Neil M Bressler

Johns Hopkins University, Baltimore, Maryland, United States

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Publications (295)1333.98 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To describe visual acuity changes associated with several cycles of accumulation, disappearance, and reaccumulation of vitelliform material in Best disease, with fundus photographs, fluorescein angiograms, and optical coherence tomography images documenting these stages. Methods: Case report with 70 months of follow-up using fundus photography, fluorescein angiography, and optical coherence tomography to image the retina. A non-Hispanic white 33-year-old man with Best disease (positive for a mutation in the BEST1 gene, namely p.Tyr167Cys:c.500A>G). Results: The patient had a history of choroidal neovascularization (CNV) followed by scarring of the macula with sustained vision loss of ∼20/250 in the left eye when he was in his twenties. He subsequently presented in his thirties with acute vision loss in the right eye 3 times during a 70-month follow-up period. Each episode of vision loss in the right eye was preceded by several months of reaccumulation of vitelliform material in the macula apparent on fundus photographs, fluorescein angiograms, and optical coherence tomography, but no evidence of CNV on presentation. Each of the three episodes of vision loss in the right eye was followed by spontaneous gradual improvement in visual acuity over the next several months, correlating with decreasing amounts of the vitelliform material on clinical examination and fundus photographs. After the third documented recovery of visual acuity, at a time of stable vision, the patient developed CNV in the right eye, treated with intravitreal ranibizumab. Conclusion: This case demonstrates that vitelliform material can reaccumulate and resorb several times in Best disease, with temporary visual acuity decline after each episode of vitelliform material accumulation. There is a need for continued vigilance for the development of CNV in patients presenting with acute vision loss, although this patient developed CNV at a time of stable vision.
    09/2015; DOI:10.1097/ICB.0000000000000207
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    ABSTRACT: To determine the impact of ranibizumab 0.5 mg on patient-reported visual function over 36 months in individuals with visual impairment from diabetic macular edema. RESTORE comprises a phase 3, randomized, multicenter, 12-month core study, and a 24-month open-label extension study. Eyes assigned ranibizumab in the core study received ranibizumab for 36 months; eyes assigned laser monotherapy in the core study received ranibizumab during the extension. The primary outcome was least-squares mean change in National Eye Institute 25-item Visual Functioning Questionnaire (NEI VFQ-25) overall composite and subscale scores. Of 303 core study participants, 240 (79%) entered the extension, comprising 83 (35%) participants initially assigned ranibizumab, 83 (35%) assigned ranibizumab plus laser combination therapy, and 74 (31%) assigned laser monotherapy. Least-squares mean (standard error) change in NEI VFQ-25 composite score from baseline to month 12 (+5.9 [1.5]; +5.0 [1.5], for the ranibizumab and combination therapy groups, respectively) decreased by month 36 (+4.1 [1.7]; +4.0 [1.7], respectively, from baseline to month 36) following reduced injection frequency relative to the core study. At 36 months, the least-squares mean (standard error) change in the laser monotherapy group was similar to that in the ranibizumab groups (+4.1 [1.8]). Most subscale scores showed outcomes similar to that for the composite score. The greatest NEI VFQ-25 gains were consistently observed in participants for whom the study eye was the better-seeing eye. Patients entering the extension were not randomized, and 21% of the core study participants did not enter the extension, which may have affected the results. Gains in patient-reported visual function at month 12 among eyes receiving ranibizumab in the core study decreased slightly by 36 months. Eyes originally receiving laser monotherapy for 12 months, then ranibizumab for 24 months achieved similar gains by 36 months to eyes receiving ranibizumab for 36 months. NCT00687804 and NCT00906464.
    Current Medical Research and Opinion 09/2015; DOI:10.1185/03007995.2015.1081880 · 2.65 Impact Factor
  • Ian C Han · Lawrence J Singerman · Alvin Schmaier · Neil M Bressler
    Jama Ophthalmology 07/2015; DOI:10.1001/jamaophthalmol.2015.2414 · 3.32 Impact Factor
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    ABSTRACT: Age-related macular degeneration (AMD), left untreated, is the leading cause of vision loss in people older than 55. Severe central vision loss occurs in the advanced stage of the disease, characterized by either the in growth of choroidal neovascularization (CNV), termed the "wet" form, or by geographic atrophy (GA) of the retinal pigment epithelium (RPE) involving the center of the macula, termed the "dry" form. Tracking the change in GA area over time is important since it allows for the characterization of the effectiveness of GA treatments. Tracking GA evolution can be achieved by physicians performing manual delineation of GA area on retinal fundus images. However, manual GA delineation is time-consuming and subject to inter-and intra-observer variability. We have developed a fully automated GA segmentation algorithm in color fundus images that uses a supervised machine learning approach employing a random forest classifier. This algorithm is developed and tested using a dataset of images from the NIH-sponsored Age Related Eye Disease Study (AREDS). GA segmentation output was compared against a manual delineation by a retina specialist. Using 143 color fundus images from 55 different patient eyes, our algorithm achieved PPV of 0.82±0.19, and NPV of 0:95±0.07. This is the first study, to our knowledge, applying machine learning methods to GA segmentation on color fundus images and using AREDS imagery for testing. These preliminary results show promising evidence that machine learning methods may have utility in automated characterization of GA from color fundus images. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Computers in Biology and Medicine 07/2015; 65:124-136. DOI:10.1016/j.compbiomed.2015.06.018 · 1.24 Impact Factor
  • Lee M Jampol · Adam R Glassman · Neil M Bressler
    Jama Ophthalmology 06/2015; 133(9). DOI:10.1001/jamaophthalmol.2015.1880 · 3.32 Impact Factor
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    ABSTRACT: The approach to managing diabetic macular edema in eyes with previous vitrectomy is based on limited evidence. Therefore, an exploratory post hoc assessment of 3-year data from eyes with and without vitrectomy before randomization in a trial that evaluated ranibizumab + prompt or deferred laser for diabetic macular edema is presented. Visual acuity and optical coherence tomography outcomes were compared between eyes with and without previous vitrectomy. At baseline, eyes with previous vitrectomy (n = 25) had longer duration of diabetes, worse visual acuity, less thickened central subfield measurements on optical coherence tomography and were more apt to have worse diabetic retinopathy severity level or previous treatment for macular edema or cataract surgery than eyes without a history of vitrectomy (n = 335). Analyses adjusted for these baseline imbalances did not identify substantial differences between eyes with and without previous vitrectomy at each annual visit through 3 years for the favorable visual acuity, optical coherence tomography central subfield thickness, or volume outcomes, although optical coherence tomography improvement appeared slower in vitrectomy eyes during the first year. This study provides little evidence that the beneficial clinical outcomes for patients with center-involved diabetic macular edema treated with anti-vascular endothelial growth factor are affected in the long term by previous vitrectomy.
    Retina (Philadelphia, Pa.) 05/2015; DOI:10.1097/IAE.0000000000000617 · 3.24 Impact Factor
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    ABSTRACT: Optimization of glycemic control is critical to reduce the number of diabetes mellitus-related complications, but long-term success is challenging. Although vision loss is among the greatest fears of individuals with diabetes, comprehensive personalized diabetes education and risk assessments are not consistently used in ophthalmologic settings. To determine whether the point-of-care measurement of hemoglobin A1c (HbA1c) and personalized diabetes risk assessments performed during retinal ophthalmologic visits improve glycemic control as assessed by HbA1c level. Ophthalmologist office-based randomized, multicenter clinical trial in which investigators from 42 sites were randomly assigned to provide either a study-prescribed augmented diabetes assessment and education or the usual care. Adults with type 1 or 2 diabetes enrolled into 2 cohorts: those with a more-frequent-than-annual follow-up (502 control participants and 488 intervention participants) and those with an annual follow-up (368 control participants and 388 intervention participants). Enrollment was from April 2011 through January 2013. Point-of-care measurements of HbA1c, blood pressure, and retinopathy severity; an individualized estimate of the risk of retinopathy progression derived from the findings from ophthalmologic visits; structured comparison and review of past and current clinical findings; and structured education with immediate assessment and feedback regarding participant's understanding. These interventions were performed at enrollment and at routine ophthalmic follow-up visits scheduled at least 12 weeks apart. Mean change in HbA1c level from baseline to 1-year follow-up. Secondary outcomes included body mass index, blood pressure, and responses to diabetes self-management practices and attitudes surveys. In the cohort with more-frequent-than-annual follow-ups, the mean (SD) change in HbA1c level at 1 year was -0.1% (1.5%) in the control group and -0.3% (1.4%) in the intervention group (adjusted mean difference, -0.09% [95% CI, -0.29% to 0.12%]; P = .35). In the cohort with annual follow-ups, the mean (SD) change in HbA1c level was 0.0% (1.1%) in the control group and -0.1% (1.6%) in the intervention group (mean difference, -0.05% [95% CI, -0.27% to 0.18%]; P = .63). Results were similar for all secondary outcomes. Long-term optimization of glycemic control is not achieved by a majority of individuals with diabetes. The addition of personalized education and risk assessment during retinal ophthalmologic visits did not result in a reduction in HbA1c level compared with usual care over 1 year. These data suggest that optimizing glycemic control remains a substantive challenge requiring interventional paradigms other than those examined in our study. Identifier:NCT01323348.
    Jama Ophthalmology 05/2015; 133(8). DOI:10.1001/jamaophthalmol.2015.1312 · 3.32 Impact Factor
  • Value in Health 05/2015; 18(3):A184. DOI:10.1016/j.jval.2015.03.1062 · 3.28 Impact Factor
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    ABSTRACT: Background: The relative efficacy and safety of intravitreous aflibercept, bevacizumab, and ranibizumab in the treatment of diabetic macular edema are unknown. Methods: At 89 clinical sites, we randomly assigned 660 adults (mean age, 61±10 years) with diabetic macular edema involving the macular center to receive intravitreous aflibercept at a dose of 2.0 mg (224 participants), bevacizumab at a dose of 1.25 mg (218 participants), or ranibizumab at a dose of 0.3 mg (218 participants). The study drugs were administered as often as every 4 weeks, according to a protocol-specified algorithm. The primary outcome was the mean change in visual acuity at 1 year. Results: From baseline to 1 year, the mean visual-acuity letter score (range, 0 to 100, with higher scores indicating better visual acuity; a score of 85 is approximately 20/20) improved by 13.3 with aflibercept, by 9.7 with bevacizumab, and by 11.2 with ranibizumab. Although the improvement was greater with aflibercept than with the other two drugs (P<0.001 for aflibercept vs. bevacizumab and P=0.03 for aflibercept vs. ranibizumab), it was not clinically meaningful, because the difference was driven by the eyes with worse visual acuity at baseline (P<0.001 for interaction). When the initial visual-acuity letter score was 78 to 69 (equivalent to approximately 20/32 to 20/40) (51% of participants), the mean improvement was 8.0 with aflibercept, 7.5 with bevacizumab, and 8.3 with ranibizumab (P>0.50 for each pairwise comparison). When the initial letter score was less than 69 (approximately 20/50 or worse), the mean improvement was 18.9 with aflibercept, 11.8 with bevacizumab, and 14.2 with ranibizumab (P<0.001 for aflibercept vs. bevacizumab, P=0.003 for aflibercept vs. ranibizumab, and P=0.21 for ranibizumab vs. bevacizumab). There were no significant differences among the study groups in the rates of serious adverse events (P=0.40), hospitalization (P=0.51), death (P=0.72), or major cardiovascular events (P=0.56). Conclusions: Intravitreous aflibercept, bevacizumab, or ranibizumab improved vision in eyes with center-involved diabetic macular edema, but the relative effect depended on baseline visual acuity. When the initial visual-acuity loss was mild, there were no apparent differences, on average, among study groups. At worse levels of initial visual acuity, aflibercept was more effective at improving vision. (Funded by the National Institutes of Health; number, NCT01627249.).
    New England Journal of Medicine 03/2015; 372(13):1193-1203. DOI:10.1056/NEJMoa1414264 · 55.87 Impact Factor
  • Neil M Bressler · Howard Bauchner
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    ABSTRACT: JAMA Ophthalmology has been notified by the University of Colorado Denver Anschutz Medical Campus that the university completed a scientific misconduct investigation involving research published by Rajendra Kadam, MPharm, and has determined that 10 papers with Kadam as an author contain falsified and/or fabricated data. For the article published in 2011 by Kadam et al in JAMA Ophthalmology, then known as Archives of Ophthalmology, the original liquid chromatographic/mass spectrometric data were not available to compare with the data used in the analysis, and the investigative committee was unable to validate the data reported in the study. Therefore, the committee was unable to reach any definitive conclusion related to the integrity or reliability of the data in this report. This Editorial Expression of Concern is to inform readers about possible concerns related to data therein. If additional information becomes available about the integrity of the data reported in this article, we will determine whether additional action is warranted.
    Jama Ophthalmology 03/2015; 133(4). DOI:10.1001/jamaophthalmol.2015.0631 · 3.32 Impact Factor
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    ABSTRACT: For the management of retinal disease, the use of intravitreous injections of anti-vascular endothelial growth factor has increased. Recent reports have suggested that this therapy may cause sustained elevation of intraocular pressure (IOP) and may potentially increase the risk of glaucoma for patients with retinal disease. To assess the risk of sustained IOP elevation or the need for IOP-lowering treatments for eyes with diabetic macular edema following repeated intravitreous injections of ranibizumab. An exploratory analysis was conducted within a Diabetic Retinopathy Clinical Research Network randomized clinical trial. Study enrollment dates were from March 20, 2007, to December 17, 2008. Of 582 eyes (of 486 participants) with center-involved diabetic macular edema and no preexisting open-angle glaucoma, 260 were randomly assigned to receive a sham injection plus focal/grid laser treatment, and 322 were randomly assigned to receive ranibizumab plus deferred or prompt focal/grid laser treatment. The cumulative probability of sustained IOP elevation, defined as IOP of at least 22 mm Hg and an increase of at least 6 mm Hg from baseline at 2 consecutive visits, or the initiation or augmentation of ocular hypotensive therapy, through 3 years of follow-up. The mean (SD) baseline IOP in both treatment groups was 16 (3) mm Hg (range, 5-24 mm Hg). The cumulative probability of sustained IOP elevation or of initiation or augmentation of ocular hypotensive therapy by 3 years, after repeated ranibizumab injections, was 9.5% for the participants who received ranibizumab plus prompt or deferred focal/grid laser treatment vs 3.4% for the participants who received a sham injection plus focal/grid laser treatment (difference, 6.1% [99% CI, -0.2% to 12.3%]; hazard ratio, 2.9 [99% CI 1.0-7.9]; P = .01). The distribution of IOP and the change in IOP from baseline at each visit through 3 years were similar in each group. In eyes with center-involved diabetic macular edema and no prior open-angle glaucoma, repeated intravitreous injections of ranibizumab may increase the risk of sustained IOP elevation or the need for ocular hypotensive treatment. Clinicians should be aware of this risk and should consider this information when following up with patients who have received intravitreous injections of anti-vascular endothelial growth factor for the treatment of diabetic macular edema.
    Jama Ophthalmology 02/2015; 133(5). DOI:10.1001/jamaophthalmol.2015.186 · 3.32 Impact Factor
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    ABSTRACT: To estimate visual impairment (VI) and blindness avoided with intravitreal ranibizumab 0.3 mg treatment for central-involved diabetic macular edema (DME) among Hispanic and non-Hispanic white individuals in the United States. Population-based model simulating visual acuity (VA) outcomes over 2 years after diagnosis and treatment of DME. Visual acuity changes with and without ranibizumab were based on data from the RISE, RIDE, and DRCR Network trials. For the better-seeing eye, VA outcomes included VI, defined as worse than 20/40 in the better-seeing eye, and blindness, defined as VA of 20/200 or worse in the better-seeing eye. Incidence of 1 or both eyes with central-involved DME in 2010 were estimated based on the 2010 United States population, prevalence of diabetes mellitus, and 1-year central-involved DME incidence rate. Sixty-one percent of incident individuals had bilateral DME and 39% had unilateral DME, but DME could develop in the fellow eye. Cases of VI and blindness avoided with ranibizumab treatment. Among approximately 102 million Hispanic and non-Hispanic white individuals in the United States 45 years of age and older in 2010, an estimated 37 274 had central-involved DME and VI eligible for ranibizumab treatment. Compared with no ranibizumab treatment, the model predicted that ranibizumab 0.3 mg every 4 weeks would reduce the number of individuals with VI from 11 438 (95% simulation interval [SI], 7249-16 077) to 6304 (95% SI, 3921-8981), a 45% (95% SI, 36%-53%) reduction at 2 years. Ranibizumab would reduce the number of incident eyes with VA worse than 20/40 from 16 910 (95% SI, 10 729-23 577) to 9361 (95% SI, 5839-13 245), a 45% (95% SI, 38%-51%) reduction. Ranibizumab was estimated to reduce the number of individuals with legal blindness by 75% (95% SI, 58%-88%) and the number of incident eyes with VA of 20/200 or worse by 76% (95% SI, 63%-87%). This model suggests that ranibizumab 0.3 mg every 4 weeks substantially reduces prevalence of VI and legal blindness 2 years after initiating treatment among Hispanic and non-Hispanic white individuals in the United States with central-involved DME that has caused vision loss. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
    Ophthalmology 02/2015; 122(5). DOI:10.1016/j.ophtha.2014.12.007 · 6.14 Impact Factor
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    ABSTRACT: To evaluate the effect of a topical, nonsteroidal antiinflammatory drug, nepafenac 0.1%, in eyes with noncentral diabetic macular edema. Multicenter, double-masked randomized trial. Individuals with good visual acuity and noncentral-involved diabetic macular edema were randomly assigned to nepafenac 0.1% (N = 61) or placebo (nepafenac vehicle, N = 64) 3 times a day for 12 months. The primary outcome was mean change in optical coherence tomography retinal volume at 12 months. Mean baseline retinal volume was 7.8 mm. At 12 months, in the nepafenac and placebo groups respectively, mean change in retinal volume was -0.03 mm and -0.02 mm (treatment group difference: -0.02, 95% confidence interval: -0.27 to 0.23, P = 0.89). Central-involved diabetic macular edema was present in 7 eyes (11%) and 9 eyes (14%) at the 12-month visit (P = 0.79), respectively. No differences in visual acuity outcomes were identified. One study participant developed a corneal melt after using nepafenac in the nonstudy eye, which had a history of severe dry eye. No additional safety concerns were evident. In eyes with noncentral diabetic macular edema and good visual acuity, topical nepafenac 0.1% 3 times daily for 1 year likely does not have a meaningful effect on optical coherence tomography-measured retinal thickness.
    Retina (Philadelphia, Pa.) 01/2015; 35(5). DOI:10.1097/IAE.0000000000000403 · 3.24 Impact Factor
  • Voraporn Chaikitmongkol · Neil M Bressler
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    ABSTRACT: Purpose: To describe the clinical and optical coherence tomography findings of an eye with diabetic macular edema that developed intraretinal fibrosis in an area previously occupied by lipid accumulating after the intravitreous ranibizumab treatment. Methods: Interventional case report. Results: An 85-year-old man presented with diabetic macular edema involving the center of the macula with a half disk area of lipid inferotemporal to the macula. He received ranibizumab treatments after the principles of the Diabetic Retinopathy Clinical Research Network retreatment guidelines. After 12 doses of intravitreous ranibizumab injections over 20 months, macular edema resolved, visual acuity improved from 20/63 to 20/40, and the central subfield thickness decreased from 404 μm to 234 μm. As the edema resolved, the area of lipid did not expand toward the fovea but was replaced by fibrosis occupying the area of lipid, only smaller in extent. Optical coherence tomography scans showed an intraretinal, dome-shaped hyperreflective area corresponding to the fibrosis. Conclusion: This case report, to our knowledge, provides the first documentation of intraretinal fibrosis replacing an area of lipid associated with diabetic macular edema after anti-vascular endothelial growth factor therapy, as had been described previously following laser photocoagulation for diabetic macular edema. Unlike some previous reports of lipid accumulating within the fovea with subsequent fibrosis corresponding to the metaplastic retinal pigment epithelium on histopathology, with or without laser treatment, the lipid in this case did not expand into the fovea before the development of fibrosis, and optical coherence tomography confirmed that the fibrosis was located in the intraretinal rather than the subretinal pigment epithelium space.
    Retinal Cases & Brief Reports 11/2014; 8(4):336-9. DOI:10.1097/ICB.0000000000000063
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    ABSTRACT: To report 5-year results from a previously reported trial evaluating intravitreal 0.5 mg ranibizumab with prompt versus deferred (for ≥24 weeks) focal/grid laser treatment for diabetic macular edema (DME). Multicenter, randomized clinical trial. Among participants from the trial with 3 years of follow-up who subsequently consented to a 2-year extension and survived through 5 years, 124 (97%) and 111 (92%) completed the 5-year visit in the prompt and deferred groups, respectively. Random assignment to ranibizumab every 4 weeks until no longer improving (with resumption if worsening) and prompt or deferred (≥24 weeks) focal/grid laser treatment. Best-corrected visual acuity at the 5-year visit. The mean change in visual acuity letter score from baseline to the 5-year visit was +7.2 letters in the prompt laser group compared with +9.8 letters in the deferred laser group (mean difference, -2.6 letters; 95% confidence interval, -5.5 to +0.4 letters; P = 0.09). At the 5-year visit in the prompt versus deferred laser groups, there was vision loss of ≥10 letters in 9% versus 8%, an improvement of ≥10 letters in 46% versus 58%, and an improvement of ≥15 letters in 27% versus 38% of participants, respectively. From baseline to 5 years, 56% of participants in the deferred group did not receive laser. The median number of injections was 13 versus 17 in the prompt and deferral groups, including 54% and 45% receiving no injections during year 4 and 62% and 52% receiving no injections during year 5, respectively. Five-year results suggest focal/grid laser treatment at the initiation of intravitreal ranibizumab is no better than deferring laser treatment for ≥24 weeks in eyes with DME involving the central macula with vision impairment. Although more than half of eyes in which laser treatment is deferred may avoid laser for at least 5 years, such eyes may require more injections to achieve these results when following this protocol. Most eyes treated with ranibizumab and either prompt or deferred laser maintain vision gains obtained by the first year through 5 years with little additional treatment after 3 years. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
    Ophthalmology 10/2014; 122(2). DOI:10.1016/j.ophtha.2014.08.047 · 6.14 Impact Factor
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    ABSTRACT: Purpose To assess the development of vision-threatening lesions at least 3.5 years after initiating anti-vascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) in eyes with age-related macular degeneration (AMD). Design Retrospective cohort study. Participants A total of 75 patients (81 eyes) with CNV secondary to AMD who received intravitreous anti-VEGF treatment and were followed for at least 3.5 years after initiating treatment. Methods Retrospective record review of patients initiating anti-VEGF treatment between November 2005 and June 2008 at a university-based institution for whom at least 3.5 years of follow-up was available at the same institution. Main Outcome Measures Predominantly hemorrhagic lesions or geographic atrophy (GA). Results Among 75 patients (81 eyes; 59% were women; median age, 78 years), mean follow-up was 4.9 years and at least 6 years for 40%. Median visual acuity (VA) was 20/80 (interquartile range [IQR], 20/50–20/100) initially, 20/63 (IQR, 20/40–20/160) at 2 years, 20/80 (IQR, 20/40–20/200) at 3.5 years, and 20/63 (IQR 20/32–20/200) at 6 years. Six eyes (7%) had predominantly hemorrhagic lesions initially, whereas this developed in an additional 3 eyes (4%, 95% confidence interval [CI], 1% to 10%) in 3.5 years and in 1 additional eye (1%, 95% CI, 0.03% to 7%) at more than 3.5 years of follow-up. Initially, GA within or overlapping the boundary of the entire CNV was present in 4 eyes (5%) and outside this boundary in 8 eyes (10%). Geographic atrophy enlarged in each eye over time. The only eyes that developed GA outside the CNV boundary were those that had GA outside the lesion at baseline. Additional atrophy within the boundary of CNV defined at baseline, termed “atrophic disciform scars,” developed in 5 eyes (6%), all within 4 years of treatment initiation. Conclusions Longer-term follow-up of neovascular AMD managed with anti-VEGF therapy suggests that predominantly hemorrhagic lesions may develop within 3.5 years of initiating therapy and more than 3.5 years after initiating therapy. In contrast, new areas of GA beyond the boundaries of the CNV lesion as defined at initiation of anti-VEGF therapy seem unlikely to develop if there is no GA outside of the CNV lesion initially.
    Ophthalmology 10/2014; 122(1). DOI:10.1016/j.ophtha.2014.07.046 · 6.14 Impact Factor
  • Y M Paulus · N M Bressler
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    ABSTRACT: Eye is the official journal of the Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory-based research.
    Eye (London, England) 09/2014; 28(12). DOI:10.1038/eye.2014.203 · 2.08 Impact Factor
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    ABSTRACT: To examine the effects of intravitreal ranibizumab (Lucentis; Genentech, Inc., South San Francisco, CA) treatment on patient-reported vision-related function, as assessed by 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) scores, in patients with visual impairment secondary to center-involved diabetic macular edema (DME).
    Ophthalmology 08/2014; 121(12). DOI:10.1016/j.ophtha.2014.07.008 · 6.14 Impact Factor
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    ABSTRACT: Importance Diabetic macular edema (DME) is a leading cause of vision loss in persons with diabetes mellitus. Although there are national estimates for the prevalence of diabetic retinopathy and its risk factors among persons with diabetes, to our knowledge, no comparable estimates are available for DME specifically. Objectives To estimate the prevalence of DME in the US population and to identify associated risk factors.Design, Setting, and Participants A cross-sectional analysis of 1038 participants aged 40 years or older with diabetes and valid fundus photographs in the 2005 to 2008 National Health and Nutrition Examination Survey.Main Outcomes and Measures The overall prevalence of DME and its prevalence according to age, race/ethnicity, and sex.Results Of the 1038 persons with diabetes analyzed for this study, 55 had DME, for an overall weighted prevalence of 3.8% (95% CI, 2.7%-4.9%) or approximately 746 000 persons in the US 2010 population aged 40 years or older. We identified no differences in the prevalence of DME by age or sex. Multivariable logistic regression analysis showed that the odds of having DME were higher for non-Hispanic blacks than for non-Hispanic whites (odds ratio [OR], 2.64; 95% CI, 1.19-5.84; P = .02). Elevated levels of glycosylated hemoglobin A1c (OR, 1.47; 95% CI, 1.26-1.71 for each 1%; P < .001) and longer duration of diabetes (OR, 8.51; 95% CI, 3.70-19.54 for ≥10 vs <10 years; P < .001) were also associated with DME prevalence.Conclusions and Relevance These results suggest a greater burden of DME among non-Hispanic blacks, individuals with high levels of hemoglobin A1c, and those with longer duration of diabetes. Given recent treatment advances in reducing vision loss and preserving vision in persons with DME, it is imperative that all persons with diabetes receive early screening; this recommendation is even more important for those at higher risk for DME.
    Jama Ophthalmology 08/2014; 132(11). DOI:10.1001/jamaophthalmol.2014.2854 · 3.32 Impact Factor
  • Neil M Bressler · Rohit Varma · Quan Doan
    Jama Ophthalmology 08/2014; 132(8):1030-1. DOI:10.1001/jamaophthalmol.2014.2445 · 3.32 Impact Factor

Publication Stats

13k Citations
1,333.98 Total Impact Points


  • 1987–2015
    • Johns Hopkins University
      • • Wilmer Eye Institute
      • • Department of Epidemiology
      Baltimore, Maryland, United States
  • 1989–2014
    • Johns Hopkins Medicine
      • Wilmer Eye Institute
      Baltimore, Maryland, United States
  • 2008–2010
    • Jaeb Center for Health Research
      Tampa, Florida, United States
  • 1999–2010
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 2009
    • Vanderbilt University
      Nashville, Michigan, United States
    • Penn State Hershey Medical Center and Penn State College of Medicine
      Hershey, Pennsylvania, United States
  • 2007
    • NEI Corporation
      Сомерсет, New Jersey, United States
  • 2005
    • Emory University
      • Department of Ophthalmology
      Atlanta, Georgia, United States
  • 2002
    • University College London
      • Institute of Ophthalmology
      London, ENG, United Kingdom
    • Osaka University
      • Division of Ophthalmology
      Ōsaka-shi, Osaka-fu, Japan
  • 2000
    • Duke University
      Durham, North Carolina, United States
  • 1996
    • University of California, Santa Barbara
      • Neuroscience Research Institute
      Santa Barbara, CA, United States
  • 1992
    • Royal Victorian Eye and Ear Hospital
      Melbourne, Victoria, Australia
  • 1985–1987
    • Harvard Medical School
      Boston, Massachusetts, United States