Aaron Y Lee1, Cecilia S Lee2, Thomas Butt3, Wen Xing4, Robert L Johnston5, Usha Chakravarthy6, Catherine Egan1, Toks Akerele7, Martin McKibbin8, Louise Downey9, Salim Natha10, Clare Bailey11, Rehna Khan12, Richard Antcliff13, Atul Varma14, Vineeth Kumar15, Marie Tsaloumas16, Kaveri Mandal17, Gerald Liew18, Pearse A Keane1, Dawn Sim19, Catey Bunce1, Adnan Tufail1. 1. Moorfields Eye Hospital NHS Foundation Trust, London, UK. 2. Department of Ophthalmology, University of Washington, Seattle, Washington, USA. 3. Institute of Ophthalmology, University College London, London, UK. 4. R&D, Moorfields Eye Hospital NHSFT, London, UK. 5. Gloucestershire Eye Department, Cheltenham General Hospital, Cheltenham, UK. 6. Belfast Health and Social Care Trust, Belfast, UK. 7. Hinchingbrooke Health Care NHS Trust, Cambridgeshire, UK. 8. Leeds Teaching Hospitals NHS Trust, Leeds, UK. 9. Hull and East Yorkshire Hospitals NHS Trust, Hull, UK. 10. Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK. 11. Bristol Eye Hospital, Bristol, UK. 12. Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK. 13. Royal United Hospital Bath NHS Trust, Bath, UK. 14. Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK. 15. Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK. 16. Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 17. Department of Ophthalmology, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK. 18. Centre for Vision Research, The University of Sydney, Sydney, New South Wales, Australia. 19. Moorfields Eye Hospital NHS Foundation Trust, London, UK Department of Cell Biology, UCL Institute of Ophthalmology, London, UK.
Abstract
BACKGROUND/AIMS: To study the effectiveness and clinical relevance of eyes treated with good (better than 6/12 or >70 Early Treatment Diabetic Retinopathy Study letters) visual acuity (VA) when initiating treatment with ranibizumab for neovascular age-related macular degeneration (nAMD) in the UK National Health Service. Currently eyes with VA better than (>) 6/12 are not routinely funded for therapy. METHODS: Multicentre national nAMD database study on patients treated 3-5 years prior to the analysis. Anonymised structured data were collected from 14 centres. The primary outcome was the mean VA at year 1, 2 and 3. Secondary measures included the number of clinic visits and injections. RESULTS: The study included 12 951 treatment-naive eyes of 11 135 patients receiving 92 976 ranibizumab treatment episodes. A total of 754 patients had baseline VA better than 6/12 and at least 1-year of follow up. Mean VA of first treated eyes with baseline VA>6/12 at year 1, 2, 3 were 6/10, 6/12, 6/15, respectively and those with baseline VA 6/12 to >6/24 were 6/15, 6/17, 6/20, respectively (p values <0.001 for comparing differences between 6/12 and 6/12-6/24 groups). For the second eyes with baseline VA>6/12, mean VA at year 1, 2, 3 were 6/9, 6/9, 6/10 and those with baseline VA 6/12 to >6/24 were 6/15, 6/15, 6/27, respectively (p values <0.001-0.005). There was no significant difference in the average number of clinic visits or injections between those with VA better and worse than 6/12. CONCLUSIONS: All eyes with baseline VA>6/12 maintained better mean VA than the eyes with baseline VA 6/12 to >6/24 at all time points for at least 2 years. The significantly better visual outcome in patients who were treated with good baseline VA has implications on future policy regarding the treatment criteria for nAMD patients' funding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND/AIMS: To study the effectiveness and clinical relevance of eyes treated with good (better than 6/12 or >70 Early Treatment Diabetic Retinopathy Study letters) visual acuity (VA) when initiating treatment with ranibizumab for neovascular age-related macular degeneration (nAMD) in the UK National Health Service. Currently eyes with VA better than (>) 6/12 are not routinely funded for therapy. METHODS: Multicentre national nAMD database study on patients treated 3-5 years prior to the analysis. Anonymised structured data were collected from 14 centres. The primary outcome was the mean VA at year 1, 2 and 3. Secondary measures included the number of clinic visits and injections. RESULTS: The study included 12 951 treatment-naive eyes of 11 135 patients receiving 92 976 ranibizumab treatment episodes. A total of 754 patients had baseline VA better than 6/12 and at least 1-year of follow up. Mean VA of first treated eyes with baseline VA>6/12 at year 1, 2, 3 were 6/10, 6/12, 6/15, respectively and those with baseline VA 6/12 to >6/24 were 6/15, 6/17, 6/20, respectively (p values <0.001 for comparing differences between 6/12 and 6/12-6/24 groups). For the second eyes with baseline VA>6/12, mean VA at year 1, 2, 3 were 6/9, 6/9, 6/10 and those with baseline VA 6/12 to >6/24 were 6/15, 6/15, 6/27, respectively (p values <0.001-0.005). There was no significant difference in the average number of clinic visits or injections between those with VA better and worse than 6/12. CONCLUSIONS: All eyes with baseline VA>6/12 maintained better mean VA than the eyes with baseline VA 6/12 to >6/24 at all time points for at least 2 years. The significantly better visual outcome in patients who were treated with good baseline VA has implications on future policy regarding the treatment criteria for nAMD patients' funding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
Drugs; Macula; Retina; Treatment Medical
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