HomeChallenging clinical situationsDisease insights, diagnosis, and monitoring

Disease insights,
diagnosis, and
monitoring

Development and standardization of “time-in-range” measurement for clinical endpoints in retinal diseases

Measurable endpoints are essential for assessing disease progression and treatment effectiveness in both clinical trials and clinical practice. However, few metrics capture disease course continuously over time. The Vision Academy has provided expert guidance on identifying a possible reliable “time-in-range” endpoint of clinical outcomes in ophthalmology.

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Simultaneous GA and CNV/MNV

Geographic atrophy (GA) and macular neovascularization (MNV) have previously been considered distinct conditions due to their differing clinical characteristics. However, recent evidence suggests the coexistence of GA and choroidal neovascularization (CNV)/MNV in some patients.

The Vision Academy has provided expert consensus on the diagnosis and management of simultaneous GA and CNV/MNV in clinical practice.

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Monitoring of the fellow eye in nAMD

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.

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Principles of a DR screening program

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.

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Pachychoroid: definition and pathogenesis

“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.

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Additional measures of visual function beyond acuity

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.

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Characterization of MNV subtypes in nAMD to optimize treatment outcomes

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.

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Characterization of MNV subtypes in nAMD to optimize treatment outcomes

Quantification of vision-related quality of life in retinal diseases

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!

Current status and perspectives of AI in retinal disease

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.

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Challenging clinical situations

Through collective expertise in areas with insufficient conclusive evidence, we seek to provide guidance on best clinical practice in key areas:

Treatment and management

Providing care that considers the individual patient’s preferences and needs should be at the forefront of clinical decision-making. The ophthalmic community should be driven by patient values, with the patient placed centrally in the treatment decision pathway. Nonetheless, there are many disease complexities that require nuanced treatment and management. We aim to provide guidance that enables ophthalmologists to navigate these clinically challenging situations.

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COVID-19

The lasting impacts of the COVID-19 pandemic have resulted in ongoing changes to clinical practice. We, in conjunction with the nAMD Barometer, have developed a range of materials to ensure ophthalmologists feel supported in making appropriate treatment decisions and to help patients better understand the safety measures put in place. These tools have been designed to be appropriate across a range of epidemic pressures and are available in multiple languages.

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