First Author: K.Gadhvi UK
Co Author(s): E. Mensah A. Ritchie A. Khalilli 0 0 0 0 0 0 0 0 0
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Evidence suggests that wet AMD predominantly affects white people. On average, 98% of patients in the major clinical trials (ANCHOR, MARINA & CATT) were white whilst only 2% came from non-white ethnicities. In our north west London population, patients with wet AMD represent 62% and 38 % of white and non-white patients respectively; meaning our non-white population is 19 times greater than that found in clinical trials. The aim of this study was to determine whether visual outcome with ranibizumab monotherapy (PRN) for wet AMD differed between white (W) and non-white (NW) patients over a 24-month treatment period.
The macular treatment clinic in a district general hospital: Central Middlesex Hospital, London, UK.
Prospective data was entered into an in-house, password protected, excel database with 17 different parameters including demographic information, baseline and monthly LogMAR visual acuity, number of ranibizumab treatments and diabetic status. Exclusion criteria included patients with no recorded vision at 24 months (W=45, NW= 19); Patients lost to follow-up or transferred to other units(W=12, NW=20), previous treatment at another unit (W=15, NW=3); patients deceased prior to completion of 24 months of treatment (W=5, NW= 3); patients with other diagnosis such as idiopathic polypoidal chortoidal vasculopathy (W=0, NW=3) and patients with no recorded or undisclosed ethnicity data (n=5). In all patients ranibizumab therapy was individualised after an initial 3 month loading phase. Improved vision was defined as an increase of 15 letters or more on the LogMar chart. Stable vision was defined as loss of less than 15 letters.
Data was analysed for 57 white and 30 non-white patient eyes over the 24 months treatment period. Average age was 87 and 83 years for whites and non-whites respectively. The mean baseline LogMAR visual acuity was 0.65 for whites and 0.90 for non-whites. At 12 months, 89% of white and 93% of non-white patients maintained vision. Improved vision occurred in 17% of white and 26% of non-white patients. At 24 months, vision was maintained in 91% and 83% of white patients and of non-white patients respectively. After 24 months of treatment, in these groups Although improved vision occurred in 18% of whites and 26% of non-white patients at 24 months, the mean letters gained was 4 for the whites and only 0.50 letters for the non-whites.
Both groups of patients were unable to achieve the visual outcome results of the major clinical trials. Age may be a contributory factor since our population is older (W/NW 87yrs/83ys) than the population of the major trials. Although more non-white compared to white patients (26% vs 18%) improved vision, visual acuity was poorer at baseline for the non-white patients which means that there was more scope for improvement. The differences noted in baseline visual acuity may also represent a less aggressive disease in white and more aggressive disease in non-white patients. On average, the white patients gained more letters than the non-whites over 24 months (4 vs 0.5 letters). Other conditions such as diabetes may be responsible for this difference (W/NW; 16%/37%), although the mechanism is unknown.