Top PDF Patient preferences in the treatment of diabetic retinopathy

Patient preferences in the treatment of diabetic retinopathy

Patient preferences in the treatment of diabetic retinopathy

cally, Bhargava’s findings showed that the most important treatment-related attributes for glaucoma were the risk of moderate visual loss (ie, the ability to continue to drive) and risk of long-term blindness. Least important included chance of surgical intervention and the use of topical medication. In our study of Canadian diabetic patients, the chances of cataract formation, improving vision, and pericentral or peripheral scotomas made the most difference in the per- ceived utility of a DR treatment relative to other treatment attributes. In addition, our findings on importance were consistent with conclusions from conjoint studies in other medical disciplines. In a recent study of disease-modifying antirheumatic preferences, for example, the tradeoffs made by patients with rheumatoid arthritis suggested that adverse events (eg, nausea, diarrhea) from a therapy were a significant driver of overall preference. 34
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<p>Patient Preferences For Chemotherapy In The Treatment Of Non-Small Cell Lung Cancer: A Multicenter Discrete Choice Experiment (DCE) Study In China</p>

<p>Patient Preferences For Chemotherapy In The Treatment Of Non-Small Cell Lung Cancer: A Multicenter Discrete Choice Experiment (DCE) Study In China</p>

Some limitations should be noted in this study. Firstly, potential selection bias might exist among patients, because the participants were healthy enough to complete the survey. Secondly, although we identi fi ed seven key attributes with different levels patient concerned most, the limited number of attributes and levels presented may not re fl ect the patient treatment decision in real world. However, the attributes used in this study were similar to those used in other studies on patient preferences towards NSCLC chemotherapy, 29,31,32 incorporating more attri- butes and levels could increase respondents burden, which could not bene fi t in DCEs study. Finally, the DCEs survey was conducted at regional large-scale tertiary Table 4 Variation In Patient Preferences For NSCLC Treatment
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<p>The Evolving Treatment of Diabetic Retinopathy</p>

<p>The Evolving Treatment of Diabetic Retinopathy</p>

and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials. Conclusion: Pharmacotherapy, both ocular and systemic, will be the primary mode of interven- tion in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a fi rst-line option when cost and treatment burden are more constrained. Results with subthreshold laser appear promising but will require more rigorous study to establish its role as adjunctive therapy. Evidence to support an optimal integration of the various treatment options is lacking. Central to the widespread adoption of any therapeutic regimen for DR and DME is substantiation of safety, ef fi cacy, and cost-effectiveness by a body of sound clinical trials. Keywords: diabetes, retina, diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor, vitrectomy pars plana vitreous surgery, antiangiogenic therapy
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Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach

Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach

Besides twice-daily administration, as chosen in our study, once-daily administration may be considered a rel- evant frequency, especially for oral drug administration. We chose twice daily for several reasons. Levels were pretested in focus groups; if focus group members had mentioned a potential influence on patient preferences by differentiating between once and twice daily, this would have been included as a separate level in our study design. Further, the aim of our study was a setting of features typical of second-line treatment of RA with DMARDs. At the time of the study’s design, there was no once-daily treatment available. More- over, we assumed twice-daily administration as perceived to be “worse” to once-daily administration, allowing the conclu- sion that once-daily administration would be even better.
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Phototherapeutic Devices for the Treatment of Diabetic Retinopathy

Phototherapeutic Devices for the Treatment of Diabetic Retinopathy

Panretinal photocoagulation has been a mainstay in the treatment of diabetic retinopathy since its introduction in the 1950s [42]. Originally, clinicians used laser burns to seal leaky vessels in the peripheral retina to reduce macular edema; however, researchers soon realized that it is the reduction in retinal metabolism, as a result of the laser burns destroying tissue, that is therapeutic. Modern therapy therefore involves an array of laser burns across the peripheral retina (1200-1500 burns of 0.5 mm diameter) (Figure 1.9), which reduce metabolic demands in the outer retina by approximately 20% [43]. The macula is carefully avoided due to its role in high acuity vision. The cell-free burned regions provide pathways for oxygen to diffuse from the outer choroidal vasculature through to the inner retina where it can help compensate for reduced oxygen supply from the inner retinal blood vessels. VEGF levels decrease in patients after laser photocoagulation, highlighting how hypoxia drives disease progression via VEGF [44].
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Patient preferences and satisfaction in the treatment of rheumatoid arthritis with biologic therapy

Patient preferences and satisfaction in the treatment of rheumatoid arthritis with biologic therapy

Abstract: Significant advances in the treatment of rheumatoid arthritis (RA) have been made over the past 10 years with the introduction of biologic therapies, such as the TNF inhibitors. With these medications, many patients with RA have seen significant improvement in symptoms, function, and quality of life. However, with the introduction of the biologics, decision-making for this chronic disease that affects up to 1% of the population has become even more complex. Patient preferences for mode and frequency of administration, and for certain risks vs benefits as well as medication beliefs are central to uptake and adherence to these medications. This review examines the current literature on patient satisfaction, adherence, and preference for biologic therapy in RA.
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Patient preferences in the treatment of hemophilia A: impact of storage conditions on product choice

Patient preferences in the treatment of hemophilia A: impact of storage conditions on product choice

However, these observed associations may not be truly linked to causality. For example, frequent traveling could be the reason for storing FVIII product at room temperature. The same applies to other associations observed in this study such as that of a high restriction of sports activities in the group of patients who stored FVIII in their refrigerator. These associa- tions could have been caused by other “hidden” variables, such as age, education, socioeconomic status, or anxiety levels regarding the use of FVIII. Indeed, “relaxed” was the only emotional attribute distinguishing both patient groups.
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Epidemiology and treatment outcomes of diabetic retinopathy in a diabetic population from Cameroon

Epidemiology and treatment outcomes of diabetic retinopathy in a diabetic population from Cameroon

We found that the duration of diabetes strongly corre- lates with the severity of retinopathy (p < 0.001, r = 0.9541) in our study population. In facts, prolonged exposure to hyperglycaemia is an established risk factor of DR, highlighting the crucial need of an optimal control of blood sugar to prevent DR. This a very difficult task in developing countries like Cameroon that face a serious lack of health care facilities for diabetes management. Consequently, delayed diagnosis and ineffective man- agement of diabetes occurring in these settings have a great impact in DR onset and progression. Much more, as microvascular complications and for instance DR are related to the duration of diabetes, early detection of retinopathy is an important preventive strategy [18]. Inter- estingly, type 2 diabetes, which is the most frequent type of diabetes, has an asymptomatic phase with actual dia- betic hyperglycemia before clinical diagnosis. This phase has been estimated to last at least 4 to 7 years [19].
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Optomap ultrawide field imaging identifies additional retinal abnormalities in patients with&nbsp;diabetic retinopathy

Optomap ultrawide field imaging identifies additional retinal abnormalities in patients with&nbsp;diabetic retinopathy

tions defined in these studies have been used in subsequent clinical trials assessing treatment efficacy and therefore guide modern clinical management of DR. The ETDRS fundus photography protocol requires pharmacological mydriasis and uses a set of seven individual stereoscopic images, each covering 30 ° of the posterior retina. The combined seven-field image includes the majority of the central retina but covers only 30% of the entire retinal surface. The ETDRS protocol remains the current gold standard imaging technique for DR classification; the recent switch from film to digital images showed no appreciable difference in sensitivity or specificity. 6,7
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Screening and treatments using telemedicine in retinopathy of prematurity

Screening and treatments using telemedicine in retinopathy of prematurity

Abstract: Several studies have validated the role of telemedicine as a new powerful screen- ing and diagnostic tool for retinal disorders, such as diabetic retinopathy and retinopathy of prematurity. With regard to retinopathy of prematurity, bedside examination with binocular indirect ophthalmoscopy has been the gold standard technique for screening, yet with several limitations. Herein, we review the current evidence that supports the role of telemedicine for the screening of infants with retinopathy of prematurity.

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Patients’ preferences for involvement in the decision-making process for treating diabetic retinopathy

Patients’ preferences for involvement in the decision-making process for treating diabetic retinopathy

When assessing the results of the diabetes cohort, it is important to compare the results with other studies, reporting representative samples of the population in different countries. A large US population-based survey exploring the decision-making style in the general popu- lation showed 9% of respondents favored a passive style, 62% favored SDM and 28% preferred to make clinical decisions by themselves [17]. An annual representative sample of Germany between 2001 and 2012 showed be- tween 14 and 22% for decision-making by the physician, between 52% and 58% for SDM, and an interval of 19% to 25% for the autonomous type of patients [23, 24]. Comparing these studies, based on the general popula- tion, with our study we found a lower percentage of pa- tients preferred PDM. This might be because diagnosis and treatment have become a high-tech area with very
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Insight into 144 patients with ocular vascular events during VEGF antagonist injections

Insight into 144 patients with ocular vascular events during VEGF antagonist injections

A total of 144 cases were available for this study, which included 32 cases retrieved from the literature, 64 reports to the Food and Drug Administration (FDA), and 48 cases contributed from 22 centers across Africa, America, Asia, and Europe (Tables 1 and 2). Eight of these cases were part of a prospective study at Mansoura University (Mansoura City, Egypt) of 42 patients treated with intravitreal beva- cizumab (33 patients with advanced proliferative diabetic retinopathy, seven with choroidal neovascularization, and two with central retinal vein occlusion). From 1665 reports of adverse effects following treatment with ranibizumab, 7167 reports of adverse effects following treatment with bevaci- zumab, 355 reports of adverse effects following treatment with pegaptanib, and 74 reports of adverse effects following treatment with aflibercept (VEGF Trap), the current study collected data on twelve ranibizumab-, 28 bevacizumab-, and six pegaptanib-related retinal vascular events.
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International Journal of Computer Science and Mobile Computing

International Journal of Computer Science and Mobile Computing

Treatment of diabetic retinopathy varies depending on the extent of the disease. It may require laser surgery to seal leaking blood vessels or to discourage new leaky blood vessels from forming. Injections of medications into the eye may be needed to decrease inflammation or stop the formation of new blood vessels. In more advanced cases, a surgical procedure to remove and replace the gel-like fluid in the back of the eye, called the vitreous, may be needed. A retinal detachment, defined as a separation of the light-receiving lining in the back of the eye, resulting from diabetic retinopathy, may also require surgical repair.
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Diabetic Retinopathy: A Concise Review

Diabetic Retinopathy: A Concise Review

Regardless of good control of systemic risk factors, a huge number of patients will in any case advance to create vision-undermining diabetic retinopathy (either macular oedema or proliferative retinopa- thy). The present standard for the management of DR are laser treatment, vitrectomy, and not all around powerful in inversion of visual loss. Along these lines, new methodologies have likewise de- veloped, for example, utilization of intraocular organization of hostile to VEGF specialists and corticosteroids in selected eyes. However, oph- thalmologists and physicians should be awake not only of the noticeable benefits but also of the poss- ible risks associated with these novel therapies. REFERENCES
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Knowledge, attitude and practice among non ophthalmic health care providers regarding eye management of diabetics in private sector of Riyadh, Saudi Arabia

Knowledge, attitude and practice among non ophthalmic health care providers regarding eye management of diabetics in private sector of Riyadh, Saudi Arabia

Consequently, research about perspective of care pro- viders should also focus on those working in the private sector due to their greater prevalence. The levels of knowledge, attitude and practice among Primary health- care (PHC) physicians concerning both DR screening and treatment of sight-threatening diabetic retinopathy have been studied by different groups such as medical students [7], pharmacists [8], PHC staff [9] and opticians [10]. In some studies, the levels were very high while, in others, they were noted to be less than desired.

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Diabetic retinopathy: variations in patient therapeutic outcomes and pharmacogenomics

Diabetic retinopathy: variations in patient therapeutic outcomes and pharmacogenomics

Such a critical step will help to select the best therapy for the patient that will aid achieving the best visual outcome at the least possible cost. Future research strategies focusing on the identification of more phenotypic variations in DR based on clinical characteristics of the disease are certainly very relevant. In addition, consolidation of knowledge on genomic biomarkers of DR associated with suboptimal treatment response is necessary. It is imperative for clinical trials focusing on DR to analyze the possible reasons behind incomplete response or no response.
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Choosing preclinical study models of diabetic retinopathy: key problems for consideration

Choosing preclinical study models of diabetic retinopathy: key problems for consideration

Abstract: Diabetic retinopathy (DR) is the most common complication of diabetes mellitus in the eye. Although the clinical treatment for DR has already developed to a relative high level, there are still many urgent problems that need to be investigated in clinical and basic science. Currently, many in vivo animal models and in vitro culture systems have been applied to solve these problems. Many approaches have also been used to establish different DR models. How- ever, till now, there has not been a single study model that can clearly and exactly mimic the developmental process of the human DR. Choosing the suitable model is important, not only for achieving our research goals smoothly, but also, to better match with different experimental proposals in the study. In this review, key problems for consideration in choosing study mod- els of DR are discussed. These problems relate to clinical relevance, different approaches for establishing models, and choice of different species of animals as well as of the specific in vitro culture systems. Attending to these considerations will deepen the understanding on current study models and optimize the experimental design for the final goal of preventing DR. Keywords: animal model, in vitro culture, ex vivo culture, neurovascular dysfunction
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The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy

The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy

PDR as often as previously thought, although screening also serves the purpose of detecting DME. 26 Only 2.3-8.6% of patient eyes that had no DR or very mild NPDR and had not required anti-VEGF treatment progressed to PDR in 5 years. Similarly, the 4-year incidence of PDR in patients with no baseline DR was 2.8% (33/1164) in a meta-analysis that included 14 studies conducted during 1986 and 2008. 24 Nevertheless, 0.3-0.8% of these eyes progressed to PDR in 1 year, suggesting that more specific, feature-based criteria would be advantageous in determining the appropriate frequency of follow-up. Our study findings need to be replicated and validated in future studies prior to recommending different
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A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema

A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema

Studies were regarded eligible if they accord with the fol- lowing criterias: (1) the study population included patients with DME; (2) the DEX implant (Ozurdex) was included as an intervention; (3) there was a comparison between the DEX implant (Ozurdex®) and anti-VEGF. Through our ana- lysis of the studies, we determined the following primary outcomes. First, the mean BCVA and mean improvement from baseline in BCVA [time points: baseline, 6 months, and 12 months]. BCVA was obtained using the Early Treatment Diabetic Retinopathy Study (ETDRS). Second, the mean CST and mean change from baseline in CST or foveal thickness, and central macular thickness (CMT) was demonstrated on optical coherence tomography (OCT) [time points: baseline, 6 months, and 12 months]. Add- itional outcomes collected included the following: 1) total number of serious adverse events (SAEs) at the end of each study; 2) elevation of intraocular pressure (IOP>21 mmHg, required glaucoma agents for IOP control, or IOP elevation by at least 5 mmHg from baseline at any follow-up visit; 3) the number of cataracts; 4) the mean number of intravitreal injections; and 5) the study design should be randomized controlled trials (RCTs).
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Central subfield thickness and cube average thickness as bioimaging biomarkers for ellipsoid zone disruption in diabetic retinopathy

Central subfield thickness and cube average thickness as bioimaging biomarkers for ellipsoid zone disruption in diabetic retinopathy

Two hundred seventy-one consecutive patients of dia- betes mellitus in the age group of 40 to 65  years were included in the study. Sample size was calculated to be 271 using the formula for sample size calculation [9]. Power of the study was 80%. Diabetes was diagnosed according to American Diabetes Association criteria as a fasting plasma glucose level ≥ 126 mg/dL (7.0 mmol/L) or 2-h post prandial glucose level ≥ 200  mg/dL (11.1  mmol/L) during an oral glucose tolerance test [10]. Based on the fundus photography and fluorescein angiography, subjects were divided into three groups according to the early treatment of diabetic retinopa- thy study (ETDRS) classification [11]: diabetes mellitus patients without retinopathy (No DR, n = 97), with non- proliferative diabetic retinopathy (NPDR, n = 91), and with proliferative diabetic retinopathy (PDR, n = 83). Healthy controls (n = 82) with no diabetes mellitus were also included. The different OCT systems show discrep- ancies which can be explained by the differences in the retinal segmentation algorithms. Whereas the Spectralis HRA + OCT and Cirrus HD-OCT include the RPE layer in the retinal segmentation, the other instruments do not. The data imply that the different OCT systems cannot be used interchangeably for the measurement of macu- lar thickness [12]. Thus it is important to have a control group for baseline values.
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