Session Title: Quick Fire Free Paper Session 01
Session Date/Time: Thursday 26/09/2013 | 08:30-10:30
Paper Time: 08:35
Venue: Hall G1 (Level 2)
First Author: A.Sallam UK
Co Author(s): J. Zarranz-Ventura Q. Mohamed R. Johnston
Data from pivotal neovascular age related macular degeneration (nAMD) trials have demonstrated an incidence of nAMD in fellow eyes of patients undergoing ranibizumab treatment ranging from 23.8% to 38.8% by 24 months. However, there is a paucity of data in the current literature with regard to the visual acuity outcomes and treatment frequency for this cohort of eyes. The aim of this study was to examine the differences in mean baseline, post treatment visual acuity and mean treatment frequency between first and second treated eyes of patients with neovascular age-related macular degeneration (nAMD) undergoing treatment with intravitreal ranibizumab.
All patients treated within a geographically well defined region of the UK (UK) served by a single hospital.
Analysis of prospectively collected data recorded within an electronic medical record system on an entire population of patients with nAMD treated with intravitreal ranibizumab using an as needed treatment regimen. Patients have visual acuity measurements and OCT scans of both eyes at each monthly follow up visit. Data collection included: age, gender, laterality, ETDRS visual acuity and number of intravitreal injections in each year of follow-up.
1487 eyes with nAMD received their first intravitreal injection of 0.5mg ranibizumab between December 2007 and February 2013. Of these eyes, 1221 were first treated and 266 were second treated eyes. 1 year data were available on 651 first treated eyes and 136 second treated eyes and 2 year data were available on 417 and 78 eyes, respectively. Significant differences were found between mean visual acuity at baseline (54.2 vs. 63.8 ETDRS letters; P<0.001), 1 year (56.8 vs. 61.2; P<0.001) and 2 years (56.0 vs.58.5; P<0.001) in first and second treated eyes, respectively. First treated eyes required a significantly higher number of injections than second treated eyes in year 1 (6.3 vs. 5.8 ; P<0.001) and year 2 (4.9 vs. 4.5 ; P<0.001), respectively.
This large clinical database study of all patients treated for nAMD within a defined population demonstrates that second treated eyes with intravitreal ranibizumab have significantly better visual acuity at baseline and at yearly intervals compared to first treated eyes and also require significantly fewer injections over the first 2 years. These findings are probably due to very early detection of disease in second eyes of patients that are under regular review (which includes OCT) following treatment of the first eye. These results highlight the importance of examining the fellow eye in patients with unilateral nAMD at each clinic consultation and support the view that the visual outcomes after treatment are directly linked to baseline visual acuity.