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Peter Cackett, Shyamanga Borooah, Mike Gavin, Dilys Oladiwura, V.Swetha Jeganathan, Scotland AMD study group; Intravitreal ranibizumab treatment of wet macular degeneration in SE Scotland - effect on blindness rates and 5 year follow up data. Invest. Ophthalmol. Vis. Sci. 2013;54(15):372.
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Intravitreal ranibizumab (IVTR) has been routinely used for the treatment of wet age-related macular degeneration (AMD) in the United Kingdom since 2007. There is little reported in the literature on the effect on blindness rates in the population or long term follow up data. We predicted that the new intervention of IVTR would reduce blind registration rates secondary to wet AMD in our population.
We obtained blind registration data for the population of SE Scotland which is recorded by the Royal National Institute for the Blind. Legal blindness is defined as a visual acuity of 0.05 (20/400) or lower in a person’s better-seeing eye. We also retrospectively analysed the case-notes of our first cohort of 100 patients who entered the service in 2007 to determine our long term follow up data to 2012. We obtained visual acuity outcome data, number of clinic visits per year, total number of injection treatments and attrition rates.
The incidence rate of legal blindness attributable to wet AMD in the population of SE Scotland decreased from 10.6 cases per 100 000 in 2004 to 4.3 cases per 100 000 in 2012, corresponding to a reduction of 59%. The incidence of legal blindness from all causes decreased from 27.8 per 100,000 in 2004 to 20.4 per 100,000 in 2011, corresponding to a reduction of 27%. For our first cohort of 100 patients mean visual acuity at the start of treatment was logmar 0.60 and after five years follow up was logmar 0.68 corresponding to a mean loss of 4 ETDRS chart letters. Average number of injections was 9.7 and mean number of clinic visits by year were 9.0 in year 1, 5.8 in year 2, 4.8 in year 3, 2.3 in year 4 and 0.5 in year 5.
Ranibizumab has been shown to be efficacious in the treatment of wet AMD through the ANCHOR and MARINA trial data. Our data showing significant reduction in blindness rates secondary to wet AMD since the commencement of treatment with IVTR demonstrates that the efficacy translates into clinical real-world practice and results in reduction in morbidity secondary to this potentially blinding condition.
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