Marie-Christine Bruender1, Nicola Benjamin2, Hansjuergen Thomas Agostini1, Andreas Stahl1, Christoph Ehlken3,4. 1. Eye Center, Medical Center, Faculty of Medicine, Albert-Ludwigs-University, Killianstraße 5, 79106, Freiburg im Breisgau, Germany. 2. Center for Pulmonary Hypertension, Thoraxclinic at the University Hospital Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany. 3. Eye Center, Medical Center, Faculty of Medicine, Albert-Ludwigs-University, Killianstraße 5, 79106, Freiburg im Breisgau, Germany. christoph.ehlken@uksh.de. 4. Department of Ophthalmology, Faculty of Medicine, Christian-Albrechts-University, Arnold-Heller-Strasse 3, 24105, Kiel, Germany. christoph.ehlken@uksh.de.
Abstract
BACKGROUND: Patients with exudative maculopathies (neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO)) are faced with a high burden of examinations and treatments. This study was conceived to analyze the accuracy of a subjective evaluation of visual acuity (VA) and metamorphopsia to detect disease reactivation, compared to morphological signs of reactivation assessed by means of SD-OCT. METHODS: Retrospective study of 888 patients treated for nAMD (n = 638), DME (84), BRVO (110), and CRVO (56) was conducted. Subjective evaluation of the patient at an examination (i.e., change of VA and/or metamorphopsia) was compared to clinical evaluation of disease activity as assessed by SD-OCT. Sensitivity and specificity, negative and positive predictive values (PPV/NPV) for detection of active disease were calculated. Factors associated with false-negative subjective evaluation were analyzed by regression analysis. RESULTS: The sensitivity of the subjective evaluation to detect disease reactivation was < 0.50 in all exudative maculopathies. Sensitivity was increased to ≥ 0.60 by combining subjective worsening with loss of 1 line in the VA test in RVO, but not in DME and nAMD. The specificity was > 0.85 in all patients. PPV was > 0.85 in patients with RVO. Regression analysis did not reveal any factors that could reliably identify patient subgroups in which OCT could be omitted, though CRVO patients with a visual acuity of < 0.3 logMAR had an odds ratio of 0.20 for false-negative subjective evaluation (p = 0.009). CONCLUSION: The accuracy of subjective evaluation to discriminate disease activity in patients with different exudative maculopathies was low and cannot substitute for frequent SD-OCT exams. Routinely assessed clinical parameters such as age, visual acuity, or treatment experience were of no use to predict the validity of subjective evaluation of disease activity. TRIAL REGISTRATION: This trial was registered at the DRKS (Deutsches Register Klinischer Studien, drks.de; No 00006851) prior to the inclusion of the first patient.
BACKGROUND:Patients with exudative maculopathies (neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO)) are faced with a high burden of examinations and treatments. This study was conceived to analyze the accuracy of a subjective evaluation of visual acuity (VA) and metamorphopsia to detect disease reactivation, compared to morphological signs of reactivation assessed by means of SD-OCT. METHODS: Retrospective study of 888 patients treated for nAMD (n = 638), DME (84), BRVO (110), and CRVO (56) was conducted. Subjective evaluation of the patient at an examination (i.e., change of VA and/or metamorphopsia) was compared to clinical evaluation of disease activity as assessed by SD-OCT. Sensitivity and specificity, negative and positive predictive values (PPV/NPV) for detection of active disease were calculated. Factors associated with false-negative subjective evaluation were analyzed by regression analysis. RESULTS: The sensitivity of the subjective evaluation to detect disease reactivation was < 0.50 in all exudative maculopathies. Sensitivity was increased to ≥ 0.60 by combining subjective worsening with loss of 1 line in the VA test in RVO, but not in DME and nAMD. The specificity was > 0.85 in all patients. PPV was > 0.85 in patients with RVO. Regression analysis did not reveal any factors that could reliably identify patient subgroups in which OCT could be omitted, though CRVO patients with a visual acuity of < 0.3 logMAR had an odds ratio of 0.20 for false-negative subjective evaluation (p = 0.009). CONCLUSION: The accuracy of subjective evaluation to discriminate disease activity in patients with different exudative maculopathies was low and cannot substitute for frequent SD-OCT exams. Routinely assessed clinical parameters such as age, visual acuity, or treatment experience were of no use to predict the validity of subjective evaluation of disease activity. TRIAL REGISTRATION: This trial was registered at the DRKS (Deutsches Register Klinischer Studien, drks.de; No 00006851) prior to the inclusion of the first patient.
Authors: Robert P Finger; Peter Wiedemann; Francisca Blumhagen; Karin Pohl; Frank G Holz Journal: Acta Ophthalmol Date: 2012-11-22 Impact factor: 3.761
Authors: Robert Hoerster; Philipp S Muether; Manuel M Hermann; Konrad Koch; Bernd Kirchhof; Sascha Fauser Journal: Br J Ophthalmol Date: 2011-07-18 Impact factor: 4.638
Authors: Michael Larsen; Sebastian M Waldstein; Francesco Boscia; Heinrich Gerding; Jordi Monés; Ramin Tadayoni; Siegfried Priglinger; Andreas Wenzel; Elizabeth Barnes; Stefan Pilz; William Stubbings; Ian Pearce Journal: Ophthalmology Date: 2016-02-17 Impact factor: 12.079
Authors: Patrick M Bossuyt; Johannes B Reitsma; David E Bruns; Constantine A Gatsonis; Paul P Glasziou; Les Irwig; Jeroen G Lijmer; David Moher; Drummond Rennie; Henrica C W de Vet; Herbert Y Kressel; Nader Rifai; Robert M Golub; Douglas G Altman; Lotty Hooft; Daniël A Korevaar; Jérémie F Cohen Journal: BMJ Date: 2015-10-28
Authors: Frank G Holz; Ramin Tadayoni; Stephen Beatty; Alan Berger; Matteo G Cereda; Rafael Cortez; Carel B Hoyng; Philip Hykin; Giovanni Staurenghi; Stephanie Heldner; Timon Bogumil; Theresa Heah; Sobha Sivaprasad Journal: Br J Ophthalmol Date: 2014-09-05 Impact factor: 4.638
Authors: Claus von der Burchard; Helge Sudkamp; Jan Tode; Cristoph Ehlken; Konstantine Purtskhvanidze; Moritz Moltmann; Britta Heimes; Peter Koch; Michael Münst; Malte Vom Endt; Timo Kepp; Dirk Theisen-Kunde; Inke König; Gereon Hüttmann; Johann Roider Journal: BMJ Open Date: 2022-06-27 Impact factor: 3.006