title: The role of social deprivation in severe neovascular age-related macular degeneration.
abstract: OBJECTIVE
  Advances in therapy have improved outcomes for patients with neovascular age-related macular degeneration (nAMD). Prompt access to treatment is a priority and may be used as a key performance indicator. In this study, we investigate how social deprivation may impact on access to services, treatment and visual impairment registration.
  
  
  METHODS
  Patients were identified retrospectively through the Certificate of Visual Impairment system for the University Hospitals Birmingham Medical Retina service. The Index of Multiple Deprivation (IMD) 2007 score was calculated for each patient. The impact of deprivation, age, gender and ethnicity on key stages in the care pathway was assessed.
  
  
  RESULTS
  120 patients were identified. Patients with greater social deprivation were under-represented, had worse visual acuity at first presentation (correlation of the better-seeing eye with IMD 0.225 (p=0.013)) and had sight-impairment registration earlier (correlation -0.246; p=0.007). 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 greater social deprivation is a serious concern. Our study strongly suggests that this vulnerable group is encountering barriers in accessing treatment in nAMD, and that these occur prior to entry into the Hospital Eye Service.
authors.affiliation: Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Sharma
authors.affiliation: Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Priscilla A
authors.initials: PA
authors.lastname: Mathewson
authors.affiliation: Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Lane
authors.affiliation: Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Shah
authors.affiliation: Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Glover
authors.affiliation: Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Palmer
authors.affiliation: Department of Primary Care and Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: M Sayeed
authors.initials: MS
authors.lastname: Haque
authors.affiliation: Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Academic Unit of Ophthalmology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Alastair K
authors.initials: AK
authors.lastname: Denniston
authors.affiliation: Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Marie D
authors.initials: MD
authors.lastname: Tsaloumas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000523:psychology*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D012042:Registries; D012189:Retrospective Studies; D012934:Social Isolation / Q000523:psychology*; D006113:United Kingdom; D019987:Persons with Visual Disabilities / Q000523:psychology; D057135:Wet Macular Degeneration / Q000523:psychology*
keywords: Degeneration; Epidemiology; Macula; Public health; Vision