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  1. Article ; Online: Counseling Patients about Rare but Serious Harms: The Importance of Absolute as well as Relative Risks.

    Reeves, Barnaby / Chakravarthy, Usha

    Ophthalmology. Retina

    2023  Volume 7, Issue 8, Page(s) 649–651

    MeSH term(s) Humans ; Risk Assessment ; Counseling
    Language English
    Publishing date 2023-08-04
    Publishing country United States
    Document type Editorial ; Comment
    ISSN 2468-6530
    ISSN (online) 2468-6530
    DOI 10.1016/j.oret.2023.04.001
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  2. Article ; Online: Does the Inhibition of Vacular Endothelial Growth Factor in Neovascular Age-Related Macular Degeneration Result in Macular Atrophy?

    Chakravarthy, Usha

    Ophthalmology

    2020  Volume 127, Issue 4, Page(s) 533–534

    MeSH term(s) Atrophy ; Endothelial Growth Factors ; Humans ; Macular Degeneration ; Prevalence ; Ranibizumab ; Tomography, Optical Coherence
    Chemical Substances Endothelial Growth Factors ; Ranibizumab (ZL1R02VT79)
    Language English
    Publishing date 2020-03-26
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 392083-5
    ISSN 1549-4713 ; 0161-6420
    ISSN (online) 1549-4713
    ISSN 0161-6420
    DOI 10.1016/j.ophtha.2020.01.016
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  3. Article ; Online: The Issue of End Point Discordance in Dry Age-Related Macular Degeneration: How Might Clinical Trials Demonstrate a Functional Benefit?

    Lad, Eleonora M / Chakravarthy, Usha

    Ophthalmology

    2023  Volume 130, Issue 9, Page(s) 890–892

    MeSH term(s) Humans ; Geographic Atrophy ; Macular Degeneration/drug therapy ; Eye Diseases
    Language English
    Publishing date 2023-06-06
    Publishing country United States
    Document type Editorial
    ZDB-ID 392083-5
    ISSN 1549-4713 ; 0161-6420
    ISSN (online) 1549-4713
    ISSN 0161-6420
    DOI 10.1016/j.ophtha.2023.05.020
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  4. Article ; Online: Age-Related Macular Degeneration: A Review.

    Fleckenstein, Monika / Schmitz-Valckenberg, Steffen / Chakravarthy, Usha

    JAMA

    2024  Volume 331, Issue 2, Page(s) 147–157

    Abstract: Importance: Age-related macular degeneration (AMD) affects approximately 20 million people in the US and 196 million people worldwide. AMD is a leading cause of severe vision impairment in older people and is expected to affect approximately 288 million ...

    Abstract Importance: Age-related macular degeneration (AMD) affects approximately 20 million people in the US and 196 million people worldwide. AMD is a leading cause of severe vision impairment in older people and is expected to affect approximately 288 million people worldwide by 2040.
    Observations: Older age, genetic factors, and environmental factors, such as cigarette smoking, are associated with development of AMD. AMD occurs when extracellular deposits accumulate in the outer retina, ultimately leading to photoreceptor degeneration and loss of central vision. The late stages of AMD are characterized by outer retinal atrophy, termed geographic atrophy, or neovascularization associated with subretinal and/or intraretinal exudation, termed exudative neovascular AMD. The annual incidence of AMD ranges from 0.3 per 1000 in people who are aged 55 to 59 years to 36.7 per 1000 in people aged 90 years or older. The estimated heritability of late-stage AMD is approximately 71% (95% CI, 18%-88%). Long-term prospective cohort studies show a significantly higher AMD incidence in people who smoke more than 20 cigarettes per day compared with people who never smoked. AMD is diagnosed primarily with clinical examination that includes a special lens that focuses light of the slit lamp through the pupil. Exudative neovascular AMD is best identified using angiography and by optical coherence tomography. Individuals with AMD who take nutritional supplements consisting of high-dose vitamin C, vitamin E, carotenoids, and zinc have a 20% probability to progress to late-stage AMD at 5 years vs a 28% probability for those taking a placebo. In exudative neovascular AMD, 94.6% of patients receiving monthly intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections experience less than a 15-letter visual acuity loss after 12 months compared with 62.2% receiving sham treatment.
    Conclusions and relevance: The prevalence of AMD is anticipated to increase worldwide to 288 million individuals by 2040. Intravitreally administered anti-VEGF treatment is first-line therapy for exudative neovascular AMD.
    MeSH term(s) Aged ; Aged, 80 and over ; Humans ; Middle Aged ; Angiogenesis Inhibitors/administration & dosage ; Angiogenesis Inhibitors/pharmacology ; Angiogenesis Inhibitors/therapeutic use ; Intravitreal Injections ; Macular Degeneration/diagnosis ; Macular Degeneration/drug therapy ; Macular Degeneration/epidemiology ; Macular Degeneration/etiology ; Prospective Studies ; Retina/drug effects ; Retina/pathology ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity ; Wet Macular Degeneration/diagnosis ; Wet Macular Degeneration/drug therapy ; Wet Macular Degeneration/epidemiology
    Chemical Substances Angiogenesis Inhibitors ; Vascular Endothelial Growth Factor A
    Language English
    Publishing date 2024-01-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2023.26074
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  5. Article ; Online: Epidemiology of geographic atrophy and its precursor features of intermediate age-related macular degeneration.

    Vujosevic, Stela / Alovisi, Camilla / Chakravarthy, Usha

    Acta ophthalmologica

    2023  Volume 101, Issue 8, Page(s) 839–856

    Abstract: Globally age-related macular degeneration (AMD) is a leading cause of blindness with a significant impact on quality of life. Geographic atrophy (GA) is the atrophic late form of AMD and its prevalence increases markedly with age with around 1 in 5 ... ...

    Abstract Globally age-related macular degeneration (AMD) is a leading cause of blindness with a significant impact on quality of life. Geographic atrophy (GA) is the atrophic late form of AMD and its prevalence increases markedly with age with around 1 in 5 persons aged 85 and above having GA in at least one eye. Bilateral GA leads to severe visual impairment thus posing a significant burden on patients, careers and health providers. The incidence and prevalence of GA varies across different geographic regions, with the highest rates in those of European ancestry. Although heterogeneity in definitions of GA and reporting strategy can explain some of the discrepancies, the data overall are consistent in showing a lower prevalence in other ethnicities such as those of Asian heritage. This is at present unexplained but thought to be due to the existence of protective factors such as differences in eye pigmentation, diet, environmental exposures and genetic variability. This review covers key aspects of the prevalence and incidence of the ocular precursor features of GA (large drusen, pigmentary abnormalities and reticular pseudo-drusen), the late stage of GA and factors that have been known to be associated with modifying risk including systemic, demographic, environment, genetic and ocular. Understanding the global epidemiology scenario is crucial for the prevention of and management of patients with GA.
    MeSH term(s) Humans ; Geographic Atrophy ; Retinal Drusen/epidemiology ; Quality of Life ; Macular Degeneration/epidemiology ; Retina
    Language English
    Publishing date 2023-11-07
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2408333-1
    ISSN 1755-3768 ; 1755-375X
    ISSN (online) 1755-3768
    ISSN 1755-375X
    DOI 10.1111/aos.15767
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  6. Article ; Online: Health technology assessment of new retinal treatments; the need to capture healthcare capacity issues.

    Gale, Richard / Cox, Oliver / Keenan, Craig / Chakravarthy, Usha

    Eye (London, England)

    2022  Volume 36, Issue 12, Page(s) 2236–2238

    MeSH term(s) Humans ; Technology Assessment, Biomedical ; Delivery of Health Care
    Language English
    Publishing date 2022-06-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 91001-6
    ISSN 1476-5454 ; 0950-222X
    ISSN (online) 1476-5454
    ISSN 0950-222X
    DOI 10.1038/s41433-022-02149-5
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  7. Article ; Online: 15 years of anti-VEGF treatment for nAMD: success or failure or something in between?

    Chakravarthy, Usha / Armendariz, Beatriz G / Fauser, Sascha

    Eye (London, England)

    2022  Volume 36, Issue 12, Page(s) 2232–2233

    MeSH term(s) Humans ; Angiogenesis Inhibitors/therapeutic use ; Ranibizumab/therapeutic use
    Chemical Substances Angiogenesis Inhibitors ; Ranibizumab (ZL1R02VT79)
    Language English
    Publishing date 2022-06-25
    Publishing country England
    Document type Editorial
    ZDB-ID 91001-6
    ISSN 1476-5454 ; 0950-222X
    ISSN (online) 1476-5454
    ISSN 0950-222X
    DOI 10.1038/s41433-022-02153-9
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  8. Article ; Online: Current Perspective on Age-Related Macular Degeneration.

    Chakravarthy, Usha / Peto, Tunde

    JAMA

    2020  Volume 324, Issue 8, Page(s) 794–795

    MeSH term(s) Aged ; Diagnosis, Differential ; Dietary Supplements ; Humans ; Macular Degeneration/classification ; Macular Degeneration/diagnosis ; Macular Degeneration/therapy
    Language English
    Publishing date 2020-08-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2020.5576
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  9. Article ; Online: Imaging geographic atrophy: integrating structure and function to better understand the effects of new treatments.

    Vujosevic, Stela / Loewenstein, Anat / O'Toole, Louise / Schmidt-Erfurth, Ursula Margarethe / Zur, Dinah / Chakravarthy, Usha

    The British journal of ophthalmology

    2024  

    Abstract: Geographic atrophy (GA) is an advanced and irreversible form of age-related macular degeneration (AMD). Chronic low grade inflammation is thought to act as an initiator of this degenerative process, resulting in loss of photoreceptors (PRs), retinal ... ...

    Abstract Geographic atrophy (GA) is an advanced and irreversible form of age-related macular degeneration (AMD). Chronic low grade inflammation is thought to act as an initiator of this degenerative process, resulting in loss of photoreceptors (PRs), retinal pigment epithelium (RPE) and the underlying choriocapillaris. This review examined the challenges of clinical trials to date which have sought to treat GA, with particular reference to the successful outcome of C3 complement inhibition. Currently, optical coherence tomography (OCT) seems to be the most suitable method to detect GA and monitor the effect of treatment. In addition, the merits of using novel anatomical endpoints in detecting GA expansion are discussed. Although best-corrected visual acuity is commonly used to monitor disease in GA, other tests to determine visual function are explored. Although not widely available, microperimetry enables quantification of retinal sensitivity (RS) and macular fixation behaviour related to fundus characteristics. There is a spatial correlation between OCT/fundus autofluorescence evaluation of PR damage outside the area of RPE loss and RS on microperimetry, showing important associations with visual function. Standardisation of testing by microperimetry is necessary to enable this modality to detect AMD progression. Artificial intelligence (AI) analysis has shown PR layers integrity precedes and exceeds GA loss. Loss of the ellipsoid zone has been recognised as a primary outcome parameter in therapeutic trials for GA. The integrity of the PR layers imaged by OCT at baseline has been shown to be an important prognostic indicator. AI has the potential to be invaluable in personalising care and justifying treatment intervention.
    Language English
    Publishing date 2024-01-30
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 80078-8
    ISSN 1468-2079 ; 0007-1161
    ISSN (online) 1468-2079
    ISSN 0007-1161
    DOI 10.1136/bjo-2023-324246
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  10. Article: Update on Current and Future Management for Diabetic Maculopathy.

    Udaondo, Patricia / Parravano, Mariacristina / Vujosevic, Stela / Zur, Dinah / Chakravarthy, Usha

    Ophthalmology and therapy

    2022  Volume 11, Issue 2, Page(s) 489–502

    Abstract: Diabetic macular edema (DME) remains the major cause of preventable blindness in the working-age population in developed countries, and screening programs are extremely important in the management of this complication of diabetic retinopathy. The ... ...

    Abstract Diabetic macular edema (DME) remains the major cause of preventable blindness in the working-age population in developed countries, and screening programs are extremely important in the management of this complication of diabetic retinopathy. The introduction of modern imaging modalities and technological advances have facilitated both the early detection and the follow-up of patients with DME, particularly optical coherence tomography angiography and artificial intelligence. Intravitreal therapy is the gold standard treatment for DME, but not all patients respond equally to this therapy, and sometimes it is not easy to apply treatment protocols correctly; for these reasons, clinical practice results may differ from those of clinical trials in terms of vision gain. One approach has been to implement new treatment regimens, such as treat and extend, and new molecules and therapeutic targets are constantly being developed. The main goal of this review paper is to describe the current treatment options and management strategies for DME in Europe and to provide a brief oversight of the novel therapeutic options on the horizon.
    Language English
    Publishing date 2022-01-31
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2193-8245
    ISSN 2193-8245
    DOI 10.1007/s40123-022-00460-8
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