Abstract
Purpose
International 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 methods
Prospective 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.
Results
Mean 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.
Conclusion
There 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.
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Acknowledgements
This study group has received a proportion of its funding from the Department of Health’s NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology. CSL is funded by NIH/NEI grant NIH/NEI K23EY024921. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. We acknowledge Paul Donachie, Gloucestershire Hospitals NHS Foundation Trust, for providing statistical advice on the manuscript.
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RLJ is the medical director of Medisoft Limited, the Electronic Medical Record software provider from which data were extracted. The remaining authors declare no conflict of interest.
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GL and AF had full access to all the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis.
The members of the UK AMD EMR Users Group (listed by centre and within each centre)
G Liew1,17, AY Lee2, J Zarranz-Ventura3, I Stratton3, C Bunce1, U Chakravarthy4, CS Lee2, PA Keane1, DA Sim1, T Akerele5, M McKibbin6, L Downey7, S Natha8, C Bailey9, R Khan10, R Antcliff11, S Armstrong12, A Varma13, V Kumar14, M Tsaloumas15, K Mandal16, C Egan1, RL Johnston3, A Tufail1, Q Mohamed3, A Sallam3, P Donachie3, S Arora7, H Cook7, K Gopalakrishnan7, F Lyon7, T Islam7, N Zaman7, O Backhouse6, T Dabbs6, B Davies6, B Mokete6, D O’Neill6, PJ Patel1, W Xing1
1Moorfields Eye Hospital NHS Trust, London, UK; 2University of Washington, WA, USA; 3Gloucestershire Hospitals NHS Foundation Trust, UK; 4Belfast Health and Social Care Trust, UK; 5Hinchingbrooke Health Care NHS Trust, UK; 6Leeds Teaching Hospitals NHS Trust, UK; 7Hull and East Yorkshire Hospitals NHS Trust, UK; 8Wrightington, Wigan and Leigh NHS Foundation Trust, UK; 9University Hospitals Bristol NHS Foundation Trust, UK; 10Calderdale and Huddersfield NHS Foundation Trust, UK; 11Royal United Hospital Bath NHS Trust, UK; 12Countess of Chester Hospital NHS Trust, UK; 13Mid Yorkshire Hospitals NHS Trust, UK; 14Wirral University Teaching Hospital NHS Foundation Trust, UK; 15University Hospital Birmingham NHS Foundation Trust, UK; 16Warrington and Halton Hospitals NHS Foundation Trust, UK; 17University of Sydney, Sydney, New South Wales, Australia.
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Liew, G., Lee, A., Zarranz-Ventura, J. et al. The UK Neovascular AMD Database Report 3: inter-centre variation in visual acuity outcomes and establishing real-world measures of care. Eye 30, 1462–1468 (2016). https://doi.org/10.1038/eye.2016.149
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DOI: https://doi.org/10.1038/eye.2016.149
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