Management of neovascular age-related macular degeneration treatment in France from 2008-2018 – the nationwide LANDSCAPE study

Abstract

Purpose : This study aimed to describe neovascular age related macular degeneration (nAMD) patient treatments journey for the entire French population between 2008 and 2018.This was a retrospective longitudinal study using exhaustive nationwide population health records of the French National Health Information database (Système National des Données de Santé [SNDS]).

Methods : We identified individuals treated for nAMD from the French population aged 50 years and older. Identification criteria were nAMD diagnosis or reimbursement of nAMD treatments (anti-VEGF injection or dynamic phototherapy with verteporfin). Exclusion criteria were high myopia, other retinal diseases diagnosis, and treatments for other macular diseases (dexamethasone implant, laser).

Results : Between 2008 and 2018, we identified 342,961 nAMD treated patients. Prior to the nAMD treatment initiation, 59% in 2008 to 87% in 2018 of patients had optical coherence tomography (OCT) imaging, while fluorescein angiography decreased steadily from 54% in 2008 to 23% in 2018. The median duration of ophthalmological follow-up was 7 years (90 months). The median annual number of consultations eye visits decreased from 9 visits in Year 1 after treatment initiation to 4 visits from Year 7 onwards. Patients were treated during 10.1 months (median) ; 48.5% of patients had a treatment < 1 year, while 24.4% patients maintained their treatment at their 11^th year. For patients remaining under treatment, the median number of anti-VEGF was 4 the 1^st year and 4 every year throughout the 10-year study period. First-line treatment was more commonly with ranibizumab (67.5% of patients) than with aflibercept (32.4%). About 20% of patients who initiated treatment switched treatment at least once.

Conclusions : LANDSCAPE provides exhaustive nationwide data on nAMD real-world management in France over a 10-year period. French nAMD patients seem well monitored by their ophthalmologist, with a median follow-up of 7 years. OCT became the routine imaging to diagnose nAMD. Over the 2008-2018 period, median anti-VEGF treatment duration was of 10 months with almost half of patients stopping their treatment within one year after treatment initiation. These results emphasize the discrepancy between the need to avoid undertreatment of nAMD and the management of nAMD in real-life study.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.