The Effects of Technological Advances on Outcomes for Elderly Persons With Exudative Age-related Macular Degeneration

Abstract

IMPORTANCE Exudative age-related macular degeneration (ARMD) is the major cause of blindness among US elderly. Developing effective therapies for this disease has been difficult.OBJECTIVES To assess the effects of introducing new therapies for treating exudative ARMD on vision of the affected population and other outcomes among Medicare beneficiaries newly diagnosed as having ARMD.DESIGN The study used data from a 5% sample of Medicare claims and enrollment data with a combination of a regression discontinuity design and propensity score matching to assess the effects on the introduction or receipt of new technologies on study outcomes during a 2-year follow-up period. SETTING AND PARTICIPANTSThe analysis was based on longitudinal data for the United States, January 1, 1994, to December 31, 2011, for Medicare beneficiaries with fee-for-service coverage. The sample was limited to beneficiaries 68 years or older newly diagnosed as having exudative ARMD as indicated by beneficiaries having no claims with this diagnosis in a 3-year look-back period.EXPOSURES The comparisons with vision outcomes were after vs before the introduction of photodynamic therapy and anti-vascular endothelial growth factor (VEGF) therapy. The comparisons for depression and long-term care facility admission were between beneficiaries newly diagnosed as having exudative ARMD who received photodynamic therapy or anti-VEGF therapy compared with beneficiaries having the diagnosis who received no therapy for this disease. MAIN OUTCOMES AND MEASURESOnset of decrease in vision, vision loss or blindness, depression, and admission to a long-term care facility. RESULTS Among beneficiaries newly diagnosed as having exudative ARMD, the introduction of anti-VEGF therapy reduced vision loss by 41% (95% CI, 52%-68%) and onset of severe vision loss and blindness by 46% (95% CI, 47%-63%). Such beneficiaries who received anti-VEGF therapy and were not admitted to a long-term care facility during the look-back period were 19% (95% CI, 72%-91%) less likely on average to be admitted to a long-term care facility during the follow-up period.CONCLUSIONS AND RELEVANCE This study demonstrates gains in population vision from the introduction of anti-VEGF therapy for patients 68 years or older with an exudative ARMD diagnosis in community-based settings in the United States.

Gaps in Receipt of Regular Eye Examinations among Medicare Beneficiaries Diagnosed with Diabetes or Chronic Eye Diseases

“…Our observational period largely preceded the introduction of anti-VEGF therapies which occurred in 2006. 27 It is possible that given the introduction of an effective therapy, rates of eye exams would have been higher for beneficiaries diagnosed with wet AMD if our observational period had included more years following 2006.…”

Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration

“…3 review on this topic (9) found four studies where the prevalence of depression was examined in patients receiving anti-VEGF treatments (22)(23)(24)36). Findings were preliminary but suggested that the wAMD patient group receiving anti-VEGF treatment still present higher rates of depression and anxiety in comparison with general population.…”

Low Vision Depression Prevention Trial in Age-Related Macular Degeneration

“…Although antiangiogenic treatments have greatly improved the prognosis of neovascular AMD, the majority of treated patients do not regain lost vision. 3,4 No medical treatment is available for patients with geographic atrophy. Thus, many patients with AMD experience irreversible vision loss, impaired functional vision, and diminished quality of life.…”