Real-World Vision in Age-Related Macular Degeneration Patients Treated with Single Anti–VEGF Drug Type for 1 Year in the IRIS Registry

Rao, Prethy; Lum, Flora; Wood, Kevin M.; Salman, Craig; Burugapalli, Bhavya; Hall, Rebecca M.; Singh, Sukhminder; Parke, David W.; Williams, George A.

doi:10.1016/j.ophtha.2017.10.010

Cited by 124 publications

(92 citation statements)

References 18 publications

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“…(12) VA gain over time is dependent on baseline characteristics and injection frequency. (12,14,29) Increasing age diminishes the VA gain expected as does a higher baseline acuity due to ceiling effect. (30) Baseline VA could even emerge as a surrogate measure for accessibility to treatment and quality of care, since simply looking at VA gains would underestimate centers that achieve short time from diagnosis to first treatment resulting in above average baseline VA but ceiling effect on VA gains.…”

Section: Discussionmentioning

confidence: 99%

“…(8,12,16) Injection frequency has been recognised as another significant factor influencing VA gain and has been hypothesised to be the major factor in studies comparing ranibizumab and aflibercept due to the change in posology from treatment as needed to treat-and-extend concomitant with the change from ranibizumab to aflibercept in clinical practice. (14,29,31,32). Moorfields Eye Hospital has a standardised treatment protocol for neovascular AMD, formerly treatment as needed, and fixed-first year/treat-and extend regimen with the introduction of aflibercept in 2014 (flow chart for aflibercept use is shown in Supplementary 2).…”

Section: Discussionmentioning

confidence: 99%

“…The advent of electronic medical records (EMR) has facilitated the collection of large amounts of data in routine clinical practice and thus has the potential to make retrospective study populations more representative of real life. (13)(14)(15)(16)(17)(18) were merged into the current centralised repository, the data warehouse. We have created a dataset from this which represents, to our knowledge, the largest single-center cohort of patients receiving treatment for neovascular AMD in the world.…”

Section: Introductionmentioning

confidence: 99%

“…This Moorfields AMD dataset is increasing steadily, with 909 new patients in 2017 alone, a number typically only comparable in magnitude to multicenter studies. (14,16) Apart from its sheer size, key advantages of this dataset include the ability to clean and validate data directly, the completeness due to the mandatory input of relevant fields including VA, the consistency of VA measurements in ETDRS letters, the lack of requirement to merge data from different sites and systems, the standardised treatment scheme following national guidelines, and the ability to directly access the raw imaging data from each study visit.…”

Section: Introductionmentioning

confidence: 99%

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One and Two Year Visual Outcomes from the Moorfields AMD Database - an Open Science Resource for the Study of Neovascular Age-related Macular Degeneration

Fasler

Moraes

Wagner

et al. 2018

Preprint

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ObjectivesTo analyse treatment outcomes and share clinical data from a large, single-center, well-curated database (8174 eyes / 6664 patients with 120,756 single entries) of patients with neovascular age related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (VEGF). By making our depersonalised raw data openly available, we aim to stimulate further research in AMD, as well as setting a precedent for future work in this area.SettingRetrospective, comparative, non-randomised electronic medical record (EMR) database cohort study of the UK Moorfields AMD database with data extracted between 2008 and 2018.Participants3357 eyes/patients (61% female). Extraction criteria were ≥ 1 ranibizumab or aflibercept injection, entry of “AMD” in the diagnosis field of the EMR, and a minimum of one year of follow-up. Exclusion criteria were unknown date of first injection and treatment outside of routine clinical care at Moorfields before the first recorded injection in the database.Main outcome measuresPrimary outcome measure was change in VA at one and two years from baseline as measured in Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Secondary outcomes were the number of injections and predictive factors for VA gain.ResultsMean VA gain at one-year and two years were +5.5±0.5 and +4.9±0.68 letters respectively. Fifty-four percent of eyes gained ≥5 letters at two years, 63% had stable VA (±≤14 letters), forty-four percent of eyes maintained good VA (≥70 letters). Patients received a mean of 7.7±0.06 injections during year one and 13.0±0.2 injections over two years.Younger age, lower baseline VA, and more injections were associated with higher VA gain at two years.ConclusionThis study benchmarks high quality EMR study results of real life AMD treatment and promotes open science in clinical AMD research by making the underlying data publicly available.Strengths and limitations of this study-Large sample size, retrospective, single centre, electronic medical record database study-High quality real life data-Open science approach with sharing of depersonalised raw data

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

One and Two Year Visual Outcomes from the Moorfields AMD Database - an Open Science Resource for the Study of Neovascular Age-related Macular Degeneration

Fasler

Moraes

Wagner

et al. 2018

Preprint

View full text Add to dashboard Cite

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“…[14] The electronic medical record (EMR) database at Moorfields Eye Hospital NHS Diabetic Retinopathy Study (ETDRS) letters, the lack of requirement to merge data from different sites and systems, the standardised treatment scheme following national guidelines, and the ability to directly access the raw imaging data from each patient visit. [15,16] The aim of this study was to analyse baseline characteristics and VA outcomes of fellow eyes (sequentially and non-sequentially treated) undergoing anti-VEGF therapy for nAMD, as well as the timelines for fellow eye involvement. We compare fellow eye outcomes to those of the respective first eyes of sequentially treated fellow eyes.…”

Section: Introductionmentioning

confidence: 99%

The Moorfields AMD Database Report 2 - Fellow Eye Involvement with Neovascular Age-related Macular Degeneration

Fasler

Moraes

et al. 2019

Preprint

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Background/AimsNeovascular age-related macular degeneration (nAMD) is frequently bilateral, and previous reports on ‘fellow eyes’’ have assumed sequential treatment after a period of treatment of the first eye only. The aim of our study was to analyse baseline characteristics and visual acuity (VA) outcomes of fellow eye involvement with nAMD, specifically differentiating between sequential and non-sequential (due to macular scarring in the first eye) anti-vascular endothelial growth factor treatment and timelines for fellow eye involvement.MethodsRetrospective, electronic medical record database study of the Moorfields AMD database of 8174 eyes/120,756 single entries with data extracted between October 21, 2008 and August 9, 2018. The dataset for analysis consisted of 1180 sequential, 413 nonsequential, and 1110 unilateral eyes.ResultsMean VA of sequentially treated fellow eyes at baseline was significantly higher (62±13), VA gain over two years lower (0.65±14), and proportion of eyes with good VA (≥20/40 or 70 letters) higher (46%) than the respective first eyes (baseline VA 54±16, VA gain at two years 5.6±15, percentage of eyes with good VA 38%). Non-sequential fellow eyes showed baseline characteristics and VA outcomes similar to first eyes. Fellow eye involvement rate was 32% at two years, and median time interval to fellow eye involvement was 71 (IQR 27-147) weeks.ConclusionThis reports shows sequentially treated nAMD fellow eyes have better baseline and final VA than non-sequentially treated eyes after 2 years of treatment. Sequentially treated eyes also had a greater proportion with good VA after 2 years of treatment.PRECISDepending on age, fellow eye involvement occurs in 32% of patients with neovascular AMD by two years. Fellow eyes generally maintain better vision, except in cases where late-stage disease in the first eye was untreated.

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Factors Associated With a Patient’s Decision to Select a Cost-effective vs the Most Effective Therapy for Their Own Eye Disease

et al. 2021

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IMPORTANCE Ten percent of the Medicare Part B budget is spent on aflibercept, used to treat a myriad of ocular neovascular diseases. A substantial portion of these costs can be attributed to a few hundred ophthalmologists, raising concerns regarding the influence of pharmaceutical companies on the choice of medication by a relatively small group of clinicians. One approach to protect patients' health care interests is to include them in deliberations on the choice of therapy for their eye disease.OBJECTIVE To examine factors associated with patients' choice between an effective and less expensive off-label drug or a more effective, but also more expensive, US Food and Drug Administration (FDA)-approved drug.

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Real-World Vision in Age-Related Macular Degeneration Patients Treated with Single Anti–VEGF Drug Type for 1 Year in the IRIS Registry

Cited by 124 publications

References 18 publications

One and Two Year Visual Outcomes from the Moorfields AMD Database - an Open Science Resource for the Study of Neovascular Age-related Macular Degeneration

One and Two Year Visual Outcomes from the Moorfields AMD Database - an Open Science Resource for the Study of Neovascular Age-related Macular Degeneration

The Moorfields AMD Database Report 2 - Fellow Eye Involvement with Neovascular Age-related Macular Degeneration

Factors Associated With a Patient’s Decision to Select a Cost-effective vs the Most Effective Therapy for Their Own Eye Disease

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