Evidence map›Paper›PMID 31918701›Full record

ArticleBMC ophthalmology2020

A systematic approach to evaluate practice-based process- and outcome data applied to the treatment of neovascular age-related macular degeneration.

Margriet I van der Reis, M Elshout, Tos T J M Berendschot, Yvonne de Jong-Hesse, Carroll A B Webers, Jan S A G Schouten

Open access · goldAbstract readComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC ophthalmology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact, top 99% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 2 countries.

Margriet I van der ReisMaastricht University Medical Center, University Eye Clinic Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
M ElshoutMaastricht University Medical Center, University Eye Clinic Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. mari_elshout@hotmail.com.
Tos T J M BerendschotMaastricht University Medical Center, University Eye Clinic Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Yvonne de Jong-HesseDepartment of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands.
Carroll A B WebersMaastricht University Medical Center, University Eye Clinic Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Jan S A G SchoutenMaastricht University Medical Center, University Eye Clinic Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Maastricht University · NLAmsterdam UMC Location VUmc · NLCanisius-Wilhelmina Ziekenhuis · NL

Funding

ZonMw 152001002
6 · The paper itself

Abstract

backgroundFollowing the principles of value-based health care, outcomes and processes of daily-practice eye care need to be systematically evaluated. We illustrate an approach that can be used to support data-driven quality improvements. We used patient data regarding the treatment of neovascular age-related macular degeneration (nAMD).

methodsIn a cohort study, we reviewed medical records of patients with nAMD confirmed on fluorescein angiography (FA). Patients were treated with intravitreal injections with bevacizumab; ranibizumab; or photodynamic therapy (PDT). Visual acuity (VA), ophthalmic exam results and treatments were recorded. VA was compared between treatments by linear mixed model. Diagnosis was re-evaluated on the original FAs. Outcome analysis was performed by 1) selecting VA as the relevant outcome parameter; 2) Preventing selection by comparing treatments with historical untreated cohort and cohorts from the literature, 3) correcting for confounding due to lesion type, and 4) identifying relevant process variables that affect the outcome. These were severity of disease at presentation, and doctor- and patient dependent process variables.

resultsIn total, 473 eyes were included. At 12 months, change in VA was 0.54, 0.48, 0.09, and 0.07 LogMAR in the no-treatment, photodynamic therapy (PDT), bevacizumab, and ranibizumab groups, respectively. Lesion type on FA differed between groups. Diagnosis of nAMD could not be confirmed in 104 patients. Patient delay, inaccurate diagnosis and treatment intervals may have impacted outcomes.

conclusionsThe effect of PDT was small to absent. Anti-VEGFs were effective and appeared as effective as in RCTs. Correct selection of a comparator cohort and addressing confounding, including confounding by indication and effect modification, are needed to achieve valid results and interpretation. Patient delay, diagnosis accuracy, indication for and application of treatment can potentially be improved to improve treatment outcomes. In a value-based care perspective, systematic evaluation of diagnostic accuracy, treatment indication, protocols, and outcomes of new interventions is needed at an early stage to improve outcomes.

Indexed as

PhotochemotherapyAgedAged, 80 and overAngiogenesis InhibitorsBevacizumabChoroidal NeovascularizationFemaleFluorescein AngiographyFollow-Up StudiesHumansIntravitreal InjectionsMaleOutcome and Process Assessment, Health CarePhotosensitizing AgentsRanibizumabRetrospective StudiesAngiogenesis InhibitorsBevacizumabPhotosensitizing AgentsRanibizumabVascular Endothelial Growth Factor AVEGFA protein, humanVerteporfinAge-related macular degeneration; outcome study; visual acuityAnti-VEGFBevacizumabPhotodynamic therapyRanibizumab

Identifiers

PMID31918701
PMCPMC6953304
OpenAlexW3001882245

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.