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Miranda Buckle, Robert Johnston, Aaron Lee, Adnan Tufail, Neovascular Age-Related Macular Degeneration Database; The Neovascular Age-Related Macular Degeneration Database: Multicentre Study Report 3: Trends in blindness and other degrees of sight impairment in ranibizumab-treated patients. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1659.
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To study the trends in blindness and other degrees of sight impairment in treatment-naïve patients receiving ranibizumab for neovascular age-related macular degeneration (nAMD) in the United Kingdom (UK) National Health Service (NHS).
Data were extracted from 14 United Kingdom centres using an electronic medical record system (EMR). The EMR mandated collection of a dataset (defined before first data entry) including: age, Early Treatment Diabetic Retinopathy Study visual acuity letter score (VA) for both eyes at all visits, and injection episodes. Up to 5 years of data for 11 135 patients (12 951 eyes; 92 976 treatment episodes) were included in this study. Participating centres used a pro re nata re-treatment posology at intended monthly follow up visits following a loading phase of 3 monthly injections. Blindness, sight impairment or loss of UK driving standard VA were defined as VA in the better-seeing eye <25 letters, 26-39 letters and <70 letters respectively at 2 consecutive visits, or one visit if no further follow up data.
Information from more than 300 000 clinic visits (2.8 million data points) was collated. Mean age at first treatment was 79.7 years, with a female preponderance of 1.7:1. The cumulative proportion of patients who avoided blindness was 98.4% at 1 year, 97% at 2 years, 95.8% at 3 years, 93.7% at 4 years and 90.7% at 5 years after initiating anti-VEGF treatment for nAMD. The proportion of patients avoiding sight impairment was 94.3 at 1 year, 90.5% at 2 years, 86.6 at 3 years, 82.7 at 4 years and 79.8 at 5 years. The proportion of patients avoiding dropping below the driving standard VA was 70% at 1 year, 55.7% at 2 years, 48.1% at 3 years, 42.4% at 4 years and 38.6% at 5 years.
This is the first multicentre real-world study on the trends in blindness and other degrees of visual impairment based on visual acuity data in patients treated with ranibizumab for nAMD. Blindness and visual impairment is low in this patient group, and there is progressive improvement in these outcomes throughout the anti-VEGF era.
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