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Purpose: Wet age-related macular degeneration (AMD) is the leading cause of blindness worldwide, although it can now be treated with regular intraocular anti-VEGF injections. In this study, we wanted to evaluate whether less frequent injections of aflibercept would make it more cost effective when compared to ranibizumab and low priced bevacizumab. Methods: We used a two-eye model to simulate the progression and the treatment of the disease. We selected an eight year period, cycles of three months and five health states based on the visual acuity of the better seeing eye. The transition probabilities and utilities attached to the health states were gathered from previous studies. We conducted the analysis from the hospital perspective and we used the health care costs obtained from Kuopio University Hospital. The costs of intraocular adverse events were taken into account. Results: The incremental cost effectiveness ratio (ICER) with 3% discount rate (€/QALY) for aflibercept compared to monthly bevacizumab was 1,801,228 and when compared to ranibizumab given as needed, the ICER was minus 3,716,943. The sensitivity analysis showed that a change of 20% of the estimated model parameters or a longer follow up period did not influence these conclusions. Conclusion: Monthly injected bevacizumab was the most cost effective treatment and monthly ranibizumab the least effective. Since QALYs are largely based on the visual acuity of the better seeing eye, a two eye model should be employed in cost effectiveness studies of any eye which improves visual acuity. [ABSTRACT FROM AUTHOR]

Purpose: In response to anti-VEGF treatment for wet AMD retinal anatomy and visual acuity is often remedied. In our previous study, we showed that visual evoked potentials (VEP) improve following successful anti-VEGF treatment. The aim of the present study was to investigate how visual acuity and retinal thickness changes are reflected in VEP parameters. Moreover, we wanted to assess the feasibility of VEP as a novel monitoring tool for wet AMD patients. Methods: 16 patients and six control subjects were enrolled in this study. Patients received three bevacizumab intravitreal injections. At the beginning of the study and four to six weeks after the last injection, the best corrected visual acuity (BCVA) test, full biomicroscope examination, OCT analysis and VEP were performed. Results: In treated eyes, logMAR visual acuity decreased on average by 0.18 ± 0.32 units, OCT retinal thickness decreased by 170 ± 200 lm and VEP amplitude increased by 1.0 ± 1.4 IV. All changes were significant at p < 0.05. There was a significant correlation between the relative changes of VEP amplitude and retinal thickness r = -0.630 (p < 0.05), and between visual acuity (logMAR) and retinal thickness r = 0.576 (p < 0.05). Conclusion: We showed that both the increase in VEP amplitude and the improvement in visual acuity are associated with the decrease in retinal thickness in treated wet AMD patients. The results do not indicate additional usefulness of VEP in the diagnosis or monitoring of wet AMD. [ABSTRACT FROM AUTHOR]

Wet age-related macular degeneration (AMD) is the leading cause of blindness in the elderly in the Western world, causing suffering to the individual and high social and healthcare costs to society. During the last decade, anti-vascular endothelial growth factors (anti-VEGF) have become the first choice treatments for this previously devastating condition. Currently, there are three intravitreally injected anti-VEGF medications available: bevacizumab, ranibizumab and aflibercept. Clinical trials have shown that these three anti-VEGF medications exert similar effects on visual acuity and possess similar safety profiles, although aflibercept requires less frequent injections. In fact, the required frequency of repeated injections represents a major burden on ophthalmology clinics. Visual evoked potential (VEP) recording offers a non-invasive tool to investigate the function of the visual pathway. The aims of this study were to determine (1) how the VEP changes after bevacizumab injections, (2) if VEP is useful as a diagnostic or monitoring tool for wet AMD, (3) if the binocular face detection task improve after anti-VEGF injections, and (4) which anti-VEGF medication and injection protocol may be considered as most cost-effective. The publication I was a pilot study of six wet AMD-patients treated with anti-VEGF injections, where VEP revealed that its latency had shortened and amplitude increased after the treatment. The subsequent publications II and III were non-randomized cohort studies. A total of 16 patients with unilateral wet AMD and six healthy control subjects were included. The patients received three bevacizumab injections every 4-6 weeks. VEPs were performed before the first injection and 4-6 weeks after the last injection with a similar time interval used for the non-treated controls. In publication II, significant changes (p < 0.05) were found in the following parameters in the treated eyes: logMAR visual acuity decreased on average by 0.18 ± 0.32 units, optical coherence tomography (OCT) retinal thickness decreased by 170 ± 200 lm and VEP amplitude increased by 1.0 ± 1.4 lV. There was a significant correlation between the relative changes of VEP amplitude and retinal thickness r = --0.630 (p < 0.05), and between visual acuity (logMAR) and retinal thickness r = 0.576 (p < 0.05). These results seem to indicate that the application of VEP does not confer any additional benefits in the diagnosis or monitoring of wet AMD. In publication III, face pictures elicited well-defined event-related components in occipital and parieto-occipital cortical areas at baseline and after treatment. The face-specific N170 component was pronounced in all subjects with longer peak latency in patients than in controls (p = 0.032). However patients did not experience any significant improvement in face-specific electrical potentials after the anti-VEGF treatment. In publication IV, the cost-effectiveness of the three anti-VEGF injections and two injection protocols (i.e. regular monthly and pro re nata) for wet AMD were compared. A two-eye Markov transition model was developed for this analysis and a sensitivity analysis of estimated model parameters was performed. Regular monthly injections of bevacizumab were superior in comparison to the other options, a result reinforced by the sensitivity analyses. National Library of Medicine Classification: W 74, WW 103, WW 166, WW 270 Medical Subject Headings: Wet Macular degeneration/drug therapy; Neurophysiology; Drug Costs; Treatment Outcome [ABSTRACT FROM AUTHOR]

Purpose: Antivascular endothelial growth factor (VEGF) agents have been shown to improve visual acuity and prevent vision loss in exudative age-relatedmacular degeneration.As the vision improves relatively quickly in response to intravitreal injections, we wanted to know whether this improvement is reflected in electrophysiological markers of visual cortical processing. Patients and methods: Our interventional case series included six elderly patients who underwent injection treatment in the affected eye. Their visual acuity, tomographic images of retinal thickness, and visual evoked potentials (VEP) were assessed before treatment and six weeks after the last injection. Results: All patients showed improved visual acuity and reduced retinal fluid after the treatment. All but one patient showed increased VEP P100 component amplitudes and/or shortened latencies in the treated eye. These VEP changes were consistent with improved vision while the untreated eyes showed no changes. Conclusions: Our results indicate that antivascular endothelial growth factor injections improved visual function of the treated eyes both at the level of the retina and at the level of visual cortical processing. [ABSTRACT FROM AUTHOR]

Purpose: People with age-related macular degeneration (AMD) have difficulties in familiar face recognition and facial expression discrimination. Our aim was to evaluate the visual processing of faces in AMD patients and whether this would be improved by anti-vascular endothelial growth factor therapy. This was a prospective interventional cohort study. Patients: Twelve patients with monocular wet AMD and 6 control subjects were recruited. Face detection processes were studied using cortical event-related potentials (ERPs). Patients received 3 bevacizumab intravitreal injections to the single affected eye. At baseline and 4–6 weeks after the last injection, clinical presentation and ERPs of the face task were evaluated. Face pictures were shown as targets (16.7%) among standard pictures of pixelated faces in an oddball-type paradigm. Results: Face pictures elicited well-defined electrical components in occipital and parieto-occipital cortical areas at baseline and after treatment. The face-specific N170 component was evident in all subjects with longer peak latency in patients than in controls (170±13 vs 155±14, P=0.032). Unexpectedly, an early component reflecting unintentional prediction of perceiving a face, that is, deviance-related negativity, was present in patients and controls. Visual acuity of the affected eye seemed improved in patients from logarithm of the minimum angle of resolution 0.71 (±0.33) to 0.52 (±0.39) by 119 (±23) days without accompanying significant change in face-specific ERPs. Conclusions: Monocular wet AMD distinctly influenced face-specific brain electrophysiological components. However, the anti-vascular endothelial growth factor treatment did not improve the binocular face detection ability. The EudraCT number of this study is 2012-000765-20. [ABSTRACT FROM AUTHOR]