The UK Neovascular AMD Database Report 3: inter-centre variation in visual acuity outcomes and establishing real-world measures of care

Liew, G., Lee, A.Y., Zarranz-Ventura, J., Stratton, I., Bunce, C., Chakravarthy, U., Lee, C.S., Keane, P.A., Sim, D.A., Akerele, T., Mckibbin, M., Downey, L., Natha, S., Bailey, C., Khan, R., Antcliff, R., Armstrong, S., Varma, A., Kumar, V., Tsaloumas, M., Mandal, K., Egan, C., Johnston, R.L. and Tufail, A. , on behalf of the UK AMD EMR Users Group (2016) The UK Neovascular AMD Database Report 3: inter-centre variation in visual acuity outcomes and establishing real-world measures of care. Eye (Basingstoke), 30 (11), 1462-1468. (doi:10.1038/eye.2016.149).

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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Contributors

Author: I. Stratton

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