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The role of social deprivation in severe neovascular age related macular degeneration

Session Details

Session Title: AMD I

Session Date/Time: Friday 12/09/2014 | 08:00-10:00

Paper Time: 08:32

Venue: Boulevard C

First Author: : H.Sharma UK

Co Author(s): :    P. Mathewson   M. Lane   P. Shah   H. Palmer   A. Denniston   M. Tsaloumas

Abstract Details

Purpose:

Advances in therapy have improved visual outcomes for patients with neovascular Age-related Macular Degeneration (nAMD). Prompt access to treatment for eligible patients is a priority and may be used as a key performance indicator. In this study we investigate the impact that social deprivation may have on interaction with these services in terms of access, treatment and visual impairment registration.

Setting:

The subjects for the study were obtained from the patient population of a large teaching hospital in the West Midlands, UK. Patients who met the inclusion criteria for the study were identified from the ophthalmology department of the Queen Elizabeth Hospital (University Hospitals Birmingham NHS Foundation Trust), Birmingham, UK.

Methods:

All patients were identified retrospectively through the Certificate of Visual Impairment registration system for the hospital's medical retina service. The Index of Multiple Deprivation (IMD) 2007 score was calculated for each patient from their home address postcode. The impact of social deprivation, age, gender and ethnicity on key stages in the care pathway was assessed.

Results:

120 patients were identified. Patients with higher levels of social deprivation were under-represented, had worse visual acuity at the time of first appointment (correlation of the better seeing eye with IMD 0.225 (p=0.013)) and had a shorter time period before being registered for sight-impairment/severe sight-impairment (correlation -0.246; p=0.007). For those patients referred, deprivation did not affect time to first appointment and was not associated with a higher rate of non-attendance.

Conclusions:

The late presentation and under-representation of patients with higher levels of social deprivation in our study is a serious concern. Our study strongly suggests that this vulnerable group is encountering barriers in accessing effective treatment in nAMD and that these occur prior to entry into the Hospital Eye Service.

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