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Vuong Nguyen, Vincent Daien, Robyn Guymer, Ian McAllister, Nigel Morlet, Daniel Barthelmes, Mark C Gillies; Social and clinical characteristics associated with low visual acuity at presentation of AMD. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1524.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the social and clinical characteristics associated with low visual acuity at presentation among a cohort of patients with neovascular age-related macular degeneration (nAMD) that had been treated with vascular endothelial growth factor (VEGF) inhibitors.
This was a cross-sectional analysis of Australian patients from a prospectively designed observational study. Participants included treatment-naïve patients with nAMD tracked by the Fight Retinal Blindness! outcome registry that commenced anti-VEGF therapy between 1st Jan 2006 to 1st Sept 2016. Demographic and clinical characteristics were recorded at baseline including age, gender, ethnicity, visual acuity, angiolesion size and type. Socio-economic status (SES) was assessed using the Australian Bureau of Statistics socio-economic indexes for areas. The primary outcome was the association between poor VA and social and clinical characteristics.
We identified 3242 treatment-naïve patients from 54 practices being treated for nAMD. Mean (SD) age at first presentation remained constant over time (79.6 [8.6] years; P = 0.608). The mean (SD) VA increased from 2009 onwards, from 50.7 (19.3) to 60.3 (17.4) letters in 2016. Poorer VA at presentation of nAMD was associated with older age (P < 0.001), predominantly classic lesions (P < 0.001), greater lesion size (P < 0.001) and treatment at a public practice (P < 0.001) after multivariable adjustment. Gender, ethnicity and SES were not independently associated with VA at presentation (P = 0.339, P = 0.293 and P = 0.726, respectively).
Poor VA at presentation was associated with older age, predominantly classic lesions, greater lesion size and treatment at a public practice but not gender, ethnicity or SES. Clinical audits into public practices are warranted to determine why patients are presenting with worse visual acuity than private counterparts. Improvements in presenting VA over the past several years provide encouraging signs that patients are better informed. Identifying barriers in accessing treatment for nAMD is a public health issue and epidemiological trends of patient’s characteristics at presentation of nAMD from large observational cohorts are particularly important for driving public health policies.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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