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Javier Zarranz-Ventura, Gerald Liew, Robert Johnston, Adnan Tufail, United Kingdom Age-related Macular Degeneration Electronic Medical Records (UK-AMD-EMR) users group; 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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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).
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.
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).
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.
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