UK Age-Related Macular Degeneration Electronic Medical Record System (AMD EMR) Users Group Report IV: Incidence of Blindness and Sight Impairment in Ranibizumab-Treated Patients.
To study the incidence of blindness and sight impairment in treatment-naive patients receiving ranibizumab (Lucentis) for neovascular age-related macular degeneration (nAMD) in the United Kingdom (UK) National Health Service.



Multicenter nAMD database study.



A total of 11 135 patients who collectively received 92 976 treatment episodes to 12 951 eyes.



Data were extracted from 14 UK centers using the same electronic medical record system (EMR). The EMR-mandated collection of a data set (defined before first data entry) including: age, Early Treatment Diabetic Retinopathy Study visual acuity letter score (VA) for both eyes at all visits, and injection episodes. Participating centers used overwhelmingly a pro re nata re-treatment posology at intended monthly follow-up visits following a loading phase of 3 monthly injections.



Incidence of blindness and sight impairment (VA in the better-seeing eye <38 letters [≤20/200 Snellen, approximately], and <68 letters [≤20/50 Snellen, approximately] at 2 consecutive visits, or 1 visit if no further follow-up data) in each year after initiating treatment.



Information from >300 000 clinic visits (2.8 million data points) collected over 5 years was collated from 14 centers. Mean age at first treatment was 79.7 years (standard deviation = 9.19 years), with a female preponderance (63%). The mean (median) VA at baseline in the better-seeing eye was 67.2 (72.0) letters, 20/40- (20/40+) approximate Snellen conversion. The cumulative incidence of new blindness and sight impairment in patients with treated nAMD in at least 1 eye at years 1 to 4 after first injection were 5.1%, 8.6%, 12% and 15.6% for new blindness and 29.6%, 41.0%, 48.7%, and 53.7% for new sight impairment, but with significant reductions in the rates between year cohorts initiating treatment (blindness [P = 4.72 × 10-08], sight impaired [P = 3.27 × 10-06]).



To the best of our knowledge, this is the first multicenter real-world study on the incidence of blindness and sight impairment based on VA data in patients treated with ranibizumab for nAMD, and its results show low incidences of both blindness and sight impairment, which both declined during the study period.
Department of Ophthalmology, Gloucestershire Hospitals National Health Services Foundation Trust, Cheltenham Hospital, Cheltenham, United Kingdom.
Robert L
RL
Johnston
Department of Ophthalmology, University of Washington, Seattle, Washington; Moorfields Eye Hospital, City Road, London, United Kingdom. Electronic address: leeay@uw.edu.
Aaron Y
AY
Lee
Retina Service, Bristol Eye Hospital, Bristol, United Kingdom.
Miranda
M
Buckle
Department of Ophthalmology, Royal United Hospitals Bath National Health Services Foundation Trust, Bath, United Kingdom.
Richard
R
Antcliff
Retina Service, Bristol Eye Hospital, Bristol, United Kingdom.
Clare
C
Bailey
Eye Clinic, St. James's University Hospital, Leeds, United Kingdom.
Martin
M
McKibbin
Centre for Vascular and Vision Sciences, Queen's University, Belfast, United Kingdom.
Usha
U
Chakravarthy
Moorfields Eye Hospital, City Road, London, United Kingdom.
Adnan
A
Tufail
D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D001766:Blindness / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab / Q000008:administration & dosage*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab