Purpose
To Utilize OCT-A to measure the change in size (mm
2
) and density (flow index) of choroidal neovascular membranes (CNVMs) from baseline to week 52 of treatment-naïve wet age-related macular ...degeneration (wARMD) patients receiving intravitreal aflibercept injections (IAI).
Methods
Patients were treated with IAI at baseline, month 1 and month 2 and then every other month for a total of 12 months. Along with clinical examination and best corrected visual acuity (BCVA), OCT-A 6- and 3-mm scans were acquired at every visit between May 2017 and January 2019. Data from baseline, week 12 and week 52 were analyzed prospectively and included in the final analysis.
Results
Twenty-five eyes from 23 patients were included in the study. The mean BCVA at baseline and week 52 increased from 20/125 to 20/80, respectively (
p
< 0.001). The mean CST at baseline and week 52 decreased from 330.48 to 222.40 μm, respectively (
p
< 0.001). 1Seventeen patients (18 eyes) completed all protocol-based 6 × 6 mm and 3 × 3 mm OCT-A scans. In this subgroup, 6-mm OCT-A scans revealed that the mean size of the CNVM before and after IAI was 1.21 mm
2
and 0.56 mm
2
, respectively (
p
< 0.001), while the 3-mm OCT-A scans at baseline and week 52 demonstrated a decrease in mean size of the CNVM from 0.89 to 0.37 mm
2
, respectively (
p
< 0.001). The 6-mm perfusion density map revealed no difference at either time points.
Conclusions
OCT-A provides a useful approach for monitoring and evaluating the treatment of intravitreal aflibercept for CNVMs. Mean size of CNVMs can be identified by 3- or 6-mm scans, but without machine learning, it requires extensive segmentation. While reproducibility and clear delineation of CNVMs in wARMD using OCT-A is challenging, OCT-A does offer the ability to monitor CNVM size changes during treatment and may offer another biomarker to assist in assessing treatment response.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract
Background
Simulation-based training (SBT) curricula for training novices in gastrointestinal endoscopy has been shown to be effective. Gamification, which is the application of game-design ...elements such as competition, rankings and rewards, has been used to enhance procedural learning in healthcare, but no studies have investigated the effects of a comprehensive gamification curriculum on the acquisition of endoscopic skills amongst novice endoscopists.
Aims
To evaluate a SBT curriculum using gamification for novice endoscopists on the performance of simulated and clinical colonoscopies, compared to a conventional SBT curriculum.
Methods
Thirty-six novice endoscopists (who had completed <20 previous colonoscopies) from the general surgery and gastroenterology programs at the University of Toronto participated. Participants were randomized into the Conventional Curriculum (CC) or the Gamified Integrated Curriculum (GIC) Group. Both groups received 6 hours of one-on-one simulation training on two simulator models, a benchtop and EndoVR® model, augmented with expert feedback, interlaced with 4 hours of small group teaching on theory of colonoscopy. The GIC group had curriculum integrated with game-design elements: a leaderboard summarizing participant performance, game narrative, achievement badges, and rewards for top performance. Performance was assessed on the simulator prior to training, immediately after training, and 4–6 weeks after training. Transfer of skills were assessed during two clinical colonoscopies between 4–6 weeks post training by blinded independent expert endoscopists. The primary outcome measure was the difference in colonoscopic performance between the two groups using validated assessment tools measuring cognitive, technical and integrative skills, including the Joint Advisory Group for GI Endoscopy Direct Observation of Procedural Skills (JAG DOPS), and the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT).
Results
The gamification group outperformed the control group in global performance for the first two clinical colonoscopies as measured by JAG DOPS (F1, 37 =12.89, P = 0.001 ) and GiECAT ( F1, 34 = 12.55; P = 0.001).
Conclusions
We found that a SBT curriculum using gamification for colonoscopy was associated with significantly improved global performance among novice endoscopists. It is an instructional strategy with potential to enhance learning.
Global performance as measured by JAG DOPS at clinical colonoscopies.
Funding Agencies
CAGAbbVie Centre of Excellence in Continuing Health Education grant number:2017 CAG-ABBVIE-ERG
PDF
