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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]

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 Wet age-related macular degeneration ( AMD) is the leading cause of blindness worldwide, which can be treated with regular intraocular anti-vascular endothelial growth factor ( VEGF) injections. In this study, we wanted to evaluate whether less frequent injections of aflibercept would make it more cost-effective when compared with 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 8-year period, 3-month cycles 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 with monthly bevacizumab was 1 801 228 and when compared with 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 A two-eye Markov transition model was developed to analyse the cost-effectiveness of wet AMD treatment, as quality of life years (QALYs) are largely based on the visual acuity of the better-seeing eye. Monthly injected bevacizumab was the most cost-effective treatment and monthly ranibizumab the least effective. [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 this 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 A total of 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 6 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, log MAR visual acuity improved on average 0.18 ± 0.32 units, OCT retinal thickness decreased 170 ± 200 micrometres and VEP amplitude increased 1.0 ± 1.4 microvolts. 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 (log MAR) 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]

Purpose: Antivascular endothelial growth factor (VEGF) agents have been shown to improve visual acuity and prevent vision loss in exudative age-related macular 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 to 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. All patients showed improved visual acuity and reduced retinal fluid after the treatment. Results: 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 in the level of the retina and in the level of visual cortical processing. [ABSTRACT FROM AUTHOR]