April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
The Neovascular Age-related Macular Degeneration Database: Report 2. Incidence, management and visual outcomes of Second treated eyes
Author Affiliations & Notes
  • Javier Zarranz-Ventura
    Vitreo-Retinal Service, Gloucestershire Hospitals NHS Trust, Cheltenham, United Kingdom
    Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
  • Gerald Liew
    Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
  • Robert Johnston
    Vitreo-Retinal Service, Gloucestershire Hospitals NHS Trust, Cheltenham, United Kingdom
  • Adnan Tufail
    Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
  • Footnotes
    Commercial Relationships Javier Zarranz-Ventura, None; Gerald Liew, RANZCO Eye Foundation/Novartis (F); Robert Johnston, Medisoft Limited (E), Novartis (C); Adnan Tufail, Novartis (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 1307. doi:
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      Javier Zarranz-Ventura, Gerald Liew, Robert Johnston, Adnan Tufail, ; The Neovascular Age-related Macular Degeneration Database: Report 2. Incidence, management and visual outcomes of Second treated eyes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1307.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To study the characteristics of second treated eyes in patients with neovascular AMD (nAMD) treated with ranibizumab in the United Kingdom (UK) National Health Service (NHS).

 
Methods
 

Multicenter national nAMD database study, including 12,951 treatment naive eyes of 11,135 patients receiving 92,976 ranibizumab injections. Up to 5 years of routinely, collected anonymized data within electronic medical record systems (EMR) were remotely extracted from 14 centers. Participating centers exclusively used ranibizumab to treat nAMD (3 monthly injections loading dose + pro-re-nata (PRN) re-treatment regimen). The minimum data set included: age, logarithm of the minimum angle of resolution (LogMAR) visual acuity (VA) at baseline and at all subsequent visits and injection episodes. Baseline, change and actual VA over 3 years, number of treatments and clinic visits were assessed.

 
Results
 

1,816 (16.3%) of the 11,135 patients received treatment to the fellow eye at some point during the study. Mean (standard deviation) of baseline and final VA were 0.66 (0.32) and 0.65 (0.40) for first eyes, and 0.41 (0.34) and 0.56 (0.40) for second eyes. The rate of VA loss after the loading phase was similar in first and second eyes (0.03 and 0.05 LogMAR units/year). When fellow eyes with baseline VA worse than 1.0 LogMAR were excluded to restrict analyses to eyes at risk of nAMD, the rate of second eye involvement was 14.0% per year (42% at 3 years). Mean number of injections/visits in years 1, 2 and 3 were similar for first and second eyes (5.6/8.2, 3.9/8.0, 3.8/8.2 and 5.5/8.7, 3.6/9.4 and 3.8/9.1, respectively).

 
Conclusions
 

Second eyes with nAMD commence treatment with better baseline VA, do not show significant vision gain but maintain better mean VA than first eyes at all time points for at least 3 years, making them the more important eye functionally. These data highlight the high burden of second eye involvement, with almost half of all eyes at risk requiring bilateral treatment by 3 years, and the need for regular monitoring of fellow eyes for best visual outcomes. This reduces the benefits of extended monitoring regimens and should be considered in service delivery discussions.

 
 
Visual acuity (VA) over a follow up period of 156 weeks. Vertical bars denote standard errors (SE). (Total N=12,951 eyes; 52 weeks= 8,598 eyes, 104 weeks= 4,990, 156 weeks= 2,470 eyes).
 
Visual acuity (VA) over a follow up period of 156 weeks. Vertical bars denote standard errors (SE). (Total N=12,951 eyes; 52 weeks= 8,598 eyes, 104 weeks= 4,990, 156 weeks= 2,470 eyes).
 
Keywords: 412 age-related macular degeneration • 463 clinical (human) or epidemiologic studies: prevalence/incidence • 462 clinical (human) or epidemiologic studies: outcomes/complications  
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