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The role of social deprivation in severe neovascular age-related macular degeneration
  1. Hannah E Sharma1,
  2. Priscilla A Mathewson1,
  3. Mark Lane1,
  4. Peter Shah1,2,3,
  5. Nicholas Glover1,
  6. Helen Palmer1,
  7. M Sayeed Haque4,
  8. Alastair K Denniston1,5,
  9. Marie D Tsaloumas1
  1. 1Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
  3. 3Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
  4. 4Department of Primary Care and Clinical Sciences, University of Birmingham, Birmingham, UK
  5. 5Academic Unit of Ophthalmology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Alastair K Denniston, Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK; a.denniston{at}bham.ac.uk

Abstract

Background/aims Advances in therapy have improved outcomes for patients with neovascular age-related macular degeneration (nAMD). Prompt access to treatment is a priority and may be used as a key performance indicator. In this study, we investigate how social deprivation may impact on access to services, treatment and visual impairment registration.

Methods Patients were identified retrospectively through the Certificate of Visual Impairment system for the University Hospitals Birmingham Medical Retina service. The Index of Multiple Deprivation (IMD) 2007 score was calculated for each patient. The impact of deprivation, age, gender and ethnicity on key stages in the care pathway was assessed.

Results 120 patients were identified. Patients with greater social deprivation were under-represented, had worse visual acuity at first presentation (correlation of the better-seeing eye with IMD 0.225 (p=0.013)) and had sight-impairment registration earlier (correlation −0.246; p=0.007). Deprivation did not affect time to first appointment, and was not associated with a higher rate of non-attendance.

Conclusions The late presentation and under-representation of patients with greater social deprivation is a serious concern. Our study strongly suggests that this vulnerable group is encountering barriers in accessing treatment in nAMD, and that these occur prior to entry into the Hospital Eye Service.

  • Macula
  • Degeneration
  • Epidemiology
  • Public health
  • Vision

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