Which visual acuity measurements define high-quality care for patients with neovascular age-related macular degeneration treated with ranibizumab?

Abstract

Purpose The purpose of this study is to define which visual acuity (VA) measurements are the best indicators of highquality care for patients receiving intravitreal ranibizumab for neovascular age-related macular degeneration (nAMD). Methods Analysis of prospectively collected data recorded within an electronic medical record system on treatment-naive, firsteligible eyes with nAMD, treated with ranibizumab using an as-needed treatment regimen with a minimum follow-up of 1 year. Data collection included the following: age, gender, laterality, type of nAMD, VA, central 1 mm OCT retinal thickness, number of intravitreal injections, and number of follow-up assessments. Results Data were available on the firsttreated eye from 406 patients with at least 1 year follow-up; of these, 198 had data at 2 years. The mean baseline VA of 54.4 Early Treatment Diabetic Retinopathy Study letters improved to 58.5 letters at 12 months and to 56.8 letters at 24 months. The mean VA changes from baseline to 1 year were þ 6.5, þ 7.5, þ 1.7, and À 1.5 letters, respectively, for baseline VA categories of 23-35, 36-55, 56-70, and 470 letters. Change in mean VA from the end of the loading phase to year 1 ranged from À 2.9 to þ 1.4 letters for the different baseline VA categories. The mean number of injections were similar across baseline VA categories ranging from 5.7 to 6.0 injections in year 1 and from 3.3 to 3.8 in year 2.Conclusions This large, real-world series demonstrates that mean change in VA is largely a function of selection criteria and baseline VA. The quality of a service is therefore better judged by actual VA outcomes and maintenance of vision after the loading phase.

Incidence and baseline clinical characteristics of treated neovascular age-related macular degeneration in a well-defined region of the UK

“…This completeness of data capture is made possible by routine use of an EMR,15 22 which records data conforming to a standardised dataset as a byproduct of routine clinical care. Further strengths include the reporting of incidence data and clinical characteristics over several years from a ‘real life’ medical retina service of patients actually being treated,23 rather than from population studies of disease (where patients may or may not have progressed to treatment) or from clinical trials (which have restricted inclusion criteria).…”

The UK Neovascular AMD Database Report 3: inter-centre variation in visual acuity outcomes and establishing real-world measures of care

“…The CATT 6 and GEFAL 17 considered a difference of five EDTRS letters to represent noninferiority, whereas the MANTA 18 considered a difference of seven letters to be noninferior. 18 Because of the 'ceiling effect', whereby eyes starting treatment with good VA have little room for further improvement, many measures are dependent on the starting VA. 11,12,20 Adjusting for age, starting VA, number of injections, and visits reduced, but did not eliminate the significant variation between centres, suggesting there are other unmeasured factors that contribute to these variations in outcomes.…”

Short-term intraocular pressure trends following intravitreal ranibizumab injections for neovascular age-related macular degeneration—the role of oral acetazolamide in protecting glaucoma patients

“…1,2 In routine clinical practice the mean number of injections is B6.0 in year 1 and 3.5 in year 2. 3 In the Seven-Up study, an observation of the 4 years following on from landmark clinical studies, a mean of approximately two anti-VEGF injections per year was reported. 4 Several studies report the extent and duration of intraocular pressure (IOP) elevation following intravitreal injections and most conclude that there is an immediate pressure rise with a slow normalisation of IOP to o30 mm Hg within the subsequent 30 min.…”