title: UK AMD EMR USERS GROUP REPORT V: benefits of initiating ranibizumab therapy for neovascular AMD in eyes with vision better than 6/12.
abstract: OBJECTIVE
  To study the effectiveness and clinical relevance of eyes treated with good (better than 6/12 or >70 Early Treatment Diabetic Retinopathy Study letters) visual acuity (VA) when initiating treatment with ranibizumab for neovascular age-related macular degeneration (nAMD) in the UK National Health Service. Currently eyes with VA better than (>) 6/12 are not routinely funded for therapy.
  
  
  METHODS
  Multicentre national nAMD database study on patients treated 3-5 years prior to the analysis. Anonymised structured data were collected from 14 centres. The primary outcome was the mean VA at year 1, 2 and 3. Secondary measures included the number of clinic visits and injections.
  
  
  RESULTS
  The study included 12 951 treatment-naive eyes of 11 135 patients receiving 92 976 ranibizumab treatment episodes. A total of 754 patients had baseline VA better than 6/12 and at least 1-year of follow up. Mean VA of first treated eyes with baseline VA>6/12 at year 1, 2, 3 were 6/10, 6/12, 6/15, respectively and those with baseline VA 6/12 to >6/24 were 6/15, 6/17, 6/20, respectively (p values <0.001 for comparing differences between 6/12 and 6/12-6/24 groups). For the second eyes with baseline VA>6/12, mean VA at year 1, 2, 3 were 6/9, 6/9, 6/10 and those with baseline VA 6/12 to >6/24 were 6/15, 6/15, 6/27, respectively (p values <0.001-0.005). There was no significant difference in the average number of clinic visits or injections between those with VA better and worse than 6/12.
  
  
  CONCLUSIONS
  All eyes with baseline VA>6/12 maintained better mean VA than the eyes with baseline VA 6/12 to >6/24 at all time points for at least 2 years. The significantly better visual outcome in patients who were treated with good baseline VA has implications on future policy regarding the treatment criteria for nAMD patients' funding.
authors: Moorfields Eye Hospital NHS Foundation Trust, London, UK.
authors: Aaron Y
authors: AY
authors: Lee
authors: Department of Ophthalmology, University of Washington, Seattle, Washington, USA.
authors: Cecilia S
authors: http://orcid.org/0000-0003-1994-7213
authors: CS
authors: Lee
authors: Institute of Ophthalmology, University College London, London, UK.
authors: Thomas
authors: T
authors: Butt
authors: R&D, Moorfields Eye Hospital NHSFT, London, UK.
authors: Wen
authors: W
authors: Xing
authors: Gloucestershire Eye Department, Cheltenham General Hospital, Cheltenham, UK.
authors: Robert L
authors: RL
authors: Johnston
authors: Belfast Health and Social Care Trust, Belfast, UK.
authors: Usha
authors: U
authors: Chakravarthy
authors: Moorfields Eye Hospital NHS Foundation Trust, London, UK.
authors: Catherine
authors: C
authors: Egan
authors: Hinchingbrooke Health Care NHS Trust, Cambridgeshire, UK.
authors: Toks
authors: T
authors: Akerele
authors: Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: Martin
authors: M
authors: McKibbin
authors: Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.
authors: Louise
authors: L
authors: Downey
authors: Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK.
authors: Salim
authors: S
authors: Natha
authors: Bristol Eye Hospital, Bristol, UK.
authors: Clare
authors: C
authors: Bailey
authors: Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK.
authors: Rehna
authors: R
authors: Khan
authors: Royal United Hospital Bath NHS Trust, Bath, UK.
authors: Richard
authors: R
authors: Antcliff
authors: Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK.
authors: Atul
authors: A
authors: Varma
authors: Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK.
authors: Vineeth
authors: V
authors: Kumar
authors: Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors: Marie
authors: M
authors: Tsaloumas
authors: Department of Ophthalmology, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK.
authors: Kaveri
authors: K
authors: Mandal
authors: Centre for Vision Research, The University of Sydney, Sydney, New South Wales, Australia.
authors: Gerald
authors: G
authors: Liew
authors: Moorfields Eye Hospital NHS Foundation Trust, London, UK.
authors: Pearse A
authors: http://orcid.org/0000-0002-9239-745X
authors: PA
authors: Keane
authors: Moorfields Eye Hospital NHS Foundation Trust, London, UK Department of Cell Biology, UCL Institute of Ophthalmology, London, UK.
authors: Dawn
authors: D
authors: Sim
authors: Moorfields Eye Hospital NHS Foundation Trust, London, UK.
authors: Catey
authors: C
authors: Bunce
authors: Moorfields Eye Hospital NHS Foundation Trust, London, UK.
authors: Adnan
authors: A
authors: Tufail
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D016208:Databases, Factual; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D019233:Retreatment; D006113:United Kingdom; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology*; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab
keywords: Drugs; Macula; Retina; Treatment Medical