Purchase this article with an account.
Jeffry Hogg, Olga Gkorou, Holly Joan Duncan, Lydia Grace Stone, Michelle Blyth, Lesley Brandes, Adele Devenport, Leanne Timms, James Stephen Talks; The prevalence and impact of treatment delays in exudative age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2941.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
There is a growing imbalance between clinical demand and capacity for exudative age-related macular degeneration (exAMD) in the UK National Health Service (NHS), but the degree of consequential sight loss remains unclear. This retrospective, observational clinical study aimed to quantify the delays to treatment which patients experience in a representative NHS centre, and to describe the associated visual outcomes.
The electronic medical record of a large provincial UK ophthalmology centre was interrogated for eyes diagnosed with exAMD in 2016 and treated with intravitreal injections (IVI) of aflibercept over a minimum of 3 years. The difference between all clinic appointments’ planned and observed dates were calculated and totalled separately for each of the first 3 years of treatment. As a pragmatic observational study visual acuity (VA) was recorded as the best of unaided, spectacle corrected or pinhole corrected VA in early treatment of diabetic retinopathy (ETDRS) letters at the end of each year of treatment as well as the number of IVIs received. Descriptive and comparative statistics were performed with SPSS v.24 and unpaired t-tests were used to compare means.
175 eyes (89 left, 87 pseudophakic) from 175 patients (109 female, mean age 79.1 years) were identified. Mean VA change over a year of treatment was 5.3, -2.3 and -0.8 ETDRS letters with a mean of 1.8, 3.6 and 2.7 weeks of cumulative treatment delay in the first, second and third years of treatment respectively. 24 (14%), 49 (28%) and 42 (24%) eyes experienced a cumulative delay to planned treatment of 4 weeks or more in the first, second and third years of treatment respectively. VA change over a year of treatment was worse for patients experiencing 4 weeks or more of cumulative delay compared to those that did not, with mean changes of -0.6 (95%CI -6.0,4.8) versus 6.3 (4.1,8.4), -3.9 (-6.5,-1.2) versus -1.7 (-3.2,-0.1) and -3.7 (-6.3,-1.2) versus 0.1 (-1.4,1.6) over the first (p=0.02), second (p=0.15) and third (p=0.01) years of treatment respectively.
It is common for NHS exAMD patients to experience significant delays in their treatment, either due to service capacity or patient factors. These delays compromise visual outcomes, particularly within the first year. These data evidence the need for increasing care capacity and improving patient adherence to treatment for exAMD within NHS services.
This is a 2021 ARVO Annual Meeting abstract.
This PDF is available to Subscribers Only