Neil M Bressler

Johns Hopkins University, Baltimore, Maryland, United States

Are you Neil M Bressler?

Claim your profile

Publications (286)1329.71 Total impact

  • Lee M Jampol, Adam R Glassman, Neil M Bressler
    Jama Ophthalmology 06/2015; DOI:10.1001/jamaophthalmol.2015.1880 · 3.83 Impact Factor
  • [Show abstract] [Hide abstract]
    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 DRCR.net 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 · 3.18 Impact Factor
  • [Show abstract] [Hide abstract]
    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. clinicaltrials.gov Identifier:NCT01323348.
    Jama Ophthalmology 05/2015; DOI:10.1001/jamaophthalmol.2015.1312 · 3.83 Impact Factor
  • Value in Health 05/2015; 18(3):A184. DOI:10.1016/j.jval.2015.03.1062 · 2.89 Impact Factor
  • [Show abstract] [Hide abstract]
    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.
    New England Journal of Medicine 03/2015; 372(13):1193-1203. DOI:10.1056/NEJMoa1414264 · 54.42 Impact Factor
  • Neil M Bressler, Howard Bauchner
    Jama Ophthalmology 03/2015; 133(4). DOI:10.1001/jamaophthalmol.2015.0631 · 3.83 Impact Factor
  • [Show abstract] [Hide abstract]
    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 · 3.83 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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 · 6.17 Impact Factor
  • [Show abstract] [Hide abstract]
    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 · 3.18 Impact Factor
  • [Show abstract] [Hide abstract]
    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 · 6.17 Impact Factor
  • [Show abstract] [Hide abstract]
    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 · 6.17 Impact Factor
  • [Show abstract] [Hide abstract]
    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 · 6.17 Impact Factor
  • [Show abstract] [Hide abstract]
    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 · 3.83 Impact Factor
  • Neil M Bressler, Rohit Varma, Quan Doan
    Jama Ophthalmology 08/2014; 132(8):1030-1. DOI:10.1001/jamaophthalmol.2014.2445 · 3.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Understanding measurement variability and relationships between measurements obtained on different optical coherence tomography (OCT) machines is critical for clinical trials and clinical settings.
    Jama Ophthalmology 07/2014; 4(1). DOI:10.1001/jamaophthalmol.2014.1698 · 3.83 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Intravitreal injections of anti-vascular endothelial growth factor agents, such as ranibizumab, have significantly improved the management of neovascular age-related macular degeneration. This study used patient-level simulation modelling to estimate the number of individuals in Australia who would have been likely to avoid legal blindness or visual impairment due to neovascular age-related macular degeneration over a 2-year period as a result of intravitreal ranibizumab injections. The modelling approach used existing data for the incidence of neovascular age-related macular degeneration in Australia and outcomes from ranibizumab trials. Blindness and visual impairment were defined as visual acuity in the better-seeing eye of worse than 6/60 or 6/12, respectively. In 2010, 14 634 individuals in Australia were estimated to develop neovascular age-related macular degeneration who would be eligible for ranibizumab therapy. Without treatment, 2246 individuals would become legally blind over 2 years. Monthly 0.5 mg intravitreal ranibizumab would reduce incident blindness by 72% (95% simulation interval, 70-74%). Ranibizumab given as needed would reduce incident blindness by 68% (64-71%). Without treatment, 4846 individuals would become visually impaired over 2 years; this proportion would be reduced by 37% (34-39%) with monthly intravitreal ranibizumab, and by 28% (23-33%) with ranibizumab given as needed. These data suggest that intravitreal injections of ranibizumab, given either monthly or as needed, can substantially lower the number of cases of blindness and visual impairment over 2 years after the diagnosis of neovascular age-related macular degeneration.
    PLoS ONE 06/2014; 9(6):e101072. DOI:10.1371/journal.pone.0101072 · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose:To evaluate the effects of 0.3 mg or 0.5 mg of ranibizumab in eyes with macular telangiectasia type 2 without subretinal neovascularization.Methods:Ten eyes were randomized to either 0.3 mg or 0.5 mg ranibizumab group in 1 eye only. Study eye received ranibizumab at baseline and at Months 1 and 2. Injections at Months 3, 4, and 5 were at investigator's discretion. Participants were followed monthly through 6 months with best-corrected visual acuity, fluorescein angiography, and optical coherence tomography.Results:For study eyes at baseline, median best-corrected visual acuity letter score was 60 (20/64 Snellen equivalent) and central subfield retinal thickness was 181.5 m. Median number of injections was six. Median change in best-corrected visual acuity at Month 3 was 4 letters (range: -5 to 9 letters) at both doses in the study eye and 3 letters (range: -10 to 5 letters) in the untreated fellow eye. At Month 3, retinal leakage decreased 0.87 disk area and 0.76 disk area for 0.3 mg and 0.5 mg ranibizumab, respectively. Median change in central subfield retinal thickness was 1 m and -11 mu m for 0.3 mg and 0.5 mg ranibizumab, respectively.Conclusion:Ranibizumab (0.3 mg or 0.5 mg) decreases leakage secondary to macular telangiectasia type 2, but accompanying improvements in best-corrected visual acuity appear similar to improvements in the untreated fellow eye where retinal thickness is relatively unchanged.
    Retina (Philadelphia, Pa.) 06/2014; 34(10). DOI:10.1097/IAE.0000000000000203 · 3.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe clinical and imaging findings in two eyes with new onset subtle neovascular age-related macular degeneration that was detected by the regular use of a home monitoring device based on preferential hyperacuity visual field testing.
    Retinal Cases & Brief Reports 06/2014; 9(1). DOI:10.1097/ICB.0000000000000085
  • Lee M Jampol, Neil M Bressler, Adam R Glassman
    JAMA The Journal of the American Medical Association 06/2014; 311(22):2269-2270. DOI:10.1001/jama.2014.2536 · 30.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Some clinical trials that proved the benefits of anti-VEGF therapy for diabetic macular edema (DME) based retreatment decisions on visual acuity and time-domain ocular coherence tomography (TD-OCT) central subfield thickness changes since the last treatment. This study assessed the impact of TD-OCT followed by spectral domain (SD)-OCT on as needed treatment decision-making in the management of DME with anti-VEGF medications. Methods: Patients previously treated for DME with anti-VEGF medications in the Retina Division of the Wilmer Eye Institute, following an IRB approved informed consent process, underwent clinical examination, TD- and SD-OCT imaging. Their retina specialists recorded whether additional anti-VEGF therapy was recommended and their level of certainty in the decision after performing a clinical examination and reviewing a TD-OCT, and then again after reviewing a SD-OCT. Results: Data were collected for 129 treatment decision pairs involving 67 eyes from 46 subjects. Non-concordant decisions occurred in 9 (7%) treatment decision pairs. In 7 of these (5%, 95% confidence interval [CI]: 2% to 11%), the addition of SD-OCT changed the retina specialist's decision from not recommending to recommending retreatment. The addition of SD-OCT increased the certainty of the retina specialist in 36% (95% CI: 27% to 45%) of all treatment decision pairs. Conclusions: SD-OCT does not appear to change the ultimate treatment decision or increase the level of certainty of the retina specialist relative to TD-OCT in most cases of DME under anti-VEGF management in clinical practice. The few non-concordant decisions appear to trend towards recommending more anti-VEGF therapy following SD-OCT.
    Investigative ophthalmology & visual science 02/2014; 55(3). DOI:10.1167/iovs.13-13049 · 3.66 Impact Factor

Publication Stats

12k Citations
1,329.71 Total Impact Points

Institutions

  • 1987–2015
    • Johns Hopkins University
      • • Wilmer Eye Institute
      • • Department of Epidemiology
      • • Department of Medicine
      Baltimore, Maryland, United States
  • 1989–2014
    • Johns Hopkins Medicine
      • • Wilmer Eye Institute
      • • Department of Pathology
      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
  • 2001
    • Université Paris-Est Créteil Val de Marne - Université Paris 12
      Créteil, Île-de-France, France
  • 2000
    • Duke University
      Durham, North Carolina, United States
  • 1996
    • University of California, Santa Barbara
      • Neuroscience Research Institute
      Santa Barbara, CA, United States
  • 1985–1987
    • Harvard Medical School
      Boston, Massachusetts, United States