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R. B. Schartz, J. T. Thompson, R. Sjaarda, J. S. Sunness; Patterns of Referral of AMD Patients for Low Vision Intervention in the Anti-VEGF Era. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4116.
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To see how the availability of Lucentis affected the referral of patients for low vision intervention
A retrospective review of all patients newly referred from a busy retinal practice for low vision consultation. Data of patients referred from 7/05-6/06 (yr1, pre-lucentis), and 7/06-6/07 (yr2, lucentis available) were compared.
In yr1, 24 patients with choroidal neovascularization (CNV) were referred for LV. In yr2, 12 patients with CNV were referred. There was a trend for those patients referred in yr2 to have worse vision than those in yr1 (Mean best-corrected logMAR VA yr1-0.67, yr2-0.86, p=0.06; mean Pelli-Robson contrast sensitivity (PRCS) yr1- 1.04, yr2- 0.84, p=0.04; magnification to read 1M text ; power to read 1M words yr1 6D, yr2 9D, p=0.07). (The visual acuities by the referring doctor measured on average 0.11 logMAR units worse than this best-corrected measure, with 14 patients having 2 or more lines of improvement in best-corrected VA as compared with the referring acuity.)In yr1 and yr2, 18 patients and 11 patients with conditions other than CNV were referred for consultation respectively. For these nonCNV patients, there was no significant difference between groups for VA (mean best-corrected VA yr1-0.62, yr 2-0.46, p=0.33 or contrast sensitivity (mean PRCS yr1-1.00, yr2-1.10, p=0.41), though the yr2 group tended to have slightly better vision.
While the use of lucentis puts visual acuity in a zone more favorable for successful low vision intervention, patients with better acuities may not be referred for low vision evaluation despite their visual impairments and the fact that without low vision intervention, they are having difficulty with reading and other ADLs. The frequent visits required for monthly injection, the tendency to wait until a course of therapy is complete before referring patients, and a lesser appreciation for the need for low vision intervention may be factors in explaining this.
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