optical coherence tomography in the Management of age-related macular degeneration among elderly patients with vision loss
DOI:
https://doi.org/10.5281/zenodo.22811919Keywords:
optical coherence tomography, age-related macular degeneration, anti-VEGF therapy, treat-and-extend, low-vision rehabilitationAbstract
Background: Age-related macular degeneration is a leading cause of irreversible vision loss among elderly patients, and optical coherence tomography is now the reference standard for diagnosing and monitoring its neovascular and atrophic forms [1,6].
Objective: This review synthesizes evidence on OCT-based classification of AMD, its role guiding anti-VEGF treat-and-extend regimens, and its relationship to low-vision rehabilitation needs of elderly patients with persistent vision loss.
Methods: We synthesized pivotal anti-VEGF trials, OCT classification reports, treat-and-extend comparative studies, epidemiological cohorts, and low-vision rehabilitation outcome studies addressing OCT-guided AMD management.
Findings: OCT biomarkers including subretinal and intraretinal fluid and pigment epithelial detachment drive anti-VEGF re-treatment decisions [14]; OCT-guided treat-and-extend regimens achieve outcomes comparable to monthly dosing with fewer injections [25,26,27]. Many elderly patients retain disabling vision loss despite treatment, for whom low-vision rehabilitation yields significant functional gains [30].
Conclusions: OCT is now the structural backbone of AMD management in elderly patients, and pairing OCT-guided anti-VEGF dosing with timely low-vision rehabilitation referral represents the current standard of care [10,1].
References
Wong, W.L., Su, X., Li, X., Cheung, C.M.G., Klein, R., Cheng, C.Y., et al. (2014) Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040. Lancet Global Health, 2(2): e106-e116. DOI: 10.1016/S2214-109X(13)70145-1
Rein, D.B., Wittenborn, J.S., Zhang, X., Honeycutt, A.A., Lesesne, S.B., Saaddine, J. (2009) Forecasting age-related macular degeneration through the year 2050: the potential impact of new treatments. Archives of Ophthalmology, 127(4): 533-540. DOI: 10.1001/archophthalmol.2009.58
Friedman, D.S., O'Colmain, B.J., Munoz, B., Tomany, S.C., McCarty, C., de Jong, P.T., et al. (2004) Prevalence of age-related macular degeneration in the United States. Archives of Ophthalmology, 122(4): 564-572. DOI: 10.1001/archopht.122.4.564
Klein, R., Klein, B.E., Knudtson, M.D., Meuer, S.M., Swift, M., Gangnon, R.E. (2007) Fifteen-year cumulative incidence of age-related macular degeneration: the Beaver Dam Eye Study. Ophthalmology, 114(2): 253-262. DOI: 10.1016/j.ophtha.2006.10.040
Huang, D., Swanson, E.A., Lin, C.P., Schuman, J.S., Stinson, W.G., Chang, W., et al. (1991) Optical coherence tomography. Science, 254(5035): 1178-1181. DOI: 10.1126/science.1957169
Hee, M.R., Baumal, C.R., Puliafito, C.A., Duker, J.S., Reichel, E., Wilkins, J.R., et al. (1995) Optical coherence tomography of age-related macular degeneration and choroidal neovascularization. Ophthalmology, 102(3): 493-503. DOI: 10.1016/S0161-6420(95)30846-9
Schmidt-Erfurth, U., Waldstein, S.M. (2016) A paradigm shift in imaging biomarkers in neovascular age-related macular degeneration. Progress in Retinal and Eye Research, 50: 1-24. DOI: 10.1016/j.preteyeres.2015.07.007
de Jong, P.T.V.M. (2006) Age-related macular degeneration. New England Journal of Medicine, 355(14): 1474-1485. DOI: 10.1056/NEJMra062326
Mitchell, P., Liew, G., Gopinath, B., Wong, T.Y. (2018) Age-related macular degeneration. Lancet, 392(10153): 1147-1159. DOI: 10.1016/S0140-6736(18)31550-2
Ferris, F.L., Wilkinson, C.P., Bird, A., Chakravarthy, U., Chew, E., Csaky, K., et al. (2013) Clinical classification of age-related macular degeneration. Ophthalmology, 120(4): 844-851. DOI: 10.1016/j.ophtha.2012.10.036
Staurenghi, G., Sadda, S., Chakravarthy, U., Spaide, R.F. (2014) Proposed lexicon for anatomic landmarks in normal posterior segment spectral-domain optical coherence tomography: the IN*OCT consensus. Ophthalmology, 121(8): 1572-1578. DOI: 10.1016/j.ophtha.2014.02.023
Sadda, S.R., Guymer, R., Holz, F.G., Schmitz-Valckenberg, S., Curcio, C.A., Bird, A.C., et al. (2018) Consensus definition for atrophy associated with age-related macular degeneration on OCT: Classification of Atrophy Report 3. Ophthalmology, 125(4): 537-548. DOI: 10.1016/j.ophtha.2017.09.028
Spaide, R.F., Jaffe, G.J., Sarraf, D., Freund, K.B., Sadda, S.R., Staurenghi, G., et al. (2020) Consensus nomenclature for reporting neovascular age-related macular degeneration data: Consensus on Neovascular Age-Related Macular Degeneration Nomenclature Study Group. Ophthalmology, 127(5): 616-636. DOI: 10.1016/j.ophtha.2019.11.004
Waldstein, S.M., Wright, J., Warburton, J., Margaron, P., Simader, C., Schmidt-Erfurth, U. (2016) Predictive value of retinal morphology for visual acuity outcomes of different ranibizumab treatment regimens for neovascular AMD. Ophthalmology, 123(1): 60-69. DOI: 10.1016/j.ophtha.2015.09.013
Keane, P.A., Patel, P.J., Liakopoulos, S., Heussen, F.M., Sadda, S.R., Tufail, A. (2012) Evaluation of age-related macular degeneration with optical coherence tomography. Survey of Ophthalmology, 57(5): 389-414. DOI: 10.1016/j.survophthal.2012.01.006
Holz, F.G., Strauss, E.C., Schmitz-Valckenberg, S., van Lookeren Campagne, M. (2014) Geographic atrophy: clinical features and potential therapeutic approaches. Ophthalmology, 121(5): 1079-1091. DOI: 10.1016/j.ophtha.2013.11.023
Rosenfeld, P.J., Brown, D.M., Heier, J.S., Boyer, D.S., Kaiser, P.K., Chung, C.Y., et al. (2006) Ranibizumab for neovascular age-related macular degeneration. New England Journal of Medicine, 355(14): 1419-1431. DOI: 10.1056/NEJMoa054481
Brown, D.M., Kaiser, P.K., Michels, M., Soubrane, G., Heier, J.S., Kim, R.Y., et al. (2006) Ranibizumab versus verteporfin for neovascular age-related macular degeneration. New England Journal of Medicine, 355(14): 1432-1444. DOI: 10.1056/NEJMoa062655
Regillo, C.D., Brown, D.M., Abraham, P., Yue, H., Ianchulev, T., Schneider, S., et al. (2008) Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER Study year 1. American Journal of Ophthalmology, 145(2): 239-248. DOI: 10.1016/j.ajo.2007.10.004
Heier, J.S., Brown, D.M., Chong, V., Korobelnik, J.F., Kaiser, P.K., Nguyen, Q.D., et al. (2012) Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology, 119(12): 2537-2548. DOI: 10.1016/j.ophtha.2012.09.006
CATT Research Group, Martin, D.F., Maguire, M.G., Ying, G.S., Grunwald, J.E., Fine, S.L., et al. (2011) Ranibizumab and bevacizumab for neovascular age-related macular degeneration. New England Journal of Medicine, 364(20): 1897-1908. DOI: 10.1056/NEJMoa1102673
CATT Research Group, Martin, D.F., Maguire, M.G., Fine, S.L., Ying, G.S., Jaffe, G.J., et al. (2012) Ranibizumab and bevacizumab for neovascular age-related macular degeneration: two-year results. Ophthalmology, 119(7): 1388-1398. DOI: 10.1016/j.ophtha.2012.03.053
Chakravarthy, U., Harding, S.P., Rogers, C.A., Downes, S.M., Lotery, A.J., Wordsworth, S., et al. (2013) Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: the IVAN randomised controlled trial. Lancet, 382(9900): 1258-1267. DOI: 10.1016/S0140-6736(13)61501-9
Freund, K.B., Korobelnik, J.F., Devenyi, R., Framme, C., Galic, J., Herbert, E., et al. (2015) Treat-and-extend regimens with anti-VEGF agents in retinal diseases: a literature review and consensus recommendations. Retina, 35(8): 1489-1506. DOI: 10.1097/IAE.0000000000000627
Wykoff, C.C., Croft, D.E., Brown, D.M., Wang, R., Payne, J.F., Clark, L., et al. (2015) Prospective trial of treat-and-extend versus monthly dosing for neovascular age-related macular degeneration: TREX-AMD 1-year results. Ophthalmology, 122(12): 2514-2522. DOI: 10.1016/j.ophtha.2015.08.009
Schmidt-Erfurth, U., Fabianska, M., Waldstein, S.M. (2018) Efficacy and safety of ranibizumab 0.5 mg treat-and-extend versus monthly dosing in neovascular age-related macular degeneration: TREND study. Ophthalmology, 125(1): 57-65. DOI: 10.1016/j.ophtha.2017.07.014
Guymer, R.H., Markey, C.M., McAllister, I.L., Gillies, M.C., Hunyor, A.P., Arnold, J.J. (2019) Tolerating subretinal fluid in neovascular age-related macular degeneration treated with ranibizumab using a treat-and-extend regimen: FLUID study 24-month results. Ophthalmology, 126(5): 723-734. DOI: 10.1016/j.ophtha.2018.11.025
Age-Related Eye Disease Study Research Group (2001) A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS Report No. 8. Archives of Ophthalmology, 119(10): 1417-1436. DOI: 10.1001/archopht.119.10.1417
Age-Related Eye Disease Study 2 Research Group (2013) Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA, 309(19): 2005-2015. DOI: 10.1001/jama.2013.4997
Stelmack, J.A., Tang, X.C., Reda, D.J., Rinne, S., Mancil, R.M., Massof, R.W. (2008) Outcomes of the veterans affairs low vision intervention trial (LOVIT). Archives of Ophthalmology, 126(5): 608-617. DOI: 10.1001/archopht.126.5.608
Owsley, C., McGwin, G., Lee, D.J., Lam, B.L., Friedman, D.S., Gower, E.W., et al. (2009) Characteristics of low-vision rehabilitation services in the United States. Archives of Ophthalmology, 127(5): 681-689. DOI: 10.1001/archophthalmol.2009.55
Mangione, C.M., Lee, P.P., Gutierrez, P.R., Spritzer, K., Berry, S., Hays, R.D. (2001) Development of the 25-item National Eye Institute Visual Function Questionnaire. Archives of Ophthalmology, 119(7): 1050-1058. DOI: 10.1001/archopht.119.7.1050
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