Disease insights, diagnosis, and monitoring
In neovascular age-related macular degeneration (nAMD), the presence of disease in one eye is a major risk factor for the development of nAMD in the fellow eye. Early detection of disease is crucial to preserve visual function; however, by the time macular neovascularization (MNV) lesions are detected in the fellow eye, many patients already have decreased visual acuity. To prevent disease from progressing to bilateral vision loss and to preserve patient visual function and quality of life, monitoring both eyes of patients with unilateral disease should be considered the standard of care.
The Vision Academy has provided expert recommendations for monitoring the fellow eye of at-risk patients with unilateral nAMD. We also give an overview of the current concepts and modalities for monitoring the fellow eye, describing the advantages and limitations of current clinic- and home-based detection methods.
As a leading cause of blindness among working-age adults worldwide, early detection of diabetic retinopathy (DR) is vitally important. The opportunity for early treatment intervention is often missed because of the asymptomatic nature of the early stages of DR. Appropriate screening can therefore help preserve vision in individuals with diabetes. Although screening programs for patients with diabetes have been successful, expert consensus on the most effective implementation has been lacking.
Following a review of the literature and available evidence, the Vision Academy has provided evidence-based recommendations for DR screening and identified the most effective DR screening strategies.
“Pachychoroid” refers to a phenotype in which functional and structural changes within the choroid are thought to play a role in the pathogenesis of a spectrum of related retinal disorders, known as the “pachychoroid spectrum”. There is a lack of consensus on various phenotypes, which can lead to a disregard of the differences in clinical characteristics and response to treatment of these disorders. The Vision Academy has therefore aimed to provide a consensus on the definition of pachychoroid and to highlight commonalities between the pathologies in the spectrum. Knowledge of the different features and processes of the disorders may help to optimize patient outcomes.
Although visual acuity is the most widely used measure of visual function, it provides only a partial representation of a patient’s overall vision. Even patients with normal visual acuity can suffer other forms of visual impairment, and patients undergoing anti-VEGF therapy often report subjective changes to their vision independent of visual acuity. The Vision Academy has developed consensus recommendations for the application of additional measures of visual function in routine clinical practice or clinical trials. Additional measures beyond visual acuity may help to identify patients who could benefit from earlier diagnosis, detection of disease progression, and treatment intervention.
nAMD is not a uniform disorder, as different subtypes of MNV have different characteristics and prognoses. This partly explains why patients respond differently to treatment according to disease characteristics. Defining and differentiating MNV subtypes is important in the management of nAMD to ensure optimal response to treatment. A clearly defined classification of MNV provides information on prognosis, thereby facilitating patient management.
The Vision Academy has provided expert consensus on the definitions and characteristics of MNV subtypes, as well as recommendations for differentiating between and tailoring treatment to specific subtypes.
Vision-related quality of life (VRQoL) is often based on patient-reported outcome measures (PROMs) that reflect specific visual impairment, such as peripheral or central vision loss and reduced vision in dim lighting. Though helpful, there are weaknesses in current VRQoL PROMs, and standardized measures are needed for comparative purposes to reflect quality of life related to visual loss seen in various retinal diseases.
The Vision Academy is working on this clinically challenging situation to provide expert guidance on the use of existing VRQoL PROMs and the future direction of VRQoL measures in retinal diseases.
Resources are coming soon!
It is anticipated that the use of artificial intelligence (AI) may revolutionize screening, diagnosis, and treatment management in retinal disease. New technologies could provide predictive features of disease progression and assessment of response to treatments, enabling greater personalization of treatment for optimal outcomes. Nonetheless, in such a rapidly evolving field, there are challenges with the practicalities of its use in clinical practice.
The Vision Academy has published two articles on the current status and perspectives of AI in retina in Current Opinion in Ophthalmology.
VIEW 'AI IN DIAGNOSIS' PUBLICATION
VIEW 'AI IN DISEASE MANAGEMENT' PUBLICATION
Challenging clinical situations
Through collective expertise in areas with insufficient conclusive evidence, we seek to provide guidance on best clinical practice in key areas:
