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Robert Johnston, Adnan Tufail, Aaron Lee, Haogang Zhu, ; The United Kingdom neovascular age-related macular degeneration database: long-term outcomes in ranibizumab treated eyes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1653.
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To study the long-term real-world outcomes of neovascular age-related macular degeneration (nAMD) in treatment naïve eyes receiving ranibizumab in the United Kingdom National Health (UK NHS).
A standardised dataset, collected within an electronic medical record system (Medisoft Ophthalmology) as a by-product of routine clinical care for up to 7 years, was anonymised and remotely extracted from 17 centres (only 1 centre had data for years 6 & 7). Analysis was restricted to eyes that received exclusively ranibizumab to treat nAMD, the vast majority using a loading phase of 3 monthly injections followed by intended monthly visits and pro re nata re-treatment. The minimum dataset included: age, Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity at baseline and at all subsequent visits and injection episodes.
13,184, 8,535, 4,938, 2,447, 849, 62 and 16 eyes completed 1-7 years of follow up respectively. The mean visual acuities at baseline (standard error), and at year 1 - 7 were: 53.56, 56.70 (0.18), 54.65 (0.24), 52.31 (0.35), 50.19 (0.54), 47.04 (0.92), 54.3 and 54.0 respectively. The mean number of injections (standard error) in eyes completing years 1-7 respectively were: 5.85 (0.02), 3.18 (0.03), 2.89 (0.04), 2.61 (0.05), 2.21 (0.08), 3.1, 3.0. The mean visit frequencies (standard error) in eyes completing years 1-7 respectively were: 9.72 (0.02), 7.64 (0.03), 7.21 (0.05), 6.92 (0.07), 6.71 (0.11), 7.1, 5.3. There was considerable variation between centres, as indicated by the results from the only centre that contributed data for 6 & 7 years follow up.
Appropriate electronic medical records allow rapid collation and analysis of real-world clinical outcomes. Mean visual acuity outcomes are worse than the landmark randomised trials but are achieved with a relatively low injection frequency and visit burden.
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