Ventura County Retina Vitreous Medical Group, Ventura, CA, USA.
Ventura County Retina Vitreous Medical Group, 3160 Telegraph Rd, Suite 230, Ventura, CA, 93003, USA.
Sci Rep. 2023 Oct 4;13(1):16710. doi: 10.1038/s41598-023-43605-w.
To access the effect of vision protection therapy on neovascular conversion in age-related macular degeneration (AMD). Patient unidentified data aggregated by Vestrum Health, LLC (VH) from over 320 US retina specialists was analyzed to compare the conversion rate from dry to neovascular (wet) AMD in a practice employing VPT (VPT group) compared to those employing standard care alone (SCA group) between January 2017 through July 2023. 500,00 eyes were filtered then matched for neovascular conversion risk factors by propensity scoring and compared in a 10/1 ratio of 7370 SCA and 737 VPT treated eyes. SCA eyes had significantly fewer clinical encounters and shorter follow up than the VPT group. Despite this, the risk of neovascular conversion by PS was significantly lower in the VPT group compared to SCA (HR 5.73, p < 0.0001). Analysis matching the encounter frequency of both groups as a post-randomization variable produced a similar HR (HR 5.98, p < 0.0001). Because 9% of eyes in the VPT group were not treated with VPT due to bilateral early (low-risk) AMD, analysis comparing the SCA group to VPT-treated eyes was done that also showed significantly lower conversion rates in the VPT-treated eyes, with or without encounter frequency matching (HR 5.84, 5.65, p < 0.0001). Visual acuity was consistently better in VPT eyes compared to SCA eyes throughout the study time window. The advantage of VPT over SCA increased with increased SCA encounter frequency and higher conversion risk factors, including age and ICD10 coded dry AMD severity. Neovascular (wet) AMD is the main cause of irreversible visual loss worldwide. Consistent with two prior studies, the current study finds Vision Protection Therapy markedly more effective at both recognizing and preventing neovascular AMD than the current standard of care, benefiting the highest risk dry AMD eyes the most.
为了评估视觉保护疗法对年龄相关性黄斑变性（AMD）新生血管转化的影响。Vestrum Health, LLC（VH）汇总了全美 320 多名视网膜专家的患者匿名数据，分析了 2017 年 1 月至 2023 年 7 月期间采用 VPT（VPT 组）的实践与仅采用标准护理（SCA 组）的实践中干性向新生血管性（湿性）AMD 转化的速率。筛选了 50 万只眼睛，并通过倾向评分匹配新生血管转化风险因素，将 7370 只 SCA 眼和 737 只 VPT 治疗眼按 10:1 的比例进行比较。SCA 组的临床就诊次数和随访时间明显少于 VPT 组。尽管如此，与 SCA 相比，VPT 组的新生血管转化风险通过 PS 显著降低（HR 5.73，p<0.0001）。分析将两组的就诊频率匹配为随机分组后的变量，得到了类似的 HR（HR 5.98，p<0.0001）。由于 VPT 组中有 9%的眼睛因双侧早期（低风险）AMD 而未接受 VPT 治疗，因此对 SCA 组与 VPT 治疗组的比较进行了分析，结果表明 VPT 治疗组的转化率也明显较低，无论是否匹配就诊频率（HR 5.84，5.65，p<0.0001）。整个研究时间窗内，VPT 眼的视力始终优于 SCA 眼。VPT 相对于 SCA 的优势随着 SCA 就诊频率和更高的转化风险因素（包括年龄和 ICD10 编码的干性 AMD 严重程度）的增加而增加。新生血管性（湿性）AMD 是全球范围内不可逆视力丧失的主要原因。与之前的两项研究一致，本研究发现视觉保护疗法在识别和预防新生血管性 AMD 方面明显优于目前的标准护理，对风险最高的干性 AMD 眼最有益。
