Recent trends in vision impairment certifications in England and Wales

Rahman, Farzana; Zekite, Antra; Bunce, Catey; Jayaram, Hari; Flanagan, Declan

doi:10.1038/s41433-020-0864-6

Cited by 55 publications

(45 citation statements)

References 12 publications

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“…The introduction of intravitreally administered anti-VEGF drugs has transformed the treatment of nAMD, moving away from an era where laser photocoagulation and verteporfin photodynamic therapy were administered in an attempt to reduce the rate at which vision was lost, to a world where improved visual and morphologic outcomes are regularly achieved, with a corresponding fall in the rate of nAMD-related blindness. [7][8][9][10][11][12][13][14] There is seldom a drug that performs better in clinical practice than in clinical trials. There are multiple reasons for this phenomenon.…”

Section: Introductionmentioning

confidence: 99%

<p>Trends in Real-World Neovascular AMD Treatment Outcomes in the UK</p>

Mehta¹,

Kim²,

Mathis³

et al. 2020

OPTH

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Purpose: To report trends in real-world outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) in the United Kingdom (UK) over the last decade. Design: Systematic review. Methods: Medline, PubMed, and Embase databases were searched from 9 April 2010 to 8 April 2020 for publications that met the inclusion criteria: treatment-naïve eyes, UK-only data and ≥1 year of follow-up. ICHOM (International Consortium for Health Outcome Measures) outcomes and study quality were assessed. Visual acuity (VA) trends were assessed in studies with ≥100 eyes at baseline. Results: Twenty-six studies (n=25,761 eyes) were included, meeting 14-17 out of 20 Institute of Health Economics Quality Appraisal of Case Series checklist domains. Only ranibizumab and aflibercept outcome data were available. The mean injection number in the first year of treatment was 5.9 in publications from 2010 to 2015 and 7.1 from 2015 to 2020. Average baseline VA and mean one-year, two-year and three-year VA gains gradually improved over the last decade. Longer-term studies reported that the visual gains achieved in the first year of treatment were rarely maintained, with under-treatment a likely contributing factor. Conclusion: UK real-world outcomes have improved over the last decade with improved service delivery and the adoption of more proactive treatment regimens but are still not always as impressive as registration clinical trial results. Access to longer-acting anti-VEGF therapies would reduce the treatment burden for patients, carers, and the healthcare system, potentially making replication of clinical trial results possible in the NHS.

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Section: Introductionmentioning

confidence: 99%

<p>Trends in Real-World Neovascular AMD Treatment Outcomes in the UK</p>

Mehta¹,

Kim²,

Mathis³

et al. 2020

OPTH

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“…Glaucoma is the leading cause of preventable vison loss in the United Kingdom and is responsible for almost one third of new vision impairment certifications [1]. The provision of safe and effective glaucoma care even prior to the current COVID-19 pandemic has been challenging.…”

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confidence: 99%

The COVID-19 pandemic will redefine the future delivery of glaucoma care

Jayaram

Strouthidis

Gazzard

2020

Eye

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“…13 Regarding medical clinics, the burden of care will be greatest on those providing macular, diabetic and glaucoma services, which are documented as the three major causes of irreversible, yet often preventable, vision loss in adults. 4,7 In this paper we have highlighted that the reduction in certifications following the onset of the COVID-19 lockdown has been greatest for those with glaucoma, as opposed to AMD. We speculate that this is because glaucomatous sight loss is generally slow, progressive and "unseen".…”

Section: Discussionmentioning

confidence: 99%

“…In their most recent publication they highlight the fact that certifications for both AMD and diabetic eye disease (DED) have reduced significantly between 2010 and 2018, whereas certifications for glaucoma have remained stable. 4 There is no reference in the 1948 National Assistance Act to Northern Ireland, nor any equivalent regional legislation. 2 In similar fashion, the Care Act 2014 and the Care and Support (SI and SSI Adults) Regulations 2014, which apply to England and Wales, and require local authorities to establish and maintain a certification register, do not apply to Northern Ireland.…”

Section: Introductionmentioning

confidence: 99%

COVID‐19: The regional impact of COVID‐19 on the certification of vision impairment in Northern Ireland

Jackson

Silvestri²,

Stevenson

et al. 2020

Ophthalmic Physiologic Optic

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Purpose: In this paper we highlight the impact which the disruption of secondary care ophthalmic services, resulting from COVID-19, has had on Sight Impairment (SI) and Severe Sight Impairment (SSI) certification in Northern Ireland. Methods: Regional data on SI and SSI certification in the period after the onset of the lockdown (19 March 2020-18 June 2020) were compared to the period immediately before lockdown (1 January 2020-18 March 2020) and to the same periods in 2019. Change documented was compared to post-lockdown reductions in primary and secondary ophthalmic care activity. Results: In 2019, during the 3-month period (19 March 2019-18 June 2019), 115 individuals were certified as sight impaired (SI 36, SSI 75, unspecified 4). Of those certified, 65 were female, 49 male. Principal causes of certification were: Age-related macular degeneration (AMD) (N = 45), glaucoma (N = 20) and diabetic eye disease (DED) (N = 10). Mean VA, recorded from the better eye of those certified, was 0.96 LogMAR. In the 3 months following the onset of lockdown (19 March 2020-18 June 2020), only 37 individuals were certified (SI 6, SSI 31), 12 female and 25 male. AMD was the most frequent cause of sight impairment (N = 20). There were only two DED certifications and one due to glaucoma. Mean VA in the better eye of those certified was 1.15LogMAR. The numbers of CVI certifications completed following the introduction of COVID-19 lockdown fell by 68%, compared to the 2019 data. There was a significant reduction in the proportion of female certifications (p = 0.01), and in certifications due to glaucoma (p = 0.02). The proportion of those certified as SSI as opposed to SI in the period after the onset of lockdown rose from 68% in 2019 to 84% in 2020. The mean VA of those certified in the period after the onset of lockdown, when compared to those certified in the other three periods, was worse by between 0.21 and 0.19 LogMAR (p = 0.06). Reductions reflected change in overall primary and secondary ophthalmic care activity. Conclusions: It is inconceivable that COVID-19 has reduced the incidence of sight-threatening eye disease. We must therefore assume that a flood of newly presenting sight loss will present once the pandemic has passed. New presentations will include those who would normally have attended during the lockdown period, and patients who, had they accessed ophthalmic care at the appropriate time, would have been saved from severe levels of blindness. The implications of the predicted increase in demand for medical, social and low vision related services are huge.

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Recent trends in vision impairment certifications in England and Wales

Cited by 55 publications

References 12 publications

<p>Trends in Real-World Neovascular AMD Treatment Outcomes in the UK</p>

<p>Trends in Real-World Neovascular AMD Treatment Outcomes in the UK</p>

The COVID-19 pandemic will redefine the future delivery of glaucoma care

COVID‐19: The regional impact of COVID‐19 on the certification of vision impairment in Northern Ireland

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