Patterns of referral of retinal patients for low vision intervention in the anti-VEGF era.
OBJECTIVE
The goal of this study was to see how the availability of ranibizumab affected the referral patterns for low vision (LV) evaluation.


METHODS
This study used a retrospective review and a comparison of all patients newly referred from retinal Practice 1 (J.T.T., R.N.S.) for LV consultation, from July 2005 to June 2006 (Year 1, preranibizumab) and from July 2006 to June 2007 (Year 2, ranibizumab available), and a retrospective review of patients referred by retinal Practice 2 (M.J.E.) since February 2007.


RESULTS
Practice 1: In Year 1, 24 patients with choroidal neovascularization were referred for LV, and in Year 2, only 12 were referred. There was a trend for those patients referred in Year 2 to have worse visual acuity and Pelli-Robson contrast sensitivity than those in Year 1. In Years 1 and 2, 18 and 11 patients with other conditions were referred for LV consultation, respectively. For these patients without choroidal neovascularization, there was no significant difference between groups for visual acuity or contrast sensitivity. Practice 2: The mean best-corrected visual acuity of patients with bilateral choroidal neovascularization referred was 20/145, and no patient had visual acuity > or =20/100.


CONCLUSIONS
Although the use of antivascular endothelial growth factor agents puts visual acuity in a zone more favorable for successful LV intervention, patients with better acuities may not be referred for LV evaluation despite their residual visual impairments and their scotomas, and despite the fact that without LV intervention, they are having difficulty with reading and other activities of daily living. The frequent visits required for monthly injection, the tendency to wait until a course of therapy is complete before referring patients, and a lesser appreciation for the need for LV intervention in patients with only moderate visual loss may be factors in explaining this.
Sunness
Janet S
JS
Richard E. Hoover Rehabilitation Services for Low Vision and Blindness, Greater Baltimore Medical Center, Baltimore, Maryland 21204, USA. jsunness@gbmc.org
Schartz
R Brandon
RB
Thompson
John T
JT
Sjaarda
Raymond N
RN
Elman
Michael J
MJ
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D020256:Choroidal Neovascularization / Q000150:complications; D015350:Contrast Sensitivity; D006801:Humans; D008266:Macula Lutea; D008268:Macular Degeneration / Q000150:complications; D009885:Ophthalmology / Q000379:methods*; D011364:Professional Practice; D000069579:Ranibizumab; D012017:Referral and Consultation; D012164:Retinal Diseases / Q000150:complications; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014787:Vision Tests; D015354:Vision, Low / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D014792:Visual Acuity / Q000187:drug effects
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab