Real-world strategies for wet AMD
In many clinical areas, early consultant-led intervention has been shown to improve clinical and patient-reported outcomes and to reduce overall treatment costs.
This paper reconfirms this finding in the treatment of wet age-related macular degeneration (wet AMD) and presents data from a publicly funded NHS fast-track (FT) centre in north-west England that aims to see and treat patients within 48 hours of referral.
Outcomes, in this real-world setting and at commissioning scale, exceed those from clinical studies.
National treatment guidelines are not onerous but are nevertheless often not met, and this paper reinforces the clinical benefits of early and on-protocol treatment and the consequent importance of patient, provider and commissioner education.
Given the cost to patients and society of poor compliance and outcomes, we call for systematic monitoring of performance metrics on a national scale.
Wet AMD is a common eye condition that leads to rapid and progressive loss of central vision and severe visual impairment.
Two agents, the anti-vascular endothelial growth factor (VEGF) antibody ranibizumab (Lucentis, Novartis) and the VEGF trap aflibercept (Eyelea, Bayer), have been shown to be highly effective in inhibiting the neovascularisation that is characteristic of wet AMD and stabilising or improving vision in most patients.
Two pivotal randomised controlled trials, ANCHOR1 and MARINA,2 underpin the use of intravitreal ranibizumab in the treatment of wet AMD. In the ANCHOR study, in which ranibizumab was administered on a four-weekly basis over two years, visual acuity (VA) improved by 15 or more letters in 40.3% of patients, with a mean improvement of 11.3 letters at one year and 10.7 letters at two years.