title: The UK Neovascular AMD Database Report 3: inter-centre variation in visual acuity outcomes and establishing real-world measures of care.
abstract: PurposeInternational variations in visual acuity (VA) outcomes of eyes treated for neovascular age-related macular degeneration (nAMD) are well-documented, but intra-country inter-centre regional variations are not known. These data are important for national quality outcome indicators. We aimed to determine intra-country and inter-centre regional variations in outcomes for treatment of nAMD.Patients and methodsProspective multicentre national database study of 13 UK centres that treated patients according to a set protocol (three loading doses, followed by Pro-Re-Nata retreatment). A total of 5811 treatment naive eyes of 5205 patients received a total of 36 206 ranibizumab injections over 12 months.ResultsMean starting VA between centres varied from 48.9 to 59.9 ETDRS letters. Mean inter-centre VA change from baseline to 12 months varied from +6.9 letters to -0.6 letters (mean of +2.5 letters). The proportion of eyes achieving VA of 70 letters or more varied between 21.9 and 48.7% at 12 months. Median number of injections (visits) at each centre varied from 5 to 8 (9 to 12), with an overall median of 6 (11). Age, starting VA, number of injections, and visits, but not gender were significantly associated with variation in these VA outcomes (P<0.01). Significant variation between centres persisted even after adjusting for these factors.ConclusionThere are modest differences in VA outcomes between centres in the UK. These differences are influenced, but not completely explained, by factors such as patient age, starting VA, number of injections, and visits. These data provide an indication of the VA outcomes that are achievable in real-world settings.
authors.affiliation: Moorfields Eye Hospital NHS Trust, London, UK.|Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Liew
authors.affiliation: Department of Ophthalmology, University of Washington, WA, USA.
authors.forename: A Y
authors.initials: AY
authors.lastname: Lee
authors.affiliation: Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK.
authors.forename: J
authors.initials: J
authors.lastname: Zarranz-Ventura
authors.affiliation: Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK.
authors.forename: I
authors.initials: I
authors.lastname: Stratton
authors.affiliation: Moorfields Eye Hospital NHS Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Bunce
authors.affiliation: Belfast Health and Social Care Trust, Belfast, UK.
authors.forename: U
authors.initials: U
authors.lastname: Chakravarthy
authors.affiliation: Department of Ophthalmology, University of Washington, WA, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Moorfields Eye Hospital NHS Trust, London, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Keane
authors.affiliation: Moorfields Eye Hospital NHS Trust, London, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Sim
authors.affiliation: Hinchingbrooke Health Care NHS Trust, Hinchingbrooke, UK.
authors.forename: T
authors.initials: T
authors.lastname: Akerele
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: M
authors.initials: M
authors.lastname: McKibbin
authors.affiliation: Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.
authors.forename: L
authors.initials: L
authors.lastname: Downey
authors.affiliation: Wrightington, Wigan and Leigh NHS Foundation Trust, Wrightington, UK.
authors.forename: S
authors.initials: S
authors.lastname: Natha
authors.affiliation: University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: C
authors.initials: C
authors.lastname: Bailey
authors.affiliation: Calderdale and Huddersfield NHS Foundation Trust, Calderdale, UK.
authors.forename: R
authors.initials: R
authors.lastname: Khan
authors.affiliation: Royal United Hospital Bath NHS Trust, Bath, UK.
authors.forename: R
authors.initials: R
authors.lastname: Antcliff
authors.affiliation: Countess of Chester Hospital NHS Trust, Chester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Armstrong
authors.affiliation: Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
authors.forename: A
authors.initials: A
authors.lastname: Varma
authors.affiliation: Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK.
authors.forename: V
authors.initials: V
authors.lastname: Kumar
authors.affiliation: University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Tsaloumas
authors.affiliation: Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK.
authors.forename: K
authors.initials: K
authors.lastname: Mandal
authors.affiliation: Moorfields Eye Hospital NHS Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Egan
authors.affiliation: Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK.
authors.forename: R L
authors.initials: RL
authors.lastname: Johnston
authors.affiliation: Moorfields Eye Hospital NHS Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Tufail
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D011446:Prospective Studies; D000069579:Ranibizumab / Q000627:therapeutic use*; D019233:Retreatment; D016896:Treatment Outcome; D006113:United Kingdom; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab