Abstract
Background
To observe visual acuity change in the stability phase when follow-up intervals are decreased in ranibizumab-treated neovascular age-related macular degeneration (nvAMD).
Methods
Selection of patients was based on a review of a cohort of 189 eyes of 154 patients with nvAMD treated with intravitreal ranibizumab in routine clinical practice. Patients were transferred from a base hospital with a 8-week follow-up interval to a community eye clinic, enabling a new follow-up interval of 4 weeks. Staff, assessment, and treatment protocols were equivalent in the two centres. Patients were included when they were in the stability phase of treatment defined 1 month after having completed their three initiation treatments with ranibizumab. Each patient was required to have attended at least a further 12 visits; this means a follow-up time for a year or longer, consisting of six visits at the base hospital followed by six visits at the new eye clinic. The best-corrected visual acuity (BCVA), follow-up intervals and injection numbers were collected.
Results
Seventy-two eyes of 62 patients were included. The mean follow-up interval for the six visits in the base hospital was 56.81 days, and in the new eye centre 31.81 days. The BCVA loss in the base hospital was −1.13 letters, compared to a gain of +4.61 letters in the community eye clinic over the six visits. The number of ranibizumab injections was 3.67 in the base hospital, compared with 3.91 in the other centre over the respective periods.
Conclusion
Visual acuity improves and severe visual loss decreases when follow-up intervals reduce from approximately 8 weeks to 4 weeks. Furthermore, using the stability phase to evaluate the outcome and effectiveness of our treatments for age-related macular degeneration appeared to be an efficient tool.
Similar content being viewed by others
References
Rostron E, McKibbin M (2012) Visual impairment certification secondary to ARMD in Leeds, 2005–2010: is the incidence falling? Eye 26:933–936
Bunce C, Xing W, Wormald R (2010) Causes of blind and partial sight certifications in England and Wales: April 2007–March 2008. Eye 24:1692–1699
Owen CG, Jarrar Z, Wormald R, Cook DG, Fletcher AE (2012) The estimated prevalence and incidence of late stage age related macular degeneration in the UK. Br J Ophthalmol 96:752–756
Bressler NM (2001) Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group Photodynamic therapy of subfoveal choroidal neovascularisation in age-related macular degeneration with verteporfin: 2-year results of 2 randomized clinical trials-tap report 2. Arch Ophthalmol 119:198–207
Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S, ANCHOR Study Group (2006) Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 355:1432–1444
Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY, for the MARINA Study Group (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355:1419–1431
CATT Research Group, Martin DF, Maguire MG, Ying GS, Grunwald JE (2011) Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med 364:1897–1908
CATT Research Group, Martin DF, Maguire MG, Fine SL, Ying GS, Jaffe GJ, Grunwald JE, Toth C, Redford M, Ferris FL (2012) Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: 2-year results. Ophthalmology 119:1388–1398
Boyer DS, Heier JS, Brown DM, Francom SF, Ianchulev T (2009) A phase IIIb study to evaluate the safety of ranibizumab in subjects with neovascular age-related macular degeneration. Ophthalmology 116:1731–1739
Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S (2009) A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol 148:43–58
Regillo CD, Brown DM, Abraham P, Yue H, Ianchulev T, Schneider S, Shams N (2008) Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER Study year 1. Am J Ophthalmol 145:239–248
Amoaku W, Blakeney S, Freeman M, Gale R, Johnston R (2012) Action on AMD. Optimising patient management: act now to ensure current and continual delivery of best possible patient care. Eye 26:2–21
Royal College of Ophthalmologists. Commissioning contemporary AMD services: a guide for commissioners and clinicians (2007) Accessed at http://www.rcophth.ac.uk/core/core_picker/download.asp?id=181&filetitle=Commissioning+Contemporary+AMD+Services
Klein R, Knudtson MD, Cruickshaks KJ, Klein BE (2008) Further observation on the association between smoking and the long-term incidence and progression of age-related macular degeneration: the Beaver Dam Eye Study. Arch Ophthalmol 126:115–121
Kelly SP, Barua A (2011) A review of safety incidents in England and Wales for vascular endothelial growth factor inhibitor medications. Eye 25:710–716
Dagostar H, Ventura AA, Chung JY, Shar AS, Kaiser PK (2009) Evaluation of injection frequency and visual acuity outcomes for ranibizumab monotherapy in exudative age-related macular degeneration. Ophthalmology 116:1740–1747
Gerding H, Loukopoulos V, Riese J, Herner L, Timmermann M (2011) Results of flexible ranibizumab treatment in age-related macular degeneration and search of parameters with impact on outcome. Graefes Arch Clin Exp Ophthalmol 249:653–662
Mariani A, Angeliki D, Ambresin A, Mantel I (2011) Characteristics of eyes with secondary loss of visual acuity receiving variable dosing ranibizumab for neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 249:1635–1642
NICE Technology Appraisal Guidance TA155. Ranibizumab and pegaptanib for the treatment of age-related macular degeneration (2008) Accessed at http://www.nice.org.uk/nicemedia/pdf/TA155guidance.pdf
Acknowledgments
We thank Victoria Allgar for the help with the statistics, and Angela Keenan for comments and help on the graphs design.
Conflict of interest
Mr. Gale is Chairman of the Eye Site Clinic Ltd and Mobile Healthcare Accommodation, and has received educational grants from and carried out advisory consultation for Novartis Pharmaceuticals UK. York Teaching Hospital conducts clinical trials sponsored by Novartis Pharmaceuticals UK
Funding
No special funding. The authors have no commercial interest in the devices used in this study
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tschuor, P., Pilly, B., Venugopal, D. et al. Optimising assessment intervals improves visual outcomes in ranibizumab-treated age-related neovascular degeneration: using the stability phase as a benchmark. Graefes Arch Clin Exp Ophthalmol 251, 2327–2330 (2013). https://doi.org/10.1007/s00417-013-2332-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-013-2332-5