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Nishal Patel, Sarah Stirrup; The impact of anti-VEGF treatment delay on the visual acuity of patients with wet age-related macular degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2018;59(9):2388.
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There is an assumption that treatment delay in wet AMD with poor vision at presentation can lead to worse outcomes after injection therapy. Our intention was to assess the impact of delay to first injection and loading phase to see if this has a negative effect on final visual acuity.
This was IRB approved retrospective analysis of electronic patient care records using Medisoft within an NHS UK AMD Service over a 5 year period. The primary outcome was to assess the change in visual acuity from confirmed diagnosis to first review post loading phase. Statistical analysis with Pearson’s correlation was carried out to assess for any association of factors between change in visual acuity and time to start treatment/time to first review.
Original fully anonymised data set received for 2515 patients (3077 eyes), all diagnosed with a form of wet AMD, of which 1745 patients (2016 eyes) with useable data were included. Most patients were seen in One Stop clinics and treated on the day of diagnosis (1457, 72.3%), with a mean number of days from diagnosis to treatment of 1.8 (±4.7). The analysis showed that delay in initiation of first IVT therapy from baseline and consequent loading dose therapy with extension to beyond 12 weeks from initiation did lead to a worsening trend in visual acuity outcomes in a real world setting. However, patients with poor vision at onset still gained the most improvement despite any delay.
Real world analysis using EMR can illustrate how delay in commencing and maintaining initial injection therapy may affect outcomes due a variety of clinical or non-clinical reasons such as increased capacity, demand and lack of resources such as staffing levels and infrastructure on health services. A fast track flexible system designed to get early diagnosis and therapy initiation for wet AMD can still lead to better outcomes, only if these are addressed. Our study proves that a dedicated AMD service that can audit its outcomes within the UK NHS can still achieve better standards of care relative to other real world studies, but cannot be compared to clinical trial outcomes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Trend bar chart showing impact of delay to first and consequent loading phase injection therapy on vision gain in wet AMD
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