Publications by authors named "David A Eichenbaum"

14 Publications

  • Page 1 of 1

Real-World Performance of a Self-Operated Home Monitoring System for Early Detection of Neovascular Age-Related Macular Degeneration.

J Clin Med 2021 Mar 25;10(7). Epub 2021 Mar 25.

Retina Vitreous Associates of Florida, 4344 Central Ave, St. Petersburg, FL 33711, USA.

The real-world performance of a home telemonitoring strategy (ForeseeHome AMD Monitoring System, Notal Vision, Inc.,Manassas VA, USA) was evaluated and compared to the device arm of the AREDS2-HOME study among patients with intermediate AMD (iAMD) who converted to neovascular AMD (nAMD). All patients with confirmed conversion to nAMD who used the home monitoring system from 10/2009 through 9/2018 were identified by Notal Vision Diagnostic Clinic's medical records. Selected outcome variables were evaluated, including visual acuity (VA) at baseline and at conversion, and change in visual acuity (VA) from baseline to time of conversion. In total, 8991 patients performed 3,200,999 tests at a frequency of 5.6 ± 3.2 times/week. The 306 eyes that converted from iAMD to nAMD over the study period (a 2.7% annual rate) were included in the analyses. There was a median (interquartile range) change of -3.0 (0.0-(-10.0)) letters among converted eyes, 81% [95% confidence interval (72-88%)] maintained a VA ≥ 20/40 at the time of conversion, while 69% of the conversion detections were triggered by system alerts. The real-world performance of an at-home testing strategy was similar to that reported for the device arm of the AREDS2-HOME study. The home telemonitoring system can markedly increase early detection of conversion to nAMD.
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http://dx.doi.org/10.3390/jcm10071355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036735PMC
March 2021

Early Experience With Brolucizumab Treatment of Neovascular Age-Related Macular Degeneration.

JAMA Ophthalmol 2021 Feb 25. Epub 2021 Feb 25.

Retina-Vitreous Associates of Florida, Tampa.

Importance: Outcome data are limited regarding early experience with brolucizumab, the most recently approved anti-vascular endothelial growth factor (VEGF) agent for the treatment of neovascular age-related macular degeneration (nAMD).

Objective: To report clinical outcomes after intravitreous injection (IVI) of brolucizumab, 6 mg, for nAMD.

Design, Setting, And Participants: This retrospective case series conducted at 15 private or academic ophthalmological centers in the United States included all consecutive patients with eyes treated with brolucizumab by 6 retina specialists between October 17, 2019, and April 1, 2020.

Exposures: Treatment with brolucizumab IVI, 6 mg.

Main Outcomes And Measures: Change in mean visual acuity (VA) and optical coherence tomography parameters, including mean central subfield thickness and presence or absence of subretinal and/or intraretinal fluid. Secondary outcomes included ocular and systemic safety.

Results: A total of 172 eyes from 152 patients (87 women [57.2%]; mean [SD] age, 80.0 [8.0] years) were included. Most eyes (166 [96.5%]) were not treatment naive, and 65.7% of these eyes (109 of 166) were switched from the prior anti-VEGF agent because of persistent fluid detected on optical coherence tomography scans. Study eyes received a mean (SD) of 1.46 (0.62) brolucizumab IVIs. The mean (SD) VA prior to starting brolucizumab was a 64.1 (15.9) Early Treatment Diabetic Retinopathy Study (ETDRS) letter score (Snellen equivalent, 20/50) and was a 63.3 (17.2) ETDRS letter score (Snellen equivalent, 20/63) at the last study evaluation (mean difference, 0.8; 95% CI, -2.7 to 4.3; P = .65). When analyzed by number of brolucizumab IVIs, the presence or absence of fluid prior to starting brolucizumab, or the presence or absence of intraocular inflammation after receiving brolucizumab, there was no difference in mean VA prior to starting brolucizumab compared with after brolucizumab IVIs or at the final study evaluation. The mean (SD) central subfield thickness in all eyes prior to starting brolucizumab was 296.7 (88.0) μm and was 269.8 (66.5) μm at the last study examination (mean difference, 26.9 µm; 95% CI, 9.0-44.7 µm; P = .003). Intraocular inflammation was reported in 14 eyes (8.1%) and was self-limited and resolved without treatment in almost half those eyes (n = 6). One previously reported eye (0.6%) had occlusive retinal vasculitis and severe loss of vision.

Conclusions And Relevance: In this analysis of brolucizumab IVI for nAMD, VA remained stable, with a reduction in central subfield thickness. Intraocular inflammation events ranged from mild with spontaneous resolution to severe occlusive retinal vasculitis in 1 eye.
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http://dx.doi.org/10.1001/jamaophthalmol.2020.7085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907988PMC
February 2021

Evolving Guidelines for Intracameral Injection.

J Glaucoma 2020 03;29 Suppl 1:S1-S7

Wilmer Eye Institute, Johns Hopkins Medical School, Baltimore, MD.

Purpose: To review evidence and provide guidelines on intracameral (ICM) injection techniques and monitoring.

Materials And Methods: A review of published literature on ICM injection and intravitreal injections formed the basis for roundtable deliberations by an expert panel of ophthalmologists.

Results: ICM injection as a way to deliver medications is growing in popularity. However, there is limited published literature and no standard approach to best practices for ICM injections, particularly when not accompanying another surgical procedure. Fortunately, there is long clinical experience with ICM manipulation and a large body of evidence surrounding intravitreal injections that has provided important guidance. The expert panel formulates several concrete guidelines and many suggested techniques to help physicians safely and effectively employ ICM injections.

Conclusions: This committee addressed the many considerations surrounding ICM injection of drugs or implants and agree that it is a safe and effective surgical procedure when performed with appropriate training and according to established safe practices.
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http://dx.doi.org/10.1097/IJG.0000000000001451DOI Listing
March 2020

Current and upcoming anti-VEGF therapies and dosing strategies for the treatment of neovascular AMD: a comparative review.

BMJ Open Ophthalmol 2019 15;4(1):e000398. Epub 2019 Dec 15.

Ophthalmology and Visual Sciences, University of Chicago, Chicago, Illinois, USA.

Age-related macular degeneration is the leading cause of vision loss in the developed world, with the expected number of affected elderly individuals reaching 17.8 million. Antivascular endothelial growth factor (anti-VEGF) injection therapy has been instrumental in treating a disease process that was previously thought to be untreatable. Over the past two decades, landmark studies have demonstrated the efficacy of different anti-VEGF medications and investigated the optimal dosing regimen and delivery mechanism to increase overall vision and minimise patient burden. In this review, we outline landmark neovascular age-related macular degeneration clinical trials that have demonstrated level 1 evidence for its usage or have contributed to the understanding of how to dose these agents.
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http://dx.doi.org/10.1136/bmjophth-2019-000398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936465PMC
December 2019

Macular thickness amplitude changes when switching from discontinuous to continuous therapy for diabetic macular oedema.

BMJ Open Ophthalmol 2019 29;4(1):e000271. Epub 2019 Mar 29.

Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA.

Objective: To investigate if the mean central retinal thickness (CRT) amplitude, measured between visits, is consistently decreased when switching from discontinuous to continuous therapy for diabetic macular oedema (DME) following fluocinolone acetonide (FAc) administration.

Methods And Analysis: In this retrospective cohort study, all patients with DME treated with FAc at a single centre were included. The primary outcome was CRT amplitude changes measured at each visit prior to and after FAc administration. Secondary outcomes included average number of DME treatments before and after FAc injection, visual acuity and intraocular pressure changes.

Results: Nineteen eyes were included. The mean (SD) follow-up after FAc was 399 (222) days. The mean (SD) CRT amplitude before FAc was 194.6 (114.90) µm, and following FAc administration, the amplitude decreased to 70.8 (94.23) µm (95% CI -189.5 to -58.1; p≤0.001). After FAc, the number of treatments required per month significantly decreased from an average of 1 treatment every 2.7 months to every 6 months (p=0.009).

Conclusion: In patients with DME, the CRT amplitude values and number of treatments significantly decrease following FAc administration while maintaining vision. Further studies are needed to evaluate the significance of these interesting findings.
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http://dx.doi.org/10.1136/bmjophth-2019-000271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528757PMC
March 2019

Ranibizumab Induces Regression of Diabetic Retinopathy in Most Patients at High Risk of Progression to Proliferative Diabetic Retinopathy.

Ophthalmol Retina 2018 10 1;2(10):997-1009. Epub 2018 Aug 1.

Genentech, Inc., South San Francisco, California.

Purpose: To evaluate diabetic retinopathy (DR) outcomes with ranibizumab (Lucentis, Genentech, Inc., South San Francisco, CA) treatment in patients with DR and diabetic macular edema (DME) at high risk of progression to proliferative disease.

Design: Post hoc analysis of the phase 3 RIDE (ClinicalTrials.gov identifier, NCT00473382) and RISE (ClinicalTrials.gov identifier, NCT00473330) clinical trials of ranibizumab for the treatment of DME.

Participants: Seven hundred forty-six patients with baseline fundus photographs and randomized for treatment.

Methods: Diabetic retinopathy outcomes were assessed through month 36 by baseline DR severity level. Diabetic retinopathy severity was quantified using the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale (DRSS).

Main Outcome Measures: Two-step or more or 3-step or more improvement or worsening on the ETDRS DRSS and time to new proliferative event (composite end point).

Results: At baseline, most patients were distributed evenly among mild or moderate nonproliferative DR (NPDR; ETDRS DRSS, 35/43), moderately severe or severe NPDR (ETDRS DRSS, 47/53), and proliferative DR (ETDRS DRSS, 60-75; 28.8%, 33.2%, and 31.1%, respectively). At month 24, rates of 2-step or more improvement with ranibizumab 0.3 mg, ranibizumab 0.5 mg, and sham treatment were highest among patients with baseline DR levels 47/53 (78.4%, 81.1%, and 11.6%, respectively) compared with patients with baseline DR levels 35/43 (10.3%, 15.8%, and 1.4%, respectively) or 60 through 75 without panretinal photocoagulation (31.0%, 36.4%, and 6.7%, respectively; all ranibizumab vs. sham comparisons, P < 0.05). In patients with baseline DR levels 47/53, ranibizumab treatment reduced the probability of patients experiencing a new proliferative event at month 36 by 3 times compared with sham treatment (12.4% and 11.9% vs. 35.2% for ranibizumab 0.3 mg, ranibizumab 0.5 mg, and sham, respectively). In patients with baseline DR levels 47/53 who achieved 2-step or more DR improvement, improvements were independent of all assessed baseline characteristics (P > 0.4).

Conclusions: Ranibizumab treatment resulted in DR improvements in all 3 baseline DR severity subsets examined. The greatest benefits in DR improvement occurred in patients with baseline moderately severe to severe NPDR (DR levels 47/53). Diabetic retinopathy improvements were rapid, clinically meaningful, and sustained through month 36.
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http://dx.doi.org/10.1016/j.oret.2018.06.005DOI Listing
October 2018

Monthly Versus Treat-and-Extend Ranibizumab for Diabetic Macular Edema: A Prospective, Randomized Trial.

Ophthalmic Surg Lasers Imaging Retina 2018 11;49(11):e191-e197

Background And Objective: Compare fixed monthly dosing of ranibizumab to treat-and-extend (T&E) ranibizumab during a period of 24 months for diabetic macular edema (DME) treatment.

Patients And Methods: Single-center, randomized, prospective pilot study that included 20 eyes of 20 subjects. Patients' best-corrected visual acuity (BCVA) was less than or equal to 20/40 and central foveal thickness on spectral-domain optical coherence tomography was greater than 325 µm. Intravitreal ranibizumab was dosed monthly or by protocol-specified treat-and-extend. Primary outcome was mean change in mean BCVA. Institutional review board approval was obtained.

Results: At month 24 (M24), there was a mean 8.3-letter gain in the monthly treatment group and an 8.5-letter gain in the T&E group (P = .082; 90% confidence interval). The average change from baseline BCVA was not statistically significantly different at any timepoint. At M24, the median number of injections in the monthly and T&E groups were 22.5 and 18.5, respectively (P = .287).

Conclusions: Visual acuity with monthly dosing appears equivalent to T&E dosing during the course of 24 months. There was a trend toward a lower injection burden in the T&E arm. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e191-e197.].
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http://dx.doi.org/10.3928/23258160-20181101-17DOI Listing
November 2018

When and How to Incorporate Steroids for Persistent Diabetic Macular Edema: A Discussion of Real-World Treatment Optimization Strategies.

Ophthalmic Surg Lasers Imaging Retina 2018 07;49(7):S5-S15

In the United States, diabetic macular edema (DME) is the leading cause of vision loss among people with diabetic retinopathy. Despite the availability of different therapies for DME, up to half of patients with DME show some persistent edema after anti-vascular endothelial growth factor (VEGF) treatment alone, leaving these patients at high risk for vision loss. However, dosing in a similar fashion to that of pivotal anti-VEGF trials is difficult because of real-life challenges faced in clinical practice. This is particularly true for DME, in that the frequency and burden of anti-VEGF injections are a major challenge to patient care. Research evaluating anti-VEGF therapies has shaped the treatment paradigms for patients with DME, and similar benefits have also been noted in clinical trials evaluating the use of intravitreal steroids. Treatment with a long-term intravitreal corticosteroid, which requires fewer injections than treatment with most short-acting therapies, has been found to reduce inflammation and improve vision in a percentage of patients. This roundtable discussion, which took place during the 2018 annual meeting of the Vit-Buckle Society, reviews the current treatment paradigms for DME and evaluates how to customize and optimize treatment strategies geared toward individualized patient care. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S5-S15.].
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http://dx.doi.org/10.3928/23258160-20180621-01DOI Listing
July 2018

Letter to the editor.

Ophthalmic Surg Lasers Imaging Retina 2015 Mar;46(3):301

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http://dx.doi.org/10.3928/23258160-20150323-01DOI Listing
March 2015

Topical lidocaine gel with and without subconjunctival lidocaine injection for intravitreal injection: a within-patient study.

Ophthalmic Surg Lasers Imaging Retina 2014 Jul-Aug;45(4):306-10

Background And Objective: To determine whether patients prefer topical anesthesia or subconjunctival anesthesia for intravitreal injection.

Patients And Methods: Consecutive patients receiving bilateral simultaneous injections of anti-vascular endothelial growth factor agents were asked to participate in this within-patient, prospective, single-blinded, randomized, factorial study. Fifty-seven patients completed the study. Both eyes were treated with topical anesthesia. One eye was also injected with subconjunctival lidocaine. Anesthesia for the next treatment visit was based on patient preference at the conclusion of the study visit and at a 4-hour and 24-hour follow-up telephone call. Patients were allowed to change their anesthesia preference during the next three visits. The final endpoint for the study was anesthesia preference for ongoing intravitreal injections.

Results: Fifty patients (88%) preferred subconjunctival anesthesia and seven patients (12%) preferred topical anesthesia for ongoing treatments. (P = .0003) CONCLUSION: Given the choice, most patients prefer subconjunctival anesthesia to topical anesthesia for intravitreal injections.
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http://dx.doi.org/10.3928/23258160-20140709-06DOI Listing
February 2015

Correspondence.

Retina 2013 Nov-Dec;33(10):2185

*Department of Ophthalmology, University of South Florida, Tampa, Florida †Retina-Vitreous Associates of Florida ‡Department of Ophthalmology, University of South Florida, Tampa, Florida.

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http://dx.doi.org/10.1097/IAE.0b013e31829f731eDOI Listing
March 2014

Multiple repeated intravitreal triamcinolone treatments for radiation-induced macular edema.

Retin Cases Brief Rep 2007 ;1(4):202-4

From Ophthalmic Consultants of Boston, Boston, Massachusetts.

Background And Purpose: This report discusses a patient with a predictably and repetitively favorable anatomic and functional response to intravitreal triamcinolone for radiation-induced macular edema. The purpose of this report is to demonstrate a situation where this treatment may have a favorable outcome over time.

Method: Retrospective interventional case study.

Result: Restoration of normal macular contour as well as maintenance of good vision after several treatments with intravitreal triamcinolone.

Conclusion: Intravitreal triamcinolone is a well-established treatment for macular edema. In the vast majority of cases, its effect is transient, and additional treatments are necessary. It is important to realize that, in certain cases which are effectively treated with this modality, it may allow for preservation of good vision over time. One must be vigilant for the known complications of intravitreal triamcinolone, especially increased intraocular pressure and cataract progression.
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http://dx.doi.org/10.1097/01.iae.0000226587.64265.deDOI Listing
November 2014