Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany.
Center for Ophthalmology, University Eye Hospital Tübingen, Tübingen, Germany.
Sci Rep. 2022 Feb 18;12(1):2789. doi: 10.1038/s41598-022-06362-w.
Neovascular age-related macular degeneration (nAMD) is a progressive retinal disease that often leads to severe and permanent vision loss. Early initiation of anti-vascular endothelial growth factor (anti-VEGF) therapy has been shown to preserve vision in nAMD patients. Concurrently, treatment outcomes in real-world are inferior to those reported in clinical trials. The most likely reasons observed are fewer treatment-intensity in routine clinical practice than in clinical trials. The other possibility could be the delay in starting treatment and the re-treatment interval. Although a negative impact of aforementioned parameters seems obvious, quantitative impact measures remain elusive in a real-world setting due to a lack of an 'optimal treatment' control group. To overcome this shortcoming, we developed, validated, and applied a model to assess and quantify the impact of anti-VEGF administration variables on visual acuity development in a prospective nAMD patient cohort. The model was further applied to probe the impact of the COVID-19 pandemic on visual progressions in nAMD patients. The presented model paves the way to systematically explore and evaluate realistic interventions in the current treatment paradigm, that can be adopted in routine clinical care.
新生血管性年龄相关性黄斑变性（nAMD）是一种进行性视网膜疾病，常导致严重和永久性视力丧失。早期使用抗血管内皮生长因子（抗 VEGF）治疗已被证明可保留 nAMD 患者的视力。然而，实际治疗效果逊于临床试验报道的结果。观察到的最可能原因是常规临床实践中的治疗强度低于临床试验。另一种可能性是治疗开始时间和再治疗间隔的延迟。尽管上述参数的负面影响似乎显而易见，但由于缺乏“最佳治疗”对照组，实际情况下仍难以确定定量影响措施。为了克服这一缺点，我们开发、验证并应用了一种模型，以评估和量化抗 VEGF 给药变量对前瞻性 nAMD 患者队列中视力发育的影响。该模型还进一步用于探究 COVID-19 大流行对 nAMD 患者视力进展的影响。所提出的模型为在当前治疗模式中系统探索和评估现实干预措施铺平了道路，这些措施可以在常规临床护理中采用。
