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      Impact on Visual Acuity in Neovascular Age Related Macular Degeneration (nAMD) in Europe Due to COVID-19 Pandemic Lockdown

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          Abstract

          This is a retrospective, multicenter study of consecutive patients with nAMD scheduled for a visit and/or a treatment with an intravitreal injection (IVI) during the 3 months before lockdown in the Ophthalmology Departments of six centers of Europe.The study was conducted on 546 patients, of which 55.13% were females, almost 100% of the patients were White/Caucasian race, and 71.53% of the patients presented a type 1 macular neovascularization (NVM). A total of 62.82% of patients (343 patients) that were on scheduled clinic visits and/or intravitreal injection treatment during the 3 months before the quarantine did not attend either to visit or for treatment during the lockdown. The mean number of injections during the lockdown was significantly reduced. This was followed by a significant reduction in the mean best-corrected visual acuity (BCVA) between the 3 months before the lockdown (mean BCVA of 60.68 ± 19.77 letters) and 6 months after lockdown (mean BCVA of 56.98 ± 22.59 letters). Patients with better BCVA before the lockdown and the ones showing neovascular activity were more likely to attend their scheduled visits and/or IVI treatments. The COVID-19 pandemic and the lockdown have led to a decrease in the number of IVI treatments in patients with nAMD, evidencing a significant vision loss at 6 months.

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          Consensus Nomenclature for Reporting Neovascular Age-Related Macular Degeneration Data

          To establish a process to evaluate and standardize a state-of-the-art nomenclature for reporting neovascular age-related macular degeneration (AMD) data.
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            Novel method for analyzing snellen visual acuity measurements.

            Most retrospective reviews convert Snellen visual acuity measurements obtained during routine clinic visits to logarithm of the minimum angle of resolution (logMAR) units so that statistical manipulations can be performed. However, visual acuity measurements expressed as logMAR units are not intuitively interpretable by clinicians. A more intuitive approach is presented here which uses the conversion of Snellen visual acuity fractions to Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores for statistical manipulations. Snellen visual acuity measurements were converted to approximate ETDRS (approxETDRS) letter scores for statistical manipulations and then converted back to Snellen equivalent fractions. The formula to convert Snellen visual acuity measurements to approxETDRS letter scores is 85 + 50 x log (Snellen fraction), which may be rounded to the nearest letter. A linear relationship exists between true ETDRS letter scores, approxETDRS letter scores, and logMAR units. The interconversion between Snellen visual acuity measurements, logMAR units, and approxETDRS letter scores was prepared in a tabular form for easy reference. The same outcomes (in Snellen fractions) were obtained with statistical manipulation of either approxETDRS letter scores or logMAR conversions. Conversion of Snellen visual acuity fractions to approxETDRS letter scores for the purpose of performing statistical manipulations provides more readily interpretable outcomes compared with the current strategy of converting Snellen visual acuity fractions to logMAR units.
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              The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis.

              To describe the natural history and progression of visual loss in eyes with untreated neovascular age-related macular degeneration (AMD). Systematic review and meta-analysis. Four thousand three hundred sixty-two untreated neovascular AMD patients from published interventional studies. A systematic review of the literature from 1980 to August 2005 was performed. Studies reporting disease progression outcomes for untreated patients with neovascular AMD were included. Outcome measures were summarized using simple counts and means. Random effects meta-analyses were conducted and tests of heterogeneity were performed where appropriate. Changes in visual acuity (VA) loss, development of comorbidities, and fellow eye involvement. Fifty-three primary studies were included. Nearly half of the studies (28) were randomized clinical trials. The quality of the studies was high, with over 80% providing level I or II evidence. Mean baseline VA among study patients was 0.64 logarithm of the minimum angle of resolution (logMAR) (approximately 20/87 Snellen). The mean VA change in logMAR progressed from 0.1 (1 line lost) at 3 months to 0.3 (2.7 lines lost) after 12 months and 0.4 (4 lines lost) after 24 months. The proportion of patients who developed severe vision loss (>6 lines) from baseline increased from 21.3% at 6 months to 41.9% by 3 years. The proportion of patients with VA worse than logMAR 1.0 (20/200 Snellen) increased from 19.7% at baseline to 75.7% by 3 years. Neovascular AMD developed in the fellow eye in 12.2% of patients by 12 months and in 26.8% by 4 years. Meta-analyses of vision outcome by subtype of neovascular AMD were not possible. A doubling of the visual angle of presenting VA may be expected to occur in the year after initial presentation in eyes with untreated neovascular AMD. No conclusions can be drawn as to the differences in rates of disease progression by neovascular AMD subtype. The diversity of reporting formats, paucity of long-term natural history data, and heterogeneity among the reported clinical studies impose limits to the clear understanding of long-term prognosis for visual function in neovascular AMD.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                25 July 2021
                August 2021
                : 10
                : 15
                : 3281
                Affiliations
                [1 ]Department of Ophthalmology, University Hospital of Alcalá de Henares, Universidad de Alcalá, 28802 Alcalá de Henares, Spain; miguelteus@ 123456gmail.com
                [2 ]Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; toro.mario@ 123456email.it (M.D.T.); sandrine.zweifel@ 123456usz.ch (S.Z.)
                [3 ]Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, 01815 Warsaw, Poland
                [4 ]Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland; robertrejdak@ 123456yahoo.com
                [5 ]Department of Ophthalmology, Ankara City Hospital, Ankara 06800, Turkey; mehmetonenster@ 123456gmail.com
                [6 ]S. Fyodorov Eye Microsurgery Federal State Institution, Russian Federation, 127486 Moscow, Russia; boris.malyugin@ 123456gmail.com
                [7 ]Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; tognetto@ 123456units.it (D.T.); giglio.rosam@ 123456gmail.com (R.G.)
                Author notes
                [* ]Correspondence: carruabarrenas@ 123456gmail.com ; Tel.: +34-(91)-8878100
                [†]

                Member of EUROCOVCAT Group.

                Author information
                https://orcid.org/0000-0002-5312-8900
                https://orcid.org/0000-0001-7152-2613
                https://orcid.org/0000-0003-3321-2723
                https://orcid.org/0000-0001-7431-1774
                https://orcid.org/0000-0001-9755-0786
                https://orcid.org/0000-0002-3835-9882
                Article
                jcm-10-03281
                10.3390/jcm10153281
                8348378
                34362066
                61bdabba-784e-4834-9a98-828aca1f9c2f
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 03 July 2021
                : 22 July 2021
                Categories
                Article

                covid-19,amd,sars-cov-2,neovascular age related macular degeneration

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