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The caliber of the retinal vessels has been shown to be associated with stroke events. However, the consistency and magnitude of association, and the changes in predicted risk independent of traditional risk factors, are unclear. To determine the association between retinal vessel caliber and the risk of stroke events, the investigators combined individual data from 20,798 people, who were free of stroke at baseline, in 6 cohort studies identified from a search of the Medline (National Library of Medicine, Bethesda, Maryland) and EMBASE (Elsevier B.V., Amsterdam, the Netherlands) databases. During follow-up of 5-12 years, 945 (4.5%) incident stroke events were recorded. Wider retinal venular caliber predicted stroke (pooled hazard ratio = 1.15, 95% confidence interval: 1.05, 1.25 per 20-micron increase in caliber), but the caliber of retinal arterioles was not associated with stroke (pooled hazard ratio = 1.00, 95% confidence interval: 0.92, 1.08). There was weak evidence of heterogeneity in the hazard ratio for retinal venular caliber, which may be attributable to differences in follow-up strategies across studies. Inclusion of retinal venular caliber in prediction models containing traditional stroke risk factors reassigned 10.1% of people at intermediate risk into different, mostly lower, risk categories.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

This study identified published studies on the quantitative accuracy of fundus autofluorescence (FAF) imaging for the detection and diagnosis of retinal conditions. However, no studies were found that had quantitatively assessed the accuracy of FAF imaging for monitoring the progression of retinal conditions or their response to therapy. Key limitations of the published studies are that their methods do not accurately reflect how FAF imaging is likely to be used in clinical practice and they are at risk of several types of bias.

Health Technology Assessment - NIHR Journals Library.

Version: April 2016

The review found insufficient evidence to recommend that pan-retinal photocoagulation is used at the non-proliferative stage of diabetic retinopathy.

Health Technology Assessment - NIHR Journals Library.

Version: July 2015

Based on a small body of evidence of variable quality, the study found that optical coherence tomography had high sensitivity and moderate specificity for diagnosing people with suspected neovascular age-related macular degeneration, and relatively high sensitivity but low specificity for monitoring those previously diagnosed with the disease.

Health Technology Assessment - NIHR Journals Library.

Version: December 2014

Eye examinations may be necessary for various reasons, for instance due to external eye injuries or sudden vision problems. Vision also tends to get worse with age, so many people end up going to see an eye doctor at some point.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 20, 2016

Diabetic retinopathy is a problem of the back of the eye that occurs in people with diabetes. In later stages of the disease, new blood vessels grow in the back of the eye and cause problems with vision. This advanced form of the disease is known as proliferative diabetic retinopathy. Anti‐VEGF has been developed to block the growth of these new vessels. It has to be injected into the eye.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

It is normal for vision to gradually worsen with age. Some people also have medical conditions that further affect their vision. One possible cause of worsening vision is age-related macular degeneration (AMD). Central vision loss makes objects appear blurry and distorted when you look at them directly. This is the type of vision we need to read, drive a car or recognize faces.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 29, 2015

Diabetic retinopathy (DR) and diabetic macular edema (DME) are microvascular complications of diabetes that are a leading cause of blindness in the diabetic population. DME — which is swelling of the retina due to leakage of fluid from blood vessels within the macula, the central portion of the retina — may occur at any time during the progression of DR. The goal of treatment is to preserve current visual acuity and reduce the chances of progression to visual loss. Successful laser treatment reduces moderate visual loss but has limited effects on improving visual acuity. Intravitreal injection of corticosteroids, such as triamcinolone acetate, may also moderately improve visual acuity, but these generally offer only short-term improvements in acuity in cases of DME refractory to laser treatment. Moreover, triamcinolone is not licensed by Health Canada for this indication. Ranibizumab is a recombinant humanized monoclonal immunoglobulin G1 antibody that binds to and inhibits the biologic activity of human vascular endothelial growth factor (VEGF). It is the only pharmacological therapy licensed in Canada for the treatment of DME.

Rapid Response Report: Peer-Reviewed Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: May 2012

One cause of loss of sight in the center of the eye is a disease called age‐related macular degeneration (AMD). AMD causes blindness in many older people in developed countries. Around the world, nearly 9% (one in 11) of people 45 to 85 years of age are estimated to have AMD. About 10% of people with AMD develop a type of AMD called neovascular (wet) AMD, which results from new blood vessels that develop in an inner layer of the eye called the choroid. If a patient with this type of AMD is not treated, the affected eye may lose sight and may develop other problems related to blindness.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Expert-reviewed information summary about the treatment of intraocular (eye) melanoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 9, 2015

Expert-reviewed information summary about the treatment of intraocular (uveal) melanoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 1, 2017

Pathologic myopia (PM) is caused by the progressive and excessive elongation of the axial length of the eyeball. Myopic choroidal neovascularization (CNV) is a complication of PM and is a serious threat to vision. CNV is observed as an abnormal growth of blood vessels located between the neurosensory retina and the retinal pigment epithelium. Symptoms include a decrease in vision, central scotoma, and/or metamorphopsia. PM has a prevalence of 0.084% among adult Canadians, and myopic CNV is a leading cause of visual disability among young adults.>

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: August 2015

The purpose of this review is to evaluate the clinical evidence, cost information, and guidelines to determine if there is evidence to support dosing regimens of 15 or more injections of ranibizumab for the treatment of age-related macular degeneration (AMD.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: March 11, 2014

Age-related macular degeneration (AMD) is a degenerative disease of the macula. In Canada, about one million people currently have early AMD and approximately 250,000 have the advanced form of AMD. AMD is the leading cause of registered visual impairment in Canada. The prevalence of blindness due to AMD in Canada has been estimated at more than 100,000. There are two types of AMD: dry AMD and neovascular (wet) AMD (wAMD). While wAMD develops in only 10% to 20% of people with dry AMD, it accounts for more than 90% of those who have advanced vision loss. The hallmark of wAMD is choroidal neovascularization, which is an abnormal angiogenic process modulated by growth factors including vascular endothelial growth factor (VEGF).

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: August 2015

Age-related macular degeneration (AMD) causes loss of central vision and is one of the leading causes of irreversible sight loss among adults registered blind. The decrease in vision is associated with a loss of independence, an increased risk of depression, falls and fractures and a decrease in health-related quality of life. There are different types of AMD, which have different manifestations, prognoses and treatment strategies. Neovascular or wet AMD has a more variable course than other types and can progress much more quickly. Neovascular AMD is due to choroidal neovascularisation (CNV), which can be subdivided into different disease types according to its appearance on fluorescein angiography: 100% classic, predominantly classic (>50% classic), minimally classic (<50% classic) or occult with no classic. AMD lesions can also be classified according to where they occur in relation to the fovea: subfoveal, juxtafoveal or extrafoveal. Geographic atrophy (or dry AMD) is associated with gradual, progressive loss of visual function, and is not considered in this report.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2008

Expert-reviewed information summary about the treatment of retinoblastoma in children.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: August 18, 2017

The systematic review found that, using the best available data, second-eye cataract surgery was associated with clinically meaningful improvement in stereopsis but did not affect other clinical measures of vision or of health-related quality of life, apart from improvements in a mental health measure in one trial. There are limitations in the evidence, however, including a lack of quality of life assessments in some trials and patients’ baseline vision before surgery being relatively good, limiting room for improvement. Further data are needed from a well-conducted randomised controlled trial that reflects current populations and enables the estimation of health-state utility values.

Health Technology Assessment - NIHR Journals Library.

Version: November 2014

Diabetes is a long-term condition that can have a major impact on the life of a child or young person, as well as their family or carers. In addition to insulin therapy, diabetes management should include education, support and access to psychological services, as detailed here and in this guideline. Preparations should also be made for the transition from paediatric to adult services, which have a somewhat different model of care and evidence base.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2015

To systematically review evidence addressing the diagnosis and management of infantile hemangiomas (IH).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2016

INDEX TEST: OCT including time-domain (TD-OCT) and the most recently developed spectral domain (SD-OCT); comparator tests: visual acuity, clinical evaluation (slit lamp), Amsler chart, colour fundus photographs, infra-red reflectance, red-free images/blue reflectance, fundus autofluorescence imaging (FAF), indocyanine green angiography (ICGA), preferential hyperacuity perimetry (PHP), and microperimetry; reference standard: fundus fluorescein angiography. Databases searched included MEDLINE, MEDLINE In Process, EMBASE, Biosis, SCI, the Cochrane Library, DARE, MEDION, and HTA database. Last literature searches: March 2013. Risk of bias assessed using QUADAS-2. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic (HSROC) curves. Twenty-two studies (2 abstracts and 20 articles) enrolling 2124 participants were identified, reporting TD-OCT (12 studies), SD-OCT (1 study), ICGA (8 studies), PHP (3 studies), Amsler grid, colour fundus photography and FAF (1 study each). Most studies were considered to have a high risk of bias in the patient selection (55%, 11/20), and flow and timing (40%, 8/20) domains. In a meta-analysis of TD-OCT studies, sensitivity and specificity (95% CI) were 88% (46-98%) and 78% (64-88%), respectively. There was insufficient information to undertake meta-analysis for other tests. TD-OCT is a sensitive test for detecting nAMD, although specificity was only moderate. Data on SD-OCT are sparse. Diagnosis of nAMD should not rely solely on OCT.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Systematic Reviews in PubMed

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