Universität zu Köln

Liakopoulos, Sandra, Spital, Georg, Brinkmann, Christian K., Schick, Tina, Ziemssen, Focke, Voegeler, Jessica, Koch, Mirja, Kirchhof, Bernd, Holz, Frank G., Pauleikhoff, Daniel and Schmitz-Valckenberg, Steffen (2020). ORCA study: real-world versus reading centre assessment of disease activity of neovascular age-related macular degeneration (nAMD). Br. J. Ophthalmol., 104 (11). S. 1573 - 1579. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-2079

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Abstract

Background/aims The prospective, non-interventional ORCA module of the OCEAN study (Observation of Treatment Patterns with Lucentis in Approved Indications) evaluated the qualiy of spectral domain-optical coherence tomography (SD-OCT) image interpretation and treatment decisions by clinicians in Germany and the impact on visual outcomes over 24 months in patients with neovascular age-related macular degeneration (nAMD). Methods 2286 SD-OCT scans of 205 eyes were independently evaluated by clinicians and reading centres (RCs) regarding signs of choroidal neovascularisation (CNV) activity, including presence of intraretinal fluid, subretinal fluid, and/or increase in pigment epithelial detachments. Agreement between clinicians and RCs was calculated. Treatment decisions by clinicians and the impact on treatment outcomes were evaluated. Results CNV activity was detected by RCs on 1578 scans (69.0%) and by clinicians on 1392 scans (60.9%), with agreement in 74.9% of cases. Of the 1578 scans with RC detected CNV activity, anti-vascular endothelial growth factor injections were performed by clinicians in only 35.5% (560/1578). In 19.7% of cases (311/1578), lack of treatment was justified by patients request, termination criteria or chronic cystoid spaces without other signs for CNV activity. In 44.8% of cases (707/1578) with RC detected CNV activity, clinicians claimed no treatment was necessary despite having correctly detected CNV activity in about 2/3 of these cases. In 34% of cases with presumed undertreatment, visual acuity declined in the following visit. Conclusion Although broad agreement on CNV activity parameters was observed between clinicians and RCs, correct identification of CNV activity did not always lead to the initiation of (re-)treatment. To preserve vision over time, correct interpretation of SD-OCT scans and careful retreatment decisions are required.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Liakopoulos, Sandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Spital, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Brinkmann, Christian K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schick, Tina UNSPECIFIED UNSPECIFIED UNSPECIFIED Ziemssen, Focke UNSPECIFIED UNSPECIFIED UNSPECIFIED Voegeler, Jessica UNSPECIFIED UNSPECIFIED UNSPECIFIED Koch, Mirja UNSPECIFIED UNSPECIFIED UNSPECIFIED Kirchhof, Bernd UNSPECIFIED UNSPECIFIED UNSPECIFIED Holz, Frank G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pauleikhoff, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmitz-Valckenberg, Steffen UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-313773
DOI:	10.1136/bjophthalmol-2019-315717
Journal or Publication Title:	Br. J. Ophthalmol.
Volume:	104
Number:	11
Page Range:	S. 1573 - 1579
Date:	2020
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1468-2079
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language VISUAL-ACUITY; RANIBIZUMAB; THERAPY; VERTEPORFIN; EFFICACY; SAFETY Multiple languages Ophthalmology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31377