May is Macula Month, the annual awareness campaign to help Australians understand their risk of macular diseases, a range of painless conditions affecting the central retina (the macula), which is at the back of the eye. When you understand your risk, and know what to do, you can take early action that could save your sight. Macular Disease Foundation Australia
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Diagnosis
Research
Treatment
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Cochrane library
Blood pressure control for diabetic retinopathy
Hypertension is a well‐known risk factor for several chronic conditions for which lowering blood pressure has proven to be beneficial. The available evidence supports a modest beneficial effect of intervention to reduce blood pressure with respect to preventing diabetic retinopathy for up to five years, particularly for hypertensive type 2 diabetics. Cochrane Database of Systematic Reviews – Intervention 28 March 2023
Non‐steroidal anti‐inflammatory agents for treating cystoid macular edema following cataract surgery
Evidence on effects of NSAIDs in patients with CME is very uncertain and further investigation is warranted. Cochrane Database of Systematic Reviews – Intervention 15 December 2023
Surgical interventions for lamellar macular holes
The included single trial demonstrated improvements in visual and anatomical outcome measures for participants with a LMH who underwent surgery compared with observation only. Therefore, we can conclude that participants who undergo surgery may achieve superior post‐operative best corrected visual acuity and anatomical outcomes compared with observation only. However, the results of a single and small RCT provides limited evidence to support or refute surgery as an effective management option for LMHs. Future RCTs with a larger number of participants and with fewer methodological limitations and biases are necessary to inform future clinical practice. Cochrane Database of Systematic Reviews – Intervention 8 November 2021
Visual cycle modulators versus placebo or observation for the prevention and treatment of geographic atrophy due to age‐related macular degeneration
There is limited evidence to support the use of visual cycle modulators (emixustat and fenretinide) for the treatment of established geographic atrophy due to Age‐related macular degeneration (AMD). The possible reduction in the incidence of choroidal neovascularisation (CNV) observed with fenretinide, and to a lesser extent, emixustat, requires formal assessment in focused studies. Cochrane Database of Systematic Reviews – Intervention 17 December 2020
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Articles
Diagnosis
Diagnostic accuracy of the Amsler Grid Test for detecting neovascular age-related Macular Degeneration: A systematic review and meta-analysis
These findings suggest that the diagnostic accuracy of the Amsler grid for the detection of neovascular age-related macular degeneration (AMD) is moderate when used in a patient population with an a priori risk of neovascular AMD, supporting that these patients should seek ophthalmic examination regularly, regardless of the results of Amsler grid test results. JAMA 16 February 2023
Diagnostic ability of macular microvasculature with swept-source OCT angiography for highly myopic glaucoma using deep learning
Macular OCT angiography (OCTA) measurements have been reported to be useful for glaucoma diagnostics. However, research on highly myopic glaucoma is lacking, and the diagnostic value of macular OCTA measurements versus OCT parameters remains inconclusive. The authors aimed to evaluate the diagnostic ability of the macular microvasculature assessed with OCTA for highly myopic glaucoma and to compare it with that of macular thickness parameters, using deep learning (DL). Scientific reports 30 March 2023
Clinic study on macular epiretinal membrane in patients under the age of 40 years
In young patients, the incidence of partial posterior vitreous detachment (P-PVD) was significantly higher in idiopathic macular epiretinal membrane (IMEM) cases than in SMEM cases. The region, MEM stage, IS/OS integrity, and etiology influenced VA. Etiology was associated most commonly with BCVA. In individuals under 40, the combination of intraoperative IVTA resulted in a more significant decrease in logMAR Vas and CFT. BMC ophthalmology 25 February 2023
Retinal disease detection using deep learning techniques: A comprehensive review
Millions of people are affected by retinal abnormalities worldwide. Early detection and treatment of these abnormalities could arrest further progression, saving multitudes from avoidable blindness. Manual disease detection is time-consuming, tedious and lacks repeatability. There have been efforts to automate ocular disease detection, riding on the successes of the application of Deep Convolutional Neural Networks (DCNNs) and vision transformers (ViTs) for Computer-Aided Diagnosis (CAD). These models have performed well, however, there remain challenges owing to the complex nature of retinal lesions. This work reviews the most common retinal pathologies, provides an overview of prevalent imaging modalities and presents a critical evaluation of current deep-learning research for the detection and grading of glaucoma, diabetic retinopathy, Age-Related Macular Degeneration and multiple retinal diseases. The work concluded that CAD, through deep learning, will increasingly be vital as an assistive technology. As future work, there is a need to explore the potential impact of using ensemble CNN architectures in multiclass, multilabel tasks. Efforts should also be expended on the improvement of model explainability to win the trust of clinicians and patients. Journal of imaging 18 April 2023
Deep learning for detection of age-related macular degeneration: A systematic review and meta-analysis of diagnostic test accuracy studies
Convolutional neural networks are mostly adopted deep learning algorithms in age-related macular degeneration detection. Convolutional neural networks, especially ResNets, are effective in detecting age-related macular degeneration with high diagnostic accuracy. Types of age-related macular degeneration and layers of the network are the two essential factors that impact the model training process. Proper layers of the network will make the model more reliable. More datasets established by new diagnostic methods will be used to train deep learning models in the future, which will benefit for fundus application screening, long-range medical treatment, and reducing the workload of physicians. Plos one 6 April 2023
Reticular Pseudodrusen: Inter-reader agreement of evaluation on OCT imaging in age-related Macular degeneration
There was generally substantial or near-substantial – but not near-perfect – agreement for assessing the presence of reticular pseudodrusen (RPD) on entire optical coherence tomography (OCT) volume scans or selected B-scans across a range of differing RPD criteria. These findings underscore how inter-reader variability would likely contribute to the variability of findings related to the clinical associations of RPD. The low levels of agreement for the assessment of RPD number on OCT B-scans underscores the likely challenges of quantifying RPD extent with manual grading. Ophthalmology science 5 May 2023
Detection of macular atrophy in age-related macular degeneration aided by artificial intelligence
There are few studies in which Artificial Intelligence optical coherence tomography (AI-OCT) methods have been used to identify macular atrophy (MA); however, results are very promising when compared to other imaging modalities. In this paper, the authors review the development and advances of ophthalmic imaging modalities and their combination with AI technology to detect MA in Age-related macular degeneration (AMD). In addition, we emphasize the application of AI-OCT as an objective, cost-effective tool for the early detection and monitoring of the progression of MA in AMD. Expert review of molecular diagnostics 5 May 2023
Early diagnosis of retinal neurovascular injury in diabetic patients without retinopathy by quantitative analysis of OCT and OCTA
Retinal neurovascular units (NVUs) may have been compromised in patients with type 2 diabetes mellitus (DM) without retinopathy. Basic clinical information and rapid noninvasive optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) techniques are useful for the quantitative assessment of retinal NVU prognosis in patients with DM without retinopathy. Acta Diabetologica 5 May 2023
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Research
Visual acuity time in range: a novel concept to describe consistency in treatment response in diabetic macular oedema
BCVA time in range may represent another way to describe visual outcomes and potential impact on vision-related functions over time for patients with DMO and provide a better understanding, for physicians and patients, of the consistency of treatment efficacy. Eye 28 March 2023
Trauma-related acute Macular Neuroretinopathy. A case report
Non-ocular trauma including head or chest trauma without direct ocular injury accounts for most cases of trauma-related acute macular neuroretinopathy. It is important to distinguish this entity, given that there are also unremarkable findings in the retinal examination of these patients. Indeed, proper clinical suspicion leads to further suitable investigations and impedes other extraordinary images, which are the basic rules in the management of traumatic patients suffering multiple injuries and incurring medical expenses. Czech and Slovak ophthalmology 30 March 2023
Imaging biomarkers and clinical factors associated with the rate of progressive inner and outer retinal thinning in patients with diabetic macular edema
The aim of this study was to assess the relationship of clinical characteristics to the rate of retinal thinning in eyes with diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (VEGF) therapy. Scientific reports 24 February 2023
Robot-assisted subretinal injection system: development and preliminary verification
Robot-assisted subretinal injection system (RASR) is able to finish subretinal injection surgery with better stability and less fatigue than manual manipulation. BMC ophthalmology 12 December 2023
Atrophy of retinal vessels in neovascular age-related macular degeneration following long-term treatment with 20 intravitreal anti-VEGF injections
In this study, the authors demonstrated that macular vessel density was lower in the foveal area in the superficial retinal plexus in AMD patients after one year and long-term anti-VEGF treatment. These vascular density changes were absent in the parafoveal and whole areas of the deep retinal plexus. These results indicate that long-term anti-VEGF treatment reduces the vascular density of the superficial retinal plexus to a greater extent compared to the deep retinal plexus. BMC ophthalmology 5 December 2023
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Treatment
Mental health support across the sight loss pathway: a qualitative exploration of eye care patients, optometrists, and ECLOs
It is important that referring optometrists are aware of the need for mental health support services and can signpost to local support services including the third sector anytime during the referral process. Eye 10 January 2023
Navigated direct photocoagulation with a 30-ms short-pulse laser for treating microaneurysms in diabetic macular edema exhibits a high closure rate
This study carried out direct photocoagulation for treating microaneurysms (MAs) in diabetic macular edema (DME) using a navigation laser system with a 30-ms pulse duration. The MA closure rate after 3 months was investigated using pre and postoperative fluorescein angiography images. Scientific reports 13 April 2023
Safety and tolerability of oral vorolanib for neovascular (wet) age-related macular degeneration: a phase I, open-label study
Oral administration of vorolanib improved visual outcomes in participants with nAMD with manageable systemic safety profiles. Eye 11 April 2023
The effect of a brief, unplanned treatment delay on neovascular age-related macular degeneration patients: a retrospective cohort study
Non-compliance to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy can result in increased disease activity in neovascular age-related macular degeneration (nAMD). This study aims to determine effects of unplanned delay in anti-VEGF injection treatment for nAMD. It demonstrates that a one-time, brief interruption in treatment for nAMD results in reversible, temporary worsening. Scientific reports 23 February 2023
Evaluation of care with intravitreal aflibercept treatment for UK patients with diabetic macular oedema: DRAKO study 24-month real-world outcomes
Year 2 results indicate that intravitreal aflibercept (IVT-AFL) is an effective treatment for diabetic macular oedema (DMO) in real-world UK clinical practice, despite relatively low injection numbers. The high baseline visual acuity and QoL scores were maintained and there was further improvement in anatomical outcomes. Eye 20 March 2023
Seven-year outcomes following intensive anti-vascular endothelial growth factor therapy in patients with exudative age-related macular degeneration
Long-term efficacy of aflibercept and ranibizumab was largely consistent. Following a two-year intensive therapy with as-needed regimen, BCVA was maintained or improved in almost half of the patients and in the ranibizumab group and more than half of the patients in the aflibercept group with very few injections. In a remarkable proportion of eyes, BCVA declined severely which underlines the need for long-term follow-ups and may indicate a more prolonged intensive therapy. BMC Ophthalmology 17 March 2023
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