Prevalence and incidence of blindness and other degrees of sight impairment in patients treated for neovascular age-related macular degeneration in a well-defined region of the United Kingdom

Abstract

Aims This study aimed to evaluate the incidence and prevalence of blindness, sight impairment, and other visual acuity (VA) states in patients receiving ranibizumab for neovascular age-related macular degeneration (nAMD) in Gloucestershire. Methods Serial VA and injection data for all treatment-naive patients receiving their first intravitreal injections of ranibizumab for nAMD in the Gloucestershire National Health Service Ophthalmology department between 2008 and 2010 were extracted from an electronic medical record system. Results The prevalence of blindness (VA in the better-seeing eye r25 Early Treatment Diabetic Retinopathy Study (ETDRS) letters) at the time of first intravitreal injection was 0.8%, increasing to 3.5% after 3 years. The prevalence of sight impairment (VA in the better-seeing eye 26-39 ETDRS letters) increased from 4.1% at baseline to 5.5% after 3 years. The incidence of initiating ranibizumab treatment for nAMD in people aged Z50 years in Gloucestershire was 111 people per 100 000 population in 2009, and 97 people in 2010. The incidence of patients meeting the visual criteria for blindness and sight impairment registration from treated nAMD in people aged Z50 years in Gloucestershire was 3.5 and 9.7 people, respectively per 100 000 population in 2010. Conclusion This is the first real-world study on the incidence and prevalence of eligibility for blindness and sight impairment registration in treated nAMD in the UK based on VA data. The incidence and prevalence of eligibility for certification of blindness or sight impairment in patients treated with ranibizumab for nAMD is low in Gloucestershire, with only 3.6% of the incident population progressing to blindness in 2010.

How urgent do intravitreal anti-VEGF injections need to be to justify the risk of transmitting COVID-19? Proof-of-concept calculations to determine the Health Adjusted Life-Year (HALY) trade-off

“…16 In a large cohort study from the United Kingdom, just 6.9% of nAMD patients became legally blind following 2 years of anti-VEGF, compared to a predicted figure of 15.7% for untreated patients. 17 The expected HALY gains per procedure that we estimate can be scaled up by applying case volumes. For example, in New Zealand, there are more than 75,000 anti-VEGF injections annually.…”

Previous Intravitreal Therapy Is Associated with Increased Risk of Posterior Capsule Rupture during Cataract Surgery

“…We believe this to be unlikely because the data in this analysis are from geographically well-defined regions of the United Kingdom, where few patients are thought likely to have sought separate or previous care from alternative ophthalmology centers. 18 Overall, this study has identified an association between previous intravitreal therapy and risk of PCR or vitreous loss during cataract surgery. The likelihood of PCR is estimated to be 1.04 times higher per injection or 2.59 times higher for those with 10 or more previous intravitreal injections after adjusting for case age, advanced cataract, and surgeon grade.…”

Visual function quality of life measure changes upon conversion to neovascular age-related macular degeneration in second eyes

“…Treatment with intravitreal injections of anti-VEGF therapy results in improvement or stabilization of vision in over 90% of NVAMD patients [6]. Even with the profound impact of anti-VEGF therapy, CNV remains the leading cause of blindness due to AMD; furthermore, 7% of eyes treated for NVAMD become legally blind after 2 years [7,8]. …”