Building on the success of anti-vascular endothelial growth factor therapy: a vision for the next decade.
Building on the success of anti-vascular endothelial growth factor therapy: a vision for the next decade.
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DOI：
10.1038/s41433-020-0895-z
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Hopkins JJ
中科院分区：
文献类型：
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作者：
Adamis AP;Brittain CJ;Dandekar A;Hopkins JJ
本文旨在确定改善视网膜疾病诊断和治疗的关键机会，并描述最近的创新，这些创新可能有助于改善现有玻璃体内血管内皮生长因子（VEGF）治疗的结果，并为新的治疗方法奠定基础。该综述首先总结了导致抗VEGF疗法发展的关键发现，并简要回顾了其对临床实践的影响。讨论了改善诊断的机会，现有疗法的现实结果，长效疗法和个性化医疗保健，以及确定治疗干预新靶点的必要性。使用基于人工智能（AI）的技术进行低成本的远程患者筛查和监测可以帮助提高诊断率，并在最小的患者负担下实现远程疾病监测。基于人工智能的工具可用于生成患者水平的预后数据并预测个体治疗需求，从而缩短优化患者治疗方案所需的时间。长效疗法可以通过减少治疗负担来帮助改善视力结果。当与人工智能产生的疾病相结合时，长效疗法可以预防视力丧失。双作用药物可能有助于提高疗效和/或持久性，超过单独使用抗VEGF药物的可能性。最近的发展和正在进行的创新将有助于建立在抗VEGF治疗的成功，以进一步减少由于视网膜疾病引起的视力丧失，同时降低整体护理负担。
This article aims to identify key opportunities for improvement in the diagnosis and treatment of retinal disease, and describe recent innovations that will potentially facilitate improved outcomes with existing intravitreal vascular endothelial growth factor (VEGF) therapies and lay the groundwork for new treatment approaches. The review begins with a summary of the key discoveries that led to the development of anti-VEGF therapies and briefly reviews their impact on clinical practice. Opportunities for improvements in diagnosis, real-world outcomes with existing therapies, long-acting therapeutics and personalised health care are discussed, as well as the need to identify new targets for therapeutic intervention. Low-cost, remote patient screening and monitoring using artificial intelligence (AI)-based technologies can help improve diagnosis rates and enable remote disease monitoring with minimal patient burden. AI-based tools can be applied to generate patient-level prognostic data and predict individual treatment needs, reducing the time needed to optimise a patient’s treatment regimen. Long-acting therapeutics can help improve visual outcomes by reducing the treatment burden. When paired with AI-generated prognoses, long-acting therapeutics enable the possibility of vision loss prevention. Dual-acting drugs may help improve efficacy and/or durability beyond what is possible with anti-VEGF agents alone. Recent developments and ongoing innovations will help build upon the success of anti-VEGF therapies to further reduce vision loss owing to retinal disease while lowering the overall burden of care.