目标:随着地理萎缩(GA)治疗方法的范式转变,就疾病的识别和诊断达成共识,以及对GA患者的管理考虑,将有助于眼保健专业人员(ECP)的日常实践,改善患者预后。
方法:修改后的Delphi面板过程(地理萎缩管理共识),包括三个总体调查和一个在调查2和调查3之间举行的虚拟现场会议。数据收集时间为2022年7月至10月。参加者包括眼科护理界的专家成员,他们在同行中表现出杰出的领导才能:一个由三名ECPs组成的指导委员会和一个由15名成员组成的小组,由五名验光师组成,五名综合眼科医生和五名视网膜专家。使用RAND/UCLA适当性方法计算与GA患者管理相关的陈述共识。
结果:在第三次调查结束时,在77份声明中,91%达成了共识。关键的共识主题包括:(1)光学相干断层扫描作为诊断和监测GA的首选方法,(2)有关将患者转诊给视网膜专家的首选实践模式,以及(3)鉴于GA新兴疗法的出现,治疗标准。
结论:提高对疾病发展早期迹象的认识,进展和确定评估GA的最佳工具建立理想的管理和转诊策略。鉴于由批准的疗法驱动的GA管理范式转变,再加上这种疾病是进行性的,导致毁灭性的视力丧失,这些策略对于确保最佳的总体结果至关重要。
With a paradigm shift in geographic atrophy (GA) treatments now available, establishing
consensus on the identification and diagnosis of the disease along with considerations for management of patients with GA will assist eye care professionals (ECP) in their day-to-day practices, leading to improved patient outcomes.
A modified Delphi panel process (Geographic Atrophy Management
Consensus) consisting of three total surveys and one virtual live meeting held between survey 2 and survey 3. Data were collected from July to October 2022. Participants included expert members of the eye care community that have demonstrated outstanding leadership among peers: a steering committee with three ECPs and a 15-member panel divided between five
optometrists, five comprehensive ophthalmologists and five retina specialists. Consensus on statements related to the management of patients with GA was calculated using the RAND/UCLA Appropriateness Method.
At the conclusion of the third survey,
consensus was reached on 91% of the 77 statements. Critical
consensus topics include: (1) optical coherence tomography as the favoured method to diagnose and monitor GA, (2) preferred practice patterns regarding referral of patients to retina specialists and (3) treatment criteria given the advent of emerging therapeutics for GA.
Generating awareness of early signs of disease development, progression and identifying the best tools to evaluate GA establishes ideal management and referral strategies. Given the paradigm shift in GA management driven by approved therapies, coupled with the fact that the disease is progressive resulting in devastating vision loss, these strategies are critical to ensure best overall outcomes.