Donghyun Jee

Neovascular age-related macular degeneration (nAMD) requires long-term anti-VEGF therapy that imposes substantial direct payer costs. LucenBS (CKD-701), the first domestic ranibizumab biosimilar in Korea, was listed under the 2024 HIRA tariff at 149,895 KRW per vial, a 74% discount versus originator ranibizumab (Lucentis; 576,879 KRW). We built a 5-state Markov cohort model stratified by best-corrected visual acuity over a 10-year horizon from the Korean payer perspective, applying identical transition probabilities, utilities and injection frequencies to both arms based on the pivotal phase 3 equivalence trial. Because efficacy was assumed equivalent, the incremental comparison is effectively a cost-minimization on discounted, survival-weighted injection exposure multiplied by the price differential; the Markov structure provided absolute costs, quality-adjusted life-years (QALYs) and threshold analyses. Costs and QALYs were discounted at 4.5% per year (1 USD = 1350 KRW). Switching from originator to biosimilar saved $8953 per patient (from $26,095 to $17,142; $8.95 million per 1000 patients) with identical 4.7223 QALYs, making the biosimilar cost-minimizing. Probabilistic analysis showed 100% probability of cost saving. The biosimilar would remain cost-effective unless its effectiveness were at least 0.24 QALYs (about 5%) lower over 10 years. The result is driven by price, not by any clinical difference.

Background/Objectives: Diabetic retinopathy is a leading cause of blindness in diabetic patients, with disease susceptibility influenced by both genetic and environmental factors. This study aimed to identify novel genetic variants associated with DR and evaluate interactions between polygenic risk scores (PRS) and lifestyle factors in a Korean diabetic cohort. Methods: After excluding subjects with non-diabetic retinopathy eye diseases (n = 2519), we analyzed data from 50,361 non-diabetic controls, 4873 diabetic participants without retinopathy (DM-NR), and 165 with diabetic retinopathy (DM-DR). We conducted genome-wide association studies comparing DM-NR and DM-DR groups, performed generalized multifactor dimensionality reduction (GMDR) analysis for epistatic interactions, developed unweighted PRS models, and examined PRS–lifestyle interactions using two-way analysis of covariance. Results: DM-DR prevalence showed strong associations with metabolic syndrome and its components. Five novel genetic variants were identified: ABCA4_rs17110929, MMP2-AS1_rs2576531, FOXP1_rs557869288, MRPS33_rs1533933, and DRD2_rs4936270. A significant three-way epistatic interaction among the first three variants was discovered through GMDR analysis. High-PRS individuals (scores 5–6) showed a 49-fold higher odds ratio of DM-DR compared to low-PRS individuals (scores 0–2; p < 0.0001). MAGMA analysis revealed enrichment in pathways related to protein degradation, vascular function, and neuronal signaling, with predominant upregulation in brain tissues. Significant PRS × lifestyle interactions were identified for fruit intake, coffee consumption, alcohol intake, eating duration, and physical activity, with lifestyle factors modifying genetic risk effects (all p < 0.003). Conclusions: These findings identify novel genetic variants and epistatic interactions in DM-DR pathogenesis, supporting the use of PRS-based risk stratification for intensive monitoring and personalized lifestyle interventions. The discovery of brain tissue-enriched pathways suggests DM-DR shares mechanisms with neurodegenerative diseases, expanding therapeutic targets beyond traditional vascular approaches.

Purpose: We sought to evaluate the relationship between blood vitamin A levels and myopia in adults aged ≥20 years in Korea. Methods: We collected data of 15,899 participants aged ≥20 years from the Korean National Health and Nutrition Examination Survey. Participants underwent refraction tests to identify myopia and high myopia, and their blood pressure and obesity levels were measured. Blood tests were conducted to assess vitamin A, fasting blood glucose, triglyceride, and total cholesterol levels. Blood vitamin A levels were classified into quartiles. Results: After adjusting for confounding variables like age, sex, income, education, hypertension, diabetes, and obesity, the odds ratio (OR) of blood vitamin A in the second quartile for myopia was 0.66, while the OR in the fourth quartile was 0.74 (P for trend < 0.001). Among women, the ORs for myopia in the second and third quartiles of blood vitamin A levels were 0.48 (95% confidence interval [CI], 0.35–0.66) and 0.67 (95% CI, 0.49–0.90), respectively (P for trend < 0.001). In men, the ORs for high myopia in the second, third, and fourth quartiles of blood vitamin A levels were 0.05 (95% CI, 0.004–0.58), 0.15 (95% CI, 0.024–0.91), and 0.05 (95% CI, 0.008–0.364), respectively (P for trend < 0.001). Conclusion: An inverse relationship was observed between higher blood vitamin A levels and the prevalence of myopia. Notably, higher blood vitamin A levels were associated with a lower prevalence of high myopia in men and a lower prevalence of myopia in women.

Purpose: We sought to compare the effect of cyclosporine 0.1% after various pretreatments in patients with dry eye disease. Methods: Two hundred seventy‐four eyes of 137 patients diagnosed with dry eye disease were retrospectively enrolled. Thirty patients (Group 1, 60 eyes) were not pretreated, while 68 patients (Group 2, 136 eyes) were pretreated with fluorometholone 0.1%, and 39 patients (Group 3, 78 eyes) were pretreated with cyclosporine 0.05% before treatment with cyclosporine 0.1%. The Ocular Surface Disease Index Questionnaire (OSDI) score, Schirmer I test result, noninvasive tear film break‐up time (NItBUT), corneal staining score, matrix metalloproteinase‐9 (MMP‐9) grade, meibography result, meibum quality and expressibility scores, and tear meniscus height were examined before treatment and at 1, 2, and 3 months after treatment. Results: All dry eye signs and symptoms of all Groups at 1, 2, and 3 months were significantly improved compared to those before treatment with cyclosporine 0.1% ( p < 0.05). Notably, the OSDI score, Schirmer I test result, NItBUT, corneal and conjunctival fluorescein score, and MMP‐9 grade in Group 3 were significantly improved compared to those in Groups 1 and 2 at 1, 2, and 3 months after treatment with cyclosporine 0.1% ( p < 0.05). The percentages of cases with treatment discontinuation in Groups 1, 2, and 3 were 20.0%, 7.4%, and 10.0%, respectively. Conclusion: Pretreatment with cyclosporine 0.05% can augment the anti‐inflammatory effect of cyclosporine 0.1%. Pretreatment with a steroid or a lower concentration of cyclosporine can increase compliance in patients using a cyclosporine 0.1% eye drop.

Background: To compare the visual outcomes of different anti-vascular endothelial growth factor (VEGF) drugs, including aflibercept, ranibizumab, and bevacizumab, in a real-world setting in Korea. Methods: We collected data from patients who received monotherapy using one of these three anti-VEGF drugs as naïve treatment after being diagnosed with neovascular age-related macular degeneration. The number of injections and visual acuity (VA) outcomes of each cohort were obtained and pairwise comparisons were performed using propensity score matching. Results: A total of 254 aflibercept, 238 ranibizumab, and 282 bevacizumab treatment-naïve eyes were included. The mean VA change at 3 years for all cohorts combined was -1.8 letters, and the mean number of injections was 9.4. In the direct comparison of the three drugs, the mean change in the VA letter score was +2.0 letters for aflibercept and -11.7 letters for bevacizumab (P < 0.001). The number of aflibercept injections was significantly higher than the number of bevacizumab injections (P = 0.002). The visual outcomes for aflibercept and ranibizumab were +4.7 letters and -1.9 letters, respectively, and comparable results were obtained (P = 0.13). The VA outcomes for ranibizumab and bevacizumab were also not significantly different (P = 0.09). The numbers of injections for aflibercept, ranibizumab, and bevacizumab were 10.8, 6.7, and 8.8, respectively. Significant differences were observed between the injection frequencies comparisons of aflibercept and ranibizumab and ranibizumab and bevacizumab (P < 0.001 and P = 0.002, respectively). Conclusions: In the Korean clinical medical environment, which included various confounding factors, especially socioeconomic ones, the aflibercept VA outcome was significantly better than that of bevacizumab, and aflibercept injections were the most numerous. These real-world data imply that the drug effect as well as the environment in which the drug can be sufficiently used affected patient final VA scores.

Background: Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. Recently, AMD prevalence in Korea has increased from 6.6% to 13.9% over the past decade, which may be a threat to the public health of Korean society. This study describes the current status, including risk factors, treatment, and economic burden of AMD in Korea.Current Concepts: Major AMD risk factors have been consistently reported, including age, hypertension, smoking, and ultraviolet radiation. The primary AMD treatment is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF). Anti-VEGF was developed and improved in terms of efficacy and safety. However, AMD treatment’s economic burden is significant. Therefore, several treatment strategies have been introduced, such as monthly, as-needed, and treat-and-extend injection strategies.Discussion and Conclusion: With the rapid increase in AMD prevalence in Korea, the economic burden of AMD management will be a significant challenge for the Korean healthcare system. Therefore, cost-effectiveness and resource allocation for AMD treatment needs to be investigated.

Purpose: To evaluate the cost-effectiveness of cataract surgery for the beginners using intraocular illumination compared to the case of using microscope illumination.Methods: A Markov model was constructed for cost-effectiveness analysis. Hypothetical Korean men and women over 50 years of age were set as a cohort, and cataract surgeons were limited to beginners with less than 2 years of experience. Cataracts were classified as severe cataracts requiring surgery and mild cataracts that did not require surgery. Cataracts was assumed to progress to severe cataracts in 10% of each year. A cost-effectiveness analysis was performed based on the difference in the complications of surgery according to intraocular and microscope illumination. For the cost, data from the National Health Insurance Corporation were used, and a micro cost calculation method was used. In the utility analysis, data from previous studies were used for utility in each cataract and complication status. Sensitivity analysis was performed to evaluate the uncertainty of the results.Results: The surgery using microscope intraocular illumination showed the cost of 3,168,895 won, and the quality-adjusted life years of 16.4 years. The surgery of intraocular illumination showed the cost of 3,200,552 won and the quality-adjusted life years of 16.5 years. the incremental cost-effectiveness ratio of intraocular illumination was 1,675,630 won compared to microscope illumination. In the sensitivity analysis to, the utility of postoperative state without complication had the greatest influence on the results.Conclusions: For beginners with less than 2 years of surgical experience, the incremental cost-effectiveness ratio was 1,675,630 won, which is acceptable in Korea's health care system, when comparing the case of using intraocular illumination to the case of using conventional microscope illumination.

We assessed the relationship between blood vitamin A levels and the risk of diabetic retinopathy. The study was population-based epidemiological study for 11,727 participants aged 40 or older who participated in the Korean National Health and Nutrition Examination Survey. Vitamin A in the blood was classified into quartiles. Diabetic retinopathy was diagnosed by the Early Treatment for Diabetic Retinopathy Study. After adjusting confounding variables such as age, sex, smoking, cholesterol, diabetes prevalence period, glycated hemoglobin levels, and high blood pressure, the odd ratio (OR) of vitamin A at quartile level 4 for diabetic retinopathy was 0.32 (95% confidence interval [CI], 0.14–0.72, P for trend < 0.001). In male, the OR of quartile 3 level vitamin A for diabetic retinopathy was 0.11 (95% CI, 0.01–0.69, P for trend = 0.010). In adults under the age of 60, the OR of vitamin A at quartile level 3 for diabetic retinopathy was 0.10. (95% CI, 0.03–0.29, P for trend < 0.001). Serum vitamin A high levels are associated with low risk of diabetic retinopathy. Particularly, there is a more effective relationship in male and adults under the age of 60.

Purpose: This study aimed to investigate the association between folate levels and the prevalence of glaucoma. Methods: This nationwide population-based cross-sectional study included 1790 participants aged ≥40 years. We analyzed data regarding the participants obtained in the 2016–2018 Korean National Health and Nutrition Examination Survey. The diagnosis of glaucoma was defined according to the International Society of Geographical and Epidemiological Ophthalmology criteria. Logistic regression analyses were used to investigate the relationship between blood folate levels and glaucoma. Results: There was a significantly lower prevalence of glaucoma in the highest quartile of blood folate levels than in the lowest quartile, after adjusting for confounding factors such as age, sex, systemic hypertension, diabetes, hypercholesterolemia, and smoking (odds ratio [OR] = 0.470; 95% confidence interval [CI], 0.291–0.759; P for trend = 0.017). There was a significantly lower risk of glaucoma in the highest quartile of blood folate levels than in the lowest quartile among women (OR = 0.188; 95% CI, 0.099–0.357; P for trend P for trend = 0.045). Conclusions: Our findings indicate a strong inverse correlation between blood folate levels and glaucoma.

Background: We determined the cost-effectiveness of the anti-vascular endothelial growth factor (VEGF) intravitreal injection versus panretinal photocoagulation (PRP) for patients with proliferative diabetic retinopathy (PDR) in South Korea. Methods: We simulated four treatment strategies using PRP and the anti-VEGF injection by constructing a Markov model for a hypothetical cohort of 50-year-old PDR patients: (1) PRP only; (2) anti-VEGF injection only; (3) PRP first; and (4) anti-VEGF injection first. Results: In this cost-effectiveness analysis, compared with only-PRP, the incremental cost-effectiveness ratio was $95,456 per quality-adjusted life-year (QALY) for PRP first, $34,375 per QALY for anti-VEGF injection first, and $33,405 per QALY for anti-VEGF injection only from a healthcare perspective. From the societal and payer perspective, strategy (2) was more cost-saving and effective than (1). In the probabilistic sensitivity analysis, only-PRP was cost-effective up to the willingness-to-pay (WTP) of about $42,000, while anti-VEGF injection only was cost-effective from a healthcare perspective. From the societal and payer perspectives, regardless of the value of WTP, anti-VEGF injection only was the most cost-effective strategy. Conclusion: In our study, the anti-VEGF injection for PDR was cost-effective from the payer and societal perspectives.