First Author: R.Johnston UK
Co Author(s): M. Buckle R. Healy Q. Mohamed A. Sallam E. Fletcher 0 0 0 0 0 0 0 0 0
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To study long-term real-world ranibizumab therapy for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD), and to benchmark standards of care.
Gloucestershire Hospitals NHS Foundation Trust paperless nAMD clinic serving a geographically discrete population of the UK UK, where very few patients access treatment elsewhere.
Up to 5 years of routinely, prospectively collected anonymised data were remotely extracted from an electronic medical record system (EMR). 1944 treatment-naïve eyes of 1628 patients, receiving a total of 20,106 ranibizumab injections were analysed The centre exclusively used ranibizumab to treat nAMD using a loading phase of 3 monthly injections and pro re nata (PRN) re-treatment regimen. The minimum data set defined before first patient data entry and mandated by the EMR, included: age at first injection, ETDRS visual acuity (VA) at baseline and at all subsequent visits and injection episodes.
Mean age at first treatment was 80.9 years with a female preponderance 1.9:1. Median (mean VA) (letters) was 58 (55) at baseline , 62 (59) at 1 year, 60 (57) at 2 years, 59 (55) at 3 years, 58 (54) at 4 years and 53 (50) at 5 years. The proportion of eyes that avoided moderate vision loss (>15 letters) at years 1 to 5 were 92.3%, 87.5%, 82.1%, 80.3% and 73.9% respectively. The proportion of eyes with VA of 70 letters (20/40) or better were: 19% at baseline, and 37%, 34%, 30%, 27%, 22% and 21% at years 1 to 5 respectively. The median number of treatments for eyes followed for 1-5 complete years were 6, 4, 4, 4, and 3 respectively. Baseline VA was inversely related to mean vision gain at three months. Older age was associated with lower presenting VA.
Real-world visual outcomes do not match the results achieved in randomised controlled clinical trials or the prn arm of the CATT trial, but were delivered with substantially fewer injections. This study provides important benchmark results for a large cohort of patients, which should be of interest to patients, retina specialists and commissioners of healthcare. This study demonstrates EMR’s potential for monitoring entire populations of treated patients.