MedExpert IMDS™ AI Based EBM System
By MedExpert Decision Support System | Apr 08, 2020
Q.
Every 12 weeks I have been taking my 95 year old grandmother for eye injections to treat her wet macular degeneration. I called her doctor to see if we could postpone the next injection to avoid exposure to COVID-19. During the call, one nurse said we need to come in at 12 weeks and in the same call I was transferred to another nurse and she said that if it were her grandmother, and given that my grandmother has an underlying heart condition, she would advise against having my grandmother sitting in a waiting room and facing two separate examination procedures and an injection.
How would experts advise?
A.
This is a decision that weighs the risk of losing sight against the chance of contracting COVID-19. Given that your grandmother is 95 and has underlying heart conditions, the risks are high should your grandmother become infected with SARS-CoV-2, the virus causing COVID-19.
MedExpert maintains an artificial intelligence (AI) based technology system that has the ability to identify world experts and track their results. MedExpert also has the ability to rapidly contact world experts to have them weigh in on individual cases. This case was summarized and sent to world experts (called FAME Experts) on April 6, 2020 to obtain their opinion on what they would do if this were their family member.
Here is a summary of expert responses as of April 8, 2020
First of all, one FAME Expert stated the following: “I don't know who has been treating your 95 y/o patient but whomever has been treating the patient has done an outstanding job of keeping her vision at an excellent level. The ability to extend the treatment interval is based on the previous examinations and the OCT's taken in the past. [Optical coherence tomography (OCT) is an eye exam technology that defines the location and nature of the changes in the retina and adjacent structures and objectively evaluates the thickness of the retina and surrounding structures.] Usually if treatment is delayed the patient will begin to leak serum or blood and may lose vision.”
And the consensus statement from world experts is: “It is safe to extend the interval, but a jump from 12 to 20 weeks is a big jump. I would recommend to go from 12 to 16 weeks, and check on OCT if it is stable. If it is, the new jump could be 20 weeks.” Optical coherence tomography (OCT) visualization does not require being touched by a nurse or technician and the machine can be cleaned prior to your visit. Avoid the waiting room by staying outside in the car until called for your appointment.
How Individual Medical Decision System (IMDS™) works
On April 6, 2020, the following question was sent to FAME experts: “95 y/o female with wet AMD diagnosed 6 years ago in her right eye only. Corrected 20/20 vision in both eyes. Receiving Eylea injection in right eye every 12 weeks for 5 years. Seeking opinion whether it safe to extend the usual 12 week injection cycle to 20 weeks to avoid COVID-19 exposure. Patient lives in San Francisco Bay Area."
On April 6, 2020, FAME Experts were identified and contacted
The following Individuals Are Considered Experts On Age-related macular degeneration
SUBJECT: Age-related macular degeneration
ORDER DATE: 2020-04-06
EXPIRATION DATE: 2020-05-06
For MedExpert Members: The following individuals have been identified as world experts. MedExpert will contact these individuals to find a local expert that will work within your plan. Should you be interested in reading the research published by these individuals, please contact MedExpert and a more detailed report will be provided to you.
This list is based on current research and can be considered useful for only 30 days. Individuals may remain on the list for longer or may be removed as a result of our regular reviews of criteria for inclusion.
|
World Experts On Macular Degeneration |
||||
|
Name |
City |
State |
Country |
Score |
|
Francesco Bandello |
Milan |
|
Italy |
2,415 |
|
Srinivas R Sadda |
Los Angeles |
CA |
United States |
2,350 |
|
K Bailey Freund |
New York |
NY |
United States |
2,295 |
|
Frank G Holz |
Heidelberg |
|
Germany |
2,230 |
|
Giuseppe Querques |
Paris |
|
France |
1,990 |
|
Emily Y Chew |
Bethesda |
MD |
United States |
1,950 |
|
Tien-Ying Wong |
Singapore |
|
SG |
1,935 |
|
Ursula Schmidt-Erfurth |
Vienna |
|
Austria |
1,890 |
|
Usha Chakravarthy |
Belfast |
|
GB |
1,880 |
|
Neil M Bressler |
Baltimore |
MD |
United States |
1,850 |
|
Christine A Curcio |
Birmingham |
AL |
United States |
1,835 |
|
Eric H Souied |
Créteil |
|
France |
1,820 |
|
Philip J Rosenfeld |
Miami |
FL |
United States |
1,815 |
|
Paul Mitchell |
Sydney |
|
Australia |
1,635 |
|
Carel B Hoyng |
Nijmegen |
|
Netherlands |
1,605 |
|
Glenn J Jaffe |
Jacksonville |
FL |
United States |
1,575 |
|
Robyn H Guymer |
Melbourne |
VIC |
Australia |
1,470 |
|
David Sarraf |
Los Angeles |
CA |
United States |
1,410 |
|
Mark C Gillies |
Sydney |
|
Australia |
1,375 |
|
Charles Clifton Wykoff |
Houston |
TX |
United States |
1,305 |
|
Sobha Sivaprasad |
London |
|
Denmark |
1,245 |
|
Giovanni Staurenghi |
Milan |
|
Italy |
1,225 |
|
Jay Chhablani |
Hyderabad |
|
India |
1,185 |
|
Cynthia A Toth |
Durham |
NC |
United States |
1,175 |
|
Maureen G Maguire |
Philadelphia |
PA |
United States |
1,170 |
|
Steffen Schmitz-Valckenberg |
Bonn |
|
Germany |
1,155 |
|
Lee Merrill Jampol |
Chicago |
IL |
United States |
1,145 |
|
Sascha Fauser |
Nijmegen |
|
Netherlands |
1,125 |
|
Sebastian Wolf |
Bern |
|
Switzerland |
1,105 |
|
Gui-Shuang Ying |
Naples |
|
Italy |
1,095 |
|
Adam R Glassman |
Tampa |
FL |
United States |
1,075 |
|
Nagahisa Yoshimura |
Kyoto |
|
Japan |
1,065 |
|
Stephen H Tsang |
New York |
NY |
United States |
1,055 |
|
Jean François Korobelnik |
Bordeaux |
|
France |
1,050 |
|
David S Boyer |
Los Angeles |
CA |
United States |
1,050 |
|
Anneke I den Hollander |
Nijmegen |
|
The Netherlands |
1,035 |
|
Michel Michaelides |
London |
|
United Kingdom |
1,010 |
|
Daniel F Martin |
Cleveland |
OH |
United States |
1,010 |
|
Adnan Tufail |
London |
|
United States |
1,005 |
|
David M Brown |
Houston |
TX |
|
1,005 |
|
Rufino Silva |
|
|
PT |
995 |
|
Tunde Peto |
Belfast |
|
United Kingdom |
985 |
|
Diana V Do |
Baltimore |
|
|
975 |
|
Quan Dong Nguyen |
Baltimore |
MD |
United States |
950 |
|
Laurent Kodjikian |
Lyon |
|
France |
945 |
|
Rishi P Singh |
Cleveland |
OH |
United States |
945 |
|
Pravin U Dugel |
Phoenix |
AZ |
United States |
930 |
|
Peter A Campochiaro |
Atlanta |
GA |
United States |
910 |
General Background Information
What is Eylea
EYLEA® (aflibercept) Injection 2 mg (0.05mL) is a prescription medicine approved for the treatment of patients with Wet Age-related Macular Degeneration (AMD), Macular Edema following Retinal Vein Occlusion (RVO), Diabetic Macular Edema (DME), and Diabetic Retinopathy (DR).
More About Macular Degeneration
Macular Degeneration is the leading cause of vision loss, affecting more than 10 million Americans. It is caused by the deterioration of the central portion of the retina, the inside back layer of the eye that records the images we see and sends them via the optic nerve from the eye to the brain. The retina’s central portion, known as the macula, is responsible for focusing central vision in the eye, and it controls our ability to read, drive a car, recognize faces or colors, and see objects in fine detail.
There are two basic types of Macular Degeneration: “dry” and “wet.” Approximately 85% to 90% of the cases of Macular Degeneration are the “dry” (atrophic) type, while 10-15% are the “wet” (exudative) type. Stargardt disease is a form of macular degeneration found in young people, caused by a recessive gene.
There are three stages of Age-related Macular Degeneration (AMD).
- Early AMD – Most people do not experience vision loss in the early stage of AMD, which is why regular eye exams are important, particularly if you have more than one risk factor (see below). Early AMD is diagnosed by the presence of medium-sized drusen (yellow deposits beneath the retina).
- Intermediate AMD – At this stage, there may be some vision loss, but there still may not be noticeable symptoms. A comprehensive eye exam with specific tests will look for larger drusen and/or pigment changes in the retina.
- Late AMD – At this stage, vision loss has become noticeable.
The biggest risk factor for Macular Degeneration is age. Your risk increases as you age, and the disease is most likely to occur in those 55 and older.
Other risk factors include:
- Genetics – People with a family history of AMD are at a higher risk.
- Race – Caucasians are more likely to develop the disease than African-Americans or Hispanics/Latinos.
- Smoking – Smoking doubles the risk of AMD.
Treatment
Agents used for the treatment of age-related MD (AMD), include verteporfin, for photodynamic therapy, and anti-VEGF agents, the aptamer pegaptanib, the monoclonal antibodies (MAbs) ranibizumab (Lucentis®) and bevacizumab (Avastin®) and the fusion protein aflibercept (Eylea®). All these drugs are effective only for the wet form of AMD, whereas for the dry form there is no treatment available.
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