Abstract
Purpose :
Neovascular age-related macular degeneration (nAMD) remains a leading cause of visual impairment, even though highly-effective medications are available. Despite evidence that low-vision (LV) services can further improve visual function, many patients with nAMD do not receive a referral for these services. This study was conducted to ascertain the characteristics associated with referral and utilization of LV services for patients with nAMD.
Methods :
The study comprised a retrospective, cross-sectional study of patients who had nAMD at an academic medical center from June 2021 through June 2022. Patient demographics, clinical characteristics, and documented referral for LV evaluation were abstracted from the health record. Patients who accessed LV services in the prior year were excluded. Treatment effectiveness was determined by comparing the presenting visual acuity (VA) with the best-corrected visual acuity (BCVA) after distance refraction. Costs, quality-adjusted life years (QALYs), and incremental costs per QALY gained were calculated using a willingness-to-pay threshold of $50,000/QALY.
Results :
Out of 560 patients with nAMD, 110 were referred for a LV evaluation (20%). Patients referred tended to be older (85 vs. 83 years, p=0.02), to have worse VA in both eyes (0.51 vs. 0.33 logMAR in the better-seeing eye, p<0.001, and 0.76 vs. 0.66 logMAR in the worse-seeing eye, p<0.001), and to have bilateral nAMD (60% vs. 43%, p=0.001). However, the frequency of nAMD treatment was generally less often for patients referred compared with those who were not (average injection interval 6.8 vs. 5.8 weeks, p=0.039). Legal blindness was more common in those referred (25% vs. 8.7%, p<0.001), but not monocular status (each 36%). Most patients who were referred completed LV appointments (86%). More than half of patients had improved VA in their better-seeing eye (53%), 36% gaining ≥2-lines of VA. This improvement in VA yielded an average gain of 0.04 QALYs/patient at a cost of $3504/QALY. The estimated net monetary benefit was $1704 per evaluation completed.
Conclusions :
Most patients with nAMD experience an improvement in BCVA with a LV evaluation. These visits lead to a significant reduction in visual disability and improvement in vision-related quality of life and can be obtained at a reasonable cost. Further efforts are needed to improve the rate at which patients with nAMD access LV services.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.