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A. Hessellund, D. A. Larsen, B. Gjedsted, T. Bek; Optimizing the Pattern of Referral for Treatment of Exudative AMD. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2242.
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The introduction of intravitreal injection of VEGF inhibitors for the treatment of choroidal neovascularizations in exudative AMD has increased the referral rates of patients with AMD for treatment. However, subsequent fluorescein angiography and OCT examinations disclose that a large proportion of these patients do not qualify for treatment. Considerable resources could be saved if these patients could be identified on the basis of the early symptoms and clinical signs so that unnecessary referrals could be omitted.
559 patients referred to our department with the diagnosis of exudative AMD were interviewed about the presence and duration of blurred vision, central dark spot, metamorphopsias, micropsia and dyschromatopisa, and were examined in a standardized way including measurement of ETDRS VA, optical coherence tomography scanning and fluorescein angiography. The patients were divided into three groups according to the conclusions of the examinations, i.e.: A) Atrophic AMD (n=382), B) Pigment epithelial detachment (N=49), C) Choroidal neovascularization (N=128). Differences in the subjective symptoms and clinical findings among these groups were studied.
From group A to C there was a trend towards: 1) significant lower ETDRS VA, A: 39.1, B: 33.0, and C: 27.5 (p<0.001 one-way Anova), 2) and significant shorter duration of symptoms, A: 96 days, B: 129 days, and C: 312 days (p<0.01 one-way Anova). Three types of symptoms differed significant among the groups, i.e.: Blurred vision (p=0.015 chi-square), central dark spot (p=0.044 chi-square), and metamorphopsias (p=0.004 chi-square). The occurrence of two other types of symptoms did not differ among the three groups, i.e.: Micropsia (p=0.95 chi-square) and dyschromatopsia (p=0.89 chi-square).
The symptoms and clinical findings of patients referred for intra-vitreal angiostatic treatment of exudative AMD with VEGF inhibitor are different among those patients who qualify for and those who do not qualify for treatment. Multi-variate analysis is needed in order to comprehend data into a model that can be used to avoid unnecessary referrals of patients who do not qualify for treatment.
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