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      • Record: found
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      • Article: found

      Unmet Needs in Ophthalmology: A European Vision Institute-Consensus Roadmap 2019–2025

      systematic-review

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          Abstract

          Purpose: To define unmet needs in ophthalmology that can realistically be addressed in the next 5 years (2019–2025) and describe potential avenues for research to address these challenges. Methods: Outcomes of a consensus process within the European Vision institute (Brussels) are outlined. Disease areas that are discussed comprise glaucoma, retinal dystrophies, diabetic retinopathy, dry eye disease, corneal diseases, cataract and refractive surgery. Results: Unmet needs in the mentioned disease areas are discussed and realistically achievable research projects outlined. Conclusions: Considerable progress can be made in the ophthalmic field and patient-relevant outcomes in the near future.

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          Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema.

          Michael Elman, Lloyd Paul Aiello, Roy Beck … (2010)
          Evaluate intravitreal 0.5 mg ranibizumab or 4 mg triamcinolone combined with focal/grid laser compared with focal/grid laser alone for treatment of diabetic macular edema (DME). Multicenter, randomized clinical trial. A total of 854 study eyes of 691 participants with visual acuity (approximate Snellen equivalent) of 20/32 to 20/320 and DME involving the fovea. Eyes were randomized to sham injection + prompt laser (n=293), 0.5 mg ranibizumab + prompt laser (n=187), 0.5 mg ranibizumab + deferred (> or =24 weeks) laser (n=188), or 4 mg triamcinolone + prompt laser (n=186). Retreatment followed an algorithm facilitated by a web-based, real-time data-entry system. Best-corrected visual acuity and safety at 1 year. The 1-year mean change (+/-standard deviation) in the visual acuity letter score from baseline was significantly greater in the ranibizumab + prompt laser group (+9+/-11, P<0.001) and ranibizumab + deferred laser group (+9+/-12, P<0.001) but not in the triamcinolone + prompt laser group (+4+/-13, P=0.31) compared with the sham + prompt laser group (+3+/-13). Reduction in mean central subfield thickness in the triamcinolone + prompt laser group was similar to both ranibizumab groups and greater than in the sham + prompt laser group. In the subset of pseudophakic eyes at baseline (n=273), visual acuity improvement in the triamcinolone + prompt laser group appeared comparable to that in the ranibizumab groups. No systemic events attributable to study treatment were apparent. Three eyes (0.8%) had injection-related endophthalmitis in the ranibizumab groups, whereas elevated intraocular pressure and cataract surgery were more frequent in the triamcinolone + prompt laser group. Two-year visual acuity outcomes were similar to 1-year outcomes. Intravitreal ranibizumab with prompt or deferred laser is more effective through at least 1 year compared with prompt laser alone for the treatment of DME involving the central macula. Ranibizumab as applied in this study, although uncommonly associated with endophthalmitis, should be considered for patients with DME and characteristics similar to those in this clinical trial. In pseudophakic eyes, intravitreal triamcinolone + prompt laser seems more effective than laser alone but frequently increases the risk of intraocular pressure elevation. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
          Article 0 comments Cited 433 times – based on 0 reviews     Review now
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            Panel-based genetic diagnostic testing for inherited eye diseases is highly accurate and reproducible, and more sensitive for variant detection, than exome sequencing.

            Mark Consugar, Daniel Navarro-Gomez, Emily Place … (2015)
            Next-generation sequencing-based methods are being adopted broadly for genetic diagnostic testing, but the performance characteristics of these techniques with regard to test accuracy and reproducibility have not been fully defined. We developed a targeted enrichment and next-generation sequencing approach for genetic diagnostic testing of patients with inherited eye disorders, including inherited retinal degenerations, optic atrophy, and glaucoma. In preparation for providing this genetic eye disease (GEDi) test on a CLIA-certified basis, we performed experiments to measure the sensitivity, specificity, and reproducibility, as well as the clinical sensitivity, of the test. The GEDi test is highly reproducible and accurate, with sensitivity and specificity of 97.9 and 100%, respectively, for single-nucleotide variant detection. The sensitivity for variant detection was notably better than the 88.3% achieved by whole-exome sequencing using the same metrics, because of better coverage of targeted genes in the GEDi test as compared with a commercially available exome capture set. Prospective testing of 192 patients with inherited retinal degenerations indicated that the clinical sensitivity of the GEDi test is high, with a diagnostic rate of 51%. Based on quantified performance metrics, the data suggest that selective targeted enrichment is preferable to whole-exome sequencing for genetic diagnostic testing.
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              Emerging therapies for inherited retinal degeneration.

              H. Scholl, R. Strauss, M. S. Singh … (2016)
              Inherited retinal degenerative diseases, a genetically and phenotypically heterogeneous group of disorders, affect the function of photoreceptor cells and are among the leading causes of blindness. Recent advances in molecular genetics and cell biology are elucidating the pathophysiological mechanisms underlying these disorders and are helping to identify new therapeutic approaches, such as gene therapy, stem cell therapy, and optogenetics. Several of these approaches have entered the clinical phase of development. Artificial replacement of dying photoreceptor cells using retinal prostheses has received regulatory approval. Precise retinal imaging and testing of visual function are facilitating more efficient clinical trial design. In individual patients, disease stage will determine whether the therapeutic strategy should comprise photoreceptor cell rescue to delay or arrest vision loss or retinal replacement for vision restoration.
              Article 0 comments Cited 88 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): ORE
                Journal ID (nlm-ta): Ophthalmic Res
                Journal ID (doi): 10.1159/issn.0030-3747
                Title: Ophthalmic Research
                Publisher: S. Karger AG
                ISSN (Print): 0030-3747
                ISSN (Electronic): 1423-0259
                Publication date Subscription-year: 2019
                Publication date (Print): September 2019
                Publication date (Electronic): 05 August 2019
                Volume: 62
                Issue: 3
                Pages: 123-133
                Affiliations
                [_a] aDepartment of Ophthalmology, University Hospital of Cologne, Cologne, Germany
                [_b] bCenter for Molecular Medicine , University of Cologne, Cologne, Germany
                [_c] cDepartment of Ophthalmology, Imperial College London, London, United Kingdom
                [_d] dAssociation for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
                [_e] eFaculty of Medicine, University of Coimbra, Coimbra, Portugal
                [_f] fEuropean Vision Institute, Brussels, Belgium
                [_g] gInstitute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
                [_h] hDepartment of Ophthalmology, University of Basel, Basel, Switzerland
                [_i] iWilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
                Author notes
                *Claus Cursiefen, MD, PhD, Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, DE–50924 Cologne (Germany), E-Mail claus.cursiefen@uk-koeln.de
                Article
                Publisher ID: 501374 Other ID: Ophthalmic Res 2019;62:123–133
                DOI: 10.1159/000501374
                PubMed ID: 31382265
                SO-VID: 976b4177-a537-4f2e-a4a3-7a9c24bcde17
                Copyright © © 2019 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 04 May 2019
                Date accepted : 06 June 2019
                Page count
                Figures: 3, Pages: 11
                Categories
                Subject: Systematic Review

                ScienceOpen disciplines: Vision sciences,Ophthalmology & Optometry,Pathology
                Keywords: Roadmap,Research,Unmet needs,Future challenges,Ophthalmology
                Data availability:
                ScienceOpen disciplines: Vision sciences, Ophthalmology & Optometry, Pathology
                Keywords: Roadmap, Research, Unmet needs, Future challenges, Ophthalmology

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