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UK AMD EMR USERS GROUP REPORT V: benefits of initiating ranibizumab therapy for neovascular AMD in eyes with vision better than 6/12
  1. Aaron Y Lee1,
  2. Cecilia S Lee2,
  3. Thomas Butt3,
  4. Wen Xing4,
  5. Robert L Johnston5,
  6. Usha Chakravarthy6,
  7. Catherine Egan1,
  8. Toks Akerele7,
  9. Martin McKibbin8,
  10. Louise Downey9,
  11. Salim Natha10,
  12. Clare Bailey11,
  13. Rehna Khan12,
  14. Richard Antcliff13,
  15. Atul Varma14,
  16. Vineeth Kumar15,
  17. Marie Tsaloumas16,
  18. Kaveri Mandal17,
  19. Gerald Liew18,
  20. Pearse A Keane1,
  21. Dawn Sim1,19,
  22. Catey Bunce1,
  23. Adnan Tufail1,
  24. on behalf of UK AMD EMR Users Group
  1. 1Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2Department of Ophthalmology, University of Washington, Seattle, Washington, USA
  3. 3Institute of Ophthalmology, University College London, London, UK
  4. 4R&D, Moorfields Eye Hospital NHSFT, London, UK
  5. 5Gloucestershire Eye Department, Cheltenham General Hospital, Cheltenham, UK
  6. 6Belfast Health and Social Care Trust, Belfast, UK
  7. 7Hinchingbrooke Health Care NHS Trust, Cambridgeshire, UK
  8. 8Leeds Teaching Hospitals NHS Trust, Leeds, UK
  9. 9Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
  10. 10Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
  11. 11Bristol Eye Hospital, Bristol, UK
  12. 12Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
  13. 13Royal United Hospital Bath NHS Trust, Bath, UK
  14. 14Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK
  15. 15Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
  16. 16Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  17. 17Department of Ophthalmology, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
  18. 18Centre for Vision Research, The University of Sydney, Sydney, New South Wales, Australia
  19. 19Department of Cell Biology, UCL Institute of Ophthalmology, London, UK
  1. Correspondence to Dr Adnan Tufail, Department of Medical Retina Moorfields Eye Hospital NHS Trust, 162 City Road, London EC1V 2PD, UK; Adnan.Tufail{at}moorfields.nhs.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.

  • Retina
  • Treatment Medical
  • Macula
  • Drugs

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