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Ben J L Burton, Tahmina Parveen; Outcome of Avastin treatment for wet age-related macular degeneration in patients with visual acuity score 85 or better at first presentation. Invest. Ophthalmol. Vis. Sci. 2018;59(9):828.
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In the UK treatment for Wet Age related macular degeneration is not funded by the NHS until vision has fallen to 85 letters or below as dictated by NICE guidance. If the affected eye is the worse seeing eye then this means the patient will lose their driving license before they are elligible for treatment.With increasing numbers of patients now being diagnosed before they have developed signifiacant visual loss this leaves NHS clinicians seeing more patients that they cannot treat. We have treated this group of patients with Avastin in the hope that they will maintain good vision, benefitting the patient, and not lose vision below 85 letters so that they do not go on to use much more expensive treatments such as Lucentis and Aflibercept, benefitting the NHS and the tax payer.We report the the results of this patient group with 4 years of follow up.
A retrospective chart review was conducted at James Paget University Hospital of patients presenting with wet AMD and vision better than 85 letters in the affected eye. The long term visual acuity change and number of injections with Avastin was recored as well as the number of clinic appointments. Patients were treated on a monthly prn regime after an initial period of monthly injections times three.
50 patients were reported on with at least one years follow up. 6 patients develope dloss of vision blow 85 letters with the result that two were switched to Lucenti san d4 were switched to Aflibercept. Visual acuity declined from a mean of 93.2 lettersat baseline by -2.5 letters at 12 months, -3.9 letters at year 2, 4.4 letters at year 3 and 7.3 letters at year 4 with a mean letter score of 85.9. Average number of injections were 6.16 in year 1, 4.52 in year 2, 4.14 in year 3 and 1.80 in year 4.
The vast majority of patients with wet AMD treated early, before vision drops below 85 letters, maintain good vision using Avastin. This is likely to represent a significant financial saving for the UK health service by avoiding the need for these patients to switch to a more expensive anti VEGF such as Lucentis or Aflibercept. There is increasing evidence that early treatment in wet AMD offers the best long term visual outcomes and delaying treatment until the vision drop sbelow 85 letters is unlikely to ever be in the patients best interests.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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