (66%; 21/32) than those who completed the PG-SGA SF paper version (26%; 7/27) (P = 0.005). All difficulty scores were excellent. For 7/9 questions on malnutrition risk awareness, >50% of the participants answered positively.Conclusion The results of this study show that self-completion of the PG-SGA SF by head and neck cancer patients is feasible and that awareness regarding malnutrition risk may increase after completing the PG-SGA SF.

Resume Objectif Mettre a jour les recommandations de la Federation France Macula (FFM) pour le diagnostic de la degenerescence maculaire liee a l’âge (DMLA) exsudative. Methode Analyse de la litterature et avis d’experts. Resultats La FFM recommande d’aboutir au diagnostic de la DMLA exsudative par l’association des donnees de l’examen du fond d’œil (ou de retinographies couleur ou monochromatiques), de la tomographie a coherence optique (OCT), montrant des manifestations exsudatives et par un examen morphologique qui peut etre non invasif (OCT-angiographie) ou invasif (angiographie a la fluoresceine ou au vert d’indocyanine). Dans les conditions optimales ou tous ces examens sont praticables, elle suggere de debuter par les examens non invasifs en premiere ligne et de recourir aux angiographies avec colorant en cas de doute diagnostic residuel. Conclusion Le diagnostic de la DMLA exsudative suit l’evolution actuelle de l’imagerie medicale, qui privilegie les examens non invasifs et reserve les autres examens aux cas de diagnostic plus difficile.

PURPOSE To evaluate macular and peripapillary vessel density (mVD, pVD) using optical coherence tomography angiography (OCT-A) in healthy subjects, patients with ocular hypertension (OHT) and primary open-angle glaucoma (POAG) patients. METHODS In this prospective observational study, OCT-A images were obtained from 60 eyes of 36 healthy, ocular hypertension (OHT), preperimetric glaucoma (PPG), early glaucoma (EG) and moderate and advanced POAG subjects. Superficial mVD was acquired over a 6×6-mm cube centered on the foveal avascular zone and pVD over a 4.5×4.5-mm cube centered on the optic disc. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell complex (GCC) thickness was calculated using spectral-domain OCT. Correlations between vascular, structural and Humphrey VF indices were evaluated (Spearman's rank correlation coefficient). RESULTS Median pVD and mVD in the PPG eyes were lower than in healthy eyes (51.87% and 47.23% versus 55.70% and 53.61%, respectively; P

Summary Purpose To assess the value of a monthly injection of Lucentis® until stable visual acuity (VA) is obtained for three consecutive months without exudation in patients with neovascular age macular degeneration (AMD). Methods Prospective, single-center, non-controlled trial including naive AMD patients with neovascularization. An assessment of VA and a spectral domain optical coherence tomography (SD-OCT) were performed at baseline and every month. Monthly injections of Lucentis® were performed over three months. The monthly injections were then continued until three consecutive stable VA results were obtained with no signs of exudation. Results Fifteen out of the 21 patients included were anatomically good responders. A mean gain of +14Le (9) was obtained up to the point at which there was no exudation. There was no additional gain from this point until 3 consecutive stable VA results were obtained. During the PRN phase, an additional mean gain of +3.2Le (7.7) was obtained. Conclusion This initial VA-guided regimen with ranibizumab might prevent the slight decrease in VA observed during the first year of PRN studies.

Resume Contexte et objectifs L’administration intravitreenne d’agents anti-VEGF, disponibles en France depuis 2007, permet de stabiliser et d’ameliorer l’acuite visuelle dans la DMLA exsudative. Depuis plusieurs annees, la prise en charge de cette pathologie a evolue, tant au niveau des methodes de diagnostic que des schemas de traitement qui se sont adaptes a la physiopathologie de la DMLA. L’objectif de cette enquete, realisee aupres d’un echantillon representatif d’ophtalmologistes francais, etait de decrire l’evolution des pratiques medicales un an apres une enquete similaire (Masse et al., J Fr Ophtalmol 2016 ; 39 : 40–47). Methode L’enquete a ete realisee de decembre 2014 a mars 2015 aupres de 191 ophtalmologistes (53 ophtalmologistes generalistes et 98 ophtalmologistes specialistes de la retine) via un questionnaire en ligne. Celui-ci a ete elabore par un comite d’ophtalmologistes afin de decrire les pratiques en matiere de depistage, de diagnostic, de traitement et de suivi de la DMLA exsudative. Resultats La premiere injection intravitreenne (IVT) d’anti-VEGF etait realisee habituellement dans les 10 jours apres le diagnostic d’une DMLA exsudative par 98 % des ophtalmologistes et par 63 % dans les 5 jours. Les protocoles de traitement consideres comme ideaux par les retinologues etaient le pro re nata (PRN) pour 58 %, l’Observe and Plan pour 25 % et le Treat and Extend pour 17 %. Des IVT bilaterales etaient realisees le meme jour par 46 % des retinologues, surtout par commodite pour le patient et en raison du risque infectieux faible. Le protocole initial etait maintenu par un tiers des retinologues tout au long du traitement, alors que les deux tiers declaraient le reevaluer apres 5 mois en moyenne. Conclusion Cette enquete met en evidence une amelioration des delais de prise en charge par rapport a l’enquete precedente et une evolution de l’organisation des ophtalmologistes et des schemas therapeutiques vers des protocoles individualises.

To update the recommendations of the France Macula Federation for treatment of wet age-related macular degeneration (AMD).Analysis of literature and expert opinion.The FFM recommends initiating anti-VEGF therapy as soon as possible after diagnosis of exudative AMD. There has been no major change in the last several years concerning the procedure of intravitreal injection itself. However, the litigious points are discussed: simultaneous bilateral injection; antibiotic therapy; medico-legal aspects. All anti-VEGF strategies possess advantages and limitations. The strategy should be left to the ophthalmologists' preference. However, the chosen strategy should be explained to patients and strictly followed.The treatment of wet-AMD is more precisely codified than before. However, various strategies still coexist.

To update the recommendations of the France Macula Federation for the diagnosis of wet age-related macular degeneration (AMD).Analysis of literature and expert opinion.The FMF recommends diagnosing wet AMD by combining the results of fundus examination (or color or monochromatic fundus photographs), optical coherence tomography (OCT) showing exudative signs, and morphological visualization of the neovascular membrane, which may be obtained non-invasively (OCT-angiography) or invasively (fluorescein and/or indocyanine green angiography). Under optimal conditions in which all these tools are available, the FMF recommends using non-invasive methods as first-line tools and resorting to dye angiography if diagnostic doubt remains.As observed in other fields of medical imaging, non-invasive methods are preferred to invasive methods for the diagnosis of wet AMD, while the latter are reserved for more difficult cases.

To assess the value of a monthly injection of LucentisProspective, single-center, non-controlled trial including naïve AMD patients with neovascularization. An assessment of VA and a spectral domain optical coherence tomography (SD-OCT) were performed at baseline and every month. Monthly injections of LucentisFifteen out of the 21 patients included were anatomically good responders. A mean gain of +14Le (9) was obtained up to the point at which there was no exudation. There was no additional gain from this point until 3 consecutive stable VA results were obtained. During the PRN phase, an additional mean gain of +3.2Le (7.7) was obtained.This initial VA-guided regimen with ranibizumab might prevent the slight decrease in VA observed during the first year of PRN studies.

Intravitreal administration of anti-VEGF agents, available in France since 2007, allows stabilization and improvement in visual acuity in wet age-related macular degeneration (AMD). In the past few years, the management of this disease has evolved in terms of both diagnostic methods and treatment schedules, which have been adapted to the pathophysiology of AMD. The goal of this survey, performed in a representative sample of French ophthalmologists, was to describe the evolution of medical practices one year after a similar survey (Massé et al., J Fr Ophtalmol 2016; 39: 40-7).The survey was performed from December, 2014 to March, 2015 in 191 ophthalmologists (53 general ophthalmologists and 98 retina specialists) with an on-line questionnaire. This questionnaire was designed by a committee of ophthalmologists to describe practices concerning screening, diagnosis, treatment and follow-up of wet AMD.An initial intravitreal injection of an anti-VEGF agent was usually performed within 10 days after the diagnosis of wet AMD by 98% of ophthalmologists and within 5 days by 63%. The treatment protocols favored by retina specialists were pro re nata (PRN) for 58%, Observe and Plan for 25% and Treat and Extend for 17%. Bilateral intravitreal injections were performed on the same day by 46% of retina specialists, mostly for the convenience of the patient and because of the low infectious risk. The initial protocol was maintained by one third of retina specialists throughout the course of treatment, while two thirds of them reported that they reassessed the protocol on average after 5 months.This survey on the practices of the ophthalmologists in wet AMD highlights an improvement in the time course of patient management and an evolution of treatment schedules toward individualized protocols.

Resume Introduction L’objectif de ce travail est de rappeler les caracteristiques cliniques des telangiectasies maculaires idiopathiques (TMI), l’apport de l’imagerie dans cette pathologie ainsi que les differents moyens therapeutiques dont nous disposons. Patients et methode Il s’agit d’une analyse retrospective concernant les patients ayant presente des TMI diagnostiquees, suivies et traitees a l’hopital de la Croix-Rousse entre juin 2010 et mars 2012. Les aspects fundoscopiques, angiographiques (AGF), cliches en autofluorescence, et en tomographie a coherence optique en spectral domaine a haute resolution (SD-OCT) ont permis de diagnostiquer et classer ces TMI en deux groupes. Les patients presentant une baisse d’acuite visuelle secondaire a un œdeme maculaire cystoide ont ete traites par laser et/ou injection intravitreenne d’anti-VEGF. Resultats L’association de l’AGF et du SD-OCT a permis de diagnostiquer deux patients presentant des TMI de groupe 1 et deux patients des TMI de groupe 2. Nous avons retrouve une efficacite fonctionnelle et anatomique du traitement par anti-VEGF dans les TMI de groupe 1. Discussion La physiopathologie des TMI est complexe. Les anti-VEGF semblent etre une alternative efficace pour le traitement de l’œdeme maculaire cystoide secondaire aux TMI de groupe 1. Conclusion Il existe encore de nombreuses incertitudes quant a la physiopathologie et le traitement des telangiectasies maculaires idiopathiques. Pour traiter l’œdeme maculaire cystoide associe aux TMI de groupe 1, les anti-VEGF, hors AMM dans cette indication, semblent etre efficaces au prix de plusieurs reinjections. Il ne semble pas exister de traitement efficace pour les TMI de groupe 2 sans complication neovasculaire. Les progres therapeutiques dont va beneficier la DMLA atrophique pourront probablement etre efficaces dans cette indication.

Resume Introduction La myopie forte est la premiere cause de neovascularisation choroidienne chez les patients de moins de 50 ans. Malgre l’absence d’etude prospective, l’injection intravitreenne d’anti-VEGF est largement utilisee dans cette indication. Le but de ce travail est d’evaluer l’efficacite du bevacizumab en injections intravitreennes utilise en premiere intention pour le traitement de neovaisseaux choroidiens retro- et juxtafoveolaires du myope fort. Patients et methodes Nous rapportons les resultats d’une etude retrospective incluant les patients myopes forts atteints de neovaisseaux retro- et juxtafoveolaires traites en premiere intention par injections intravitreennes de 1,25 mg (0,05 cm 3 ) de bevacizumab ou Avastin ® a l’hopital de la Croix-Rousse, Lyon, entre janvier 2009 et juin 2010. La visite initiale comportait pour chaque patient un interrogatoire a la recherche d’un syndrome maculaire, une mesure de l’acuite visuelle, une mesure de la pression intraoculaire, un fond d’œil, une angiographie a la fluoresceine et une optical coherence tomography (OCT) maculaire. Les patients etaient suivis chaque mois et retraites en cas de persistance ou recidive de l’exsudation neovasculaire. Resultats Huit yeux de huit patients presentant un neovaisseau choroidien naif de tout traitement ont ete traites et suivis au minimum 12 mois avec un suivi moyen de 19 mois. L’âge moyen des patients etait de 49 ans avec une erreur refractive moyenne de −11 dioptries. Dans 75 % des cas, une fibrose du neovaisseau a ete obtenue a 12 mois pour une moyenne de trois injections. A un an, tous les patients sauf un avaient stabilise ou ameliore leur vision. Les metamorphopsies avaient disparu dans plus de 50 % des cas apres la premiere injection et dans 100 % des cas a un an. Aucun effet indesirable n’a ete constate au cours du suivi. Conclusion Dans ce travail, l’injection intravitreenne de bevacizumab ou Avastin ® semble efficace et bien toleree dans le traitement des neovaisseaux choroidiens retro- et juxtafoveolaires naifs du myope fort. Il persiste, cependant, de nombreuses incertitudes quant a l’utilisation hors AMM des anti-VEGF dans cette indication. Des etudes prospectives a grande echelle pourront peut-etre, un jour, nous apporter des reponses plus precises.

The pathophysiology of nonarteritic anterior ischemic optic neuropathy (NA-AION) is still imperfectly understood, but arterial hypertension seems to play a decisive role. Intolerance to hypoxia is defined as desaturation of hemoglobin more than 15% at rest and/or elevation of blood pressure at rest or after exercise over 20mmHg in hypoxia. We report the case of a 66-year-old woman who presented bilateral NA-AION during a trek at high altitude (>2500m). The etiological check up was negative. Due to the circumstances of occurrence, we requested a tolerance to hypoxia test, which was positive. In this case, the combined effects of altitude and effort probably led to prolonged desaturation of oxyhemoglobin associated with an excessive blood pressure increase upon exercise leading to ischemia of the optic nerve head. This case showed the value of a systematic search for hypoxia tolerance in patients with nonarteritic anterior ischemic optic neuropathy occurring during a situation of prolonged hypoxia (long-distance flight, high altitude).

Resume Contexte et objectifs La DMLA exsudative est caracterisee par la formation de neovaisseaux choroidiens, mediee par le facteur de croissance endothelial vasculaire (VEGF) responsable d’une baisse d’acuite visuelle et de metamorphopsies d’apparition brutale. L’injection intravitreenne d’anti-VEGF permet de stabiliser, voire d’ameliorer, l’acuite visuelle. Si la question de la phase d’induction par injection d’anti-VEGF fait consensus chez les ophtalmologues, il existerait des divergences en pratique quant aux modalites de prise en charge therapeutique. L’objectif de ce travail etait d’explorer cette hypothese et de mieux comprendre les pratiques en vie reelle. Methode L’institut Ipsos a realise une enquete qualitative aupres de 16 specialistes de la retine et de 9 ophtalmologues generalistes, en septembre et octobre 2013, a l’aide d’un questionnaire elabore par un comite scientifique d’experts. Quinze entretiens telephoniques et 4 dialogues en face a face avec un specialiste de la retine et un ophtalmologue ont ete effectues. Cette enquete qualitative a permis le developpement d’une enquete quantitative aupres de specialistes de la retine et ophtalmologues generalistes, realisee entre novembre 2013 et janvier 2014, visant a decrire les pratiques en matiere de diagnostic, de traitement et de suivi de la DMLA exsudative. Resultats Une distribution des roles et tâches entre l’ophtalmologue assumant le diagnostic initial et le retinologue en charge du traitement et du suivi a ete mise en evidence. Le traitement etait initie dans le delai de 10 jours suivant le diagnostic recommande par la HAS chez seulement un tiers des patients. Apres la phase d’induction therapeutique, a savoir les trois injections d’anti-VEGF mensuelles, les pratiques de traitement et de suivi etaient heterogenes avec 74 % des medecins qui utilisaient un protocole de traitement pro re nata (PRN), 22 % un protocole bimestriel (avec controle mensuel dans 19,4 % des cas) et 4 % un protocole inject and extend. Il y avait peu de modifications du protocole choisi en cas de recidives. Conclusion Les trois quarts des ophtalmologues declarent utiliser un protocole PRN et plus de 90 % declarent voir leur patient tous les mois, que ce soit pour une injection ou pour une visite de controle. Cette uniformite apparente est en realite plus complexe : pour la grande majorite, ils ont pour objectif de suivre au plus pres le patient pour traiter a la moindre recidive, mais avec une grande variabilite dans les pratiques afin d’individualiser le traitement.

Wet AMD is characterized by the formation of choroidal neovascularization, mediated by vascular endothelial growth factor (VEGF) and responsible for a decrease in visual acuity and metamorphopsia of sudden onset. Intravitreal anti-VEGF can stabilize or even improve visual acuity. Although there is a consensus among ophthalmologists about the induction phase injection of anti-VEGF, there appear to be differences in practice regarding therapeutic treatment modalities. The goal of this work was to explore this hypothesis and to better understand real life practices.The Ipsos institute conducted a qualitative survey of 16 retinal specialists and 9 general ophthalmologists in September and October 2013, using a questionnaire developed by a scientific committee of experts. Fifteen telephone interviews and 4 face-to-face meetings with a retina specialist and an ophthalmologist were conducted. This qualitative study allowed the development of a quantitative survey of 200 retina specialists and general ophthalmologists, conducted between November 2013 and January 2014, to describe practices in diagnosis, treatment and follow-up of wet AMD.A distribution of roles between the ophthalmologist making the initial diagnosis and the retinal specialists responsible for treatment and follow-up was noted. Treatment was initiated within 10 days of diagnosis as recommended by the HAS in only one third of patients. After the induction phase of treatment, i.e. three monthly injections of anti-VEGF, treatment and monitoring practices were heterogeneous with 74% of physicians using a PRN treatment protocol, 22% a bimonthly protocol (with monthly monitoring in 19.4% of cases) and 4% a "treat and extend" protocol. There was little change in the protocol chosen in the case of recurrence.Three quarters of ophthalmologists report using a PRN protocol, and over 90% report seeing their patients monthly, either for injection or for a check-up. This apparent uniformity is in reality more complex: for the large majority, they prefer to closely follow the patient so as to treat the slightest recurrence, but with great variability in practices with regard to individualization of treatment.

Introduction/objectives/aim Age-related macular degeneration (AMD) is the leading cause of visual acuity loss in patients aged 65 and above, with the number of cases expected to increase over the next decade. We present the results of an AMD screening trial using a nonmydriatic digital color fundus camera and telemedicine, and report the impact this screening has on the medical course of positive patients. Material and method Over two years, color fundus photographs were taken for patients consulting health examination centers and transmitted electronically to an ophthalmology department. The rates of occurrence of different grades of AMD were then calculated. Positive patients were then contacted by telephone to complete a questionnaire. Results/observations A total of 1448 photos from 726 patients were interpreted, of which 82% were gradable. Age-related macular degeneration was diagnosed for 15.3% (111) of the patients, with 10.2% (74), 3.4% (25), 1.1% (8), and 0.5% (4) at grades 1, 2, 3, and 4, respectively. Among the positive patients, 74 agreed to participate in the survey. The mean time since their last ophthalmologic exam was seven years and 43 only consulted their ophthalmologist as recommended, on average 31 days after the initial screening. For 32 of these patients (74%), the face-to-face diagnostic was also positive. Prophylactic treatment was initiated for 5 patients, and 2 patients received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.

To evaluate the retinal and choroidal changes in White Dot syndromes (WDS) using ‘’en face’’ and B-scan OCT images. All the study patients underwent a comprehensive ophthalmologic examination including biomicroscopic fundus examination, color photography, fundus autofluorescence, fluorescein angiography, indocyanin green angiography and B scan and "en face" SD-OCT. A total of 10 patients with Multiple evanescent white dot syndrome (MEWDS), 4 cases diagnosed with acute posterior multifocal placoid pigment epitheliopathy (AMPPE), 1 case of serpiginous choroidopathy, 4 cases of multifocal choroiditis, 3 cases of punctuate inner choroidopathy (PIC) and 3 cases diagnosed with Birdshot disease were analysed and included in the study. The B-scan findings were correlated with the angiography findings as well as with the ‘’en face’’ OCT scans. In all the cases the ‘’en face’’ OCT, providing a layer-by-layer view of the involved retina, enabled depicting in detail the IS/OS envolvement and the extent of the outer retinal damage. The patho-physiologic mechanism of the WDS remains poorly understood. All these entities probably share a common pathway leading to external retinal involvem

Purpose: To investigate the use of a nonmydriatic digital color fundus camera and telemedicine as screening tools for age-related macular degeneration (AMD). Methods: Nonmydriatic color fundus photography was performed on patients consulting health examination centers and transmitted by telemedicine to an ophthalmology department. Rates for different grades of AMD were calculated and also statistically related to the presence or absence of risk factors. Results: Among the 1,022 patients screened, a total of 1,363 color fundus photographs were interpreted, with 80% gradable images, allowing a diagnosis of AMD in 178 photographs. Among all the gradable images, 83.7% had no AMD (grade 0). The rates of AMD at grades 1, 2, 3 and 4 were 8%, 5.6%, 2.3% and 0.4%, respectively. A statistical odds ratio was found between the presence of AMD on fundus photographs and age, familial history of AMD or prior cataract surgery. Conclusions: Nonmydriatic color fundus photography and telemedicine succeeded in screening for AMD.

Summary Aim To compare the efficacy and safety of bevacizumab versus ranibizumab in the treatment of patients with neovascular age-related macular degeneration (AMD). Patients and methods Retrospective case-controlled series of 30 patients treated with intravitreal bevacizumab and 28 patients treated with intravitreal ranibizumab for exudative AMD. Main outcomes measured included best-corrected visual acuity (BCVA), central macular thickness (CMT) and foveal thickness, quantity of subretinal fluid, neovessel size and total number of injections over the first year treatment period. A secondary outcome was the report of any adverse events in both groups. Results BCVA stabilized and increased from LogMAR 0.70 to 0.47 in the bevacizumab group and from 0.55 to 0.54 in the ranibizumab group ( P > 0.05). CMT decreased in the bevacizumab group from 369 to 284 μm and in the ranibizumab group from 340 to 271 μm ( P > 0.05). The number of injection was significantly lower (4.8) in the bevacizumab group than in the ranibizumab group (5.8) ( P Conclusion This retrospective study failed to show a difference in visual and anatomic outcomes between bevacizumab and ranibizumab. The number of re-treatment was lower in the bevacizumab group ( P = 0.03).

The pathophysiology of nonarteritic anterior ischemic optic neuropathy (NA-AION) is still imperfectly understood, but arterial hypertension seems to play a decisive role. Intolerance to hypoxia is defined as desaturation of hemoglobin more than 15% at rest and/or elevation of blood pressure at rest or after exercise over 20mmHg in hypoxia. We report the case of a 66-year-old woman who presented bilateral NA-AION during a trek at high altitude (2500m). The etiological check up was negative. Due to the circumstances of occurrence, we requested a tolerance to hypoxia test, which was positive. In this case, the combined effects of altitude and effort probably led to prolonged desaturation of oxyhemoglobin associated with an excessive blood pressure increase upon exercise leading to ischemia of the optic nerve head. This case showed the value of a systematic search for hypoxia tolerance in patients with nonarteritic anterior ischemic optic neuropathy occurring during a situation of prolonged hypoxia (long-distance flight, high altitude).