Shaare Zedek Medical Center, Jerusalem, Israel.
School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Int Ophthalmol. 2024 Mar 11;44(1):126. doi: 10.1007/s10792-024-03072-2.
To compare therapeutic decisions between 3 diagnostic protocols and to assess the need for in-person physical doctor-patient encounter in follow up and treatment of neovascular exudative age-related macular degeneration (AMD).
Analysis of 88 eyes of 88 unique patients with neovascular AMD who were routinely followed at our medical retina clinic. A retinal specialist reviewed all images in advance and wrote his decisions. He later attended an in-person encounters with all patients and documented his decisions. Masking was done by not exposing any identifying information to the specialist and by randomizing patient's images order before the in-person encounter. Therapeutic decisions regarding intravitreal injections intervals and agent selection were made based on three protocols: (1) optic coherence tomography (OCT); (2) OCT/Ultra-widefield (UWF) color image; (3) OCT/UWF/full clinical exam. Visual acuity (VA) was incorporated into all protocols.
We found an agreement of 93% between those protocols regarding the intervals of injections, and of 100% regarding injection agent selection. When comparing OCT, OCT/UWF and OCT/UWF/clinical exam guided decision making, there were no discrepancies between OCT and OCT/UWF. There were 6 out of 88 discrepancies (7%) between OCT/UWF and OCT/UWF/clinical exam. Of those 6 discrepancies, all were regarding intervals (Bland-Altman bias = - 0.2386). All discrepancies between OCT/UWF and OCT/UWF/Clinical exam were due to patients' preferences, socioeconomic issues and fellow eye considerations, addressed during the face-to-face encounter with patients. Physical examination itself did not affect decision making.
Neovascular exudative AMD follow up and treatment decisions can be guided by VA and OCT, with UWF adding important information regarding macula and peripheral retina, but rarely affecting decision making. However, decision making may also be driven by patients' preferences and other considerations that are being made only during the face-to-face visit and discussion. Thus, every approach supporting imaging only decision making, must take these factors into account.
比较 3 种诊断方案的治疗决策，并评估在随访和治疗新生血管性渗出性年龄相关性黄斑变性（AMD）时是否需要进行面对面的医患接触。
对在我们的医学视网膜诊所常规随访的 88 例 88 只患眼的新生血管性 AMD 患者进行分析。一名视网膜专家预先查看所有图像并写下他的决策。然后，他与所有患者进行面对面的交流，并记录他的决策。通过不向专家透露任何识别信息并在面对面交流之前随机排列患者图像的顺序来进行掩蔽。根据以下三种方案做出关于玻璃体内注射间隔和药物选择的治疗决策：（1）光学相干断层扫描（OCT）；（2）OCT/超宽视野（UWF）彩色图像；（3）OCT/UWF/全面临床检查。所有方案均纳入视力（VA）。
我们发现这三种方案在注射间隔方面的一致性为 93%，在注射药物选择方面的一致性为 100%。比较 OCT、OCT/UWF 和 OCT/UWF/临床检查指导的决策时，OCT 和 OCT/UWF 之间没有差异。在 OCT/UWF 和 OCT/UWF/临床检查之间有 6 个差异（7%）。这 6 个差异均与间隔有关（Bland-Altman 偏倚= -0.2386）。OCT/UWF 和 OCT/UWF/临床检查之间的所有差异均归因于患者的偏好、社会经济问题和对另一只眼的考虑，这些问题是在与患者进行面对面交流时提出的。体格检查本身并不影响决策。
新生血管性渗出性 AMD 的随访和治疗决策可以通过 VA 和 OCT 指导，UWF 提供黄斑和周边视网膜的重要信息，但很少影响决策。然而，决策也可能受到患者偏好和仅在面对面访问和讨论中做出的其他考虑因素的驱动。因此，每一种支持仅基于影像学做出决策的方法都必须考虑到这些因素。
