Fasler, K. | Search bioRxiv

bioRxiv2019

The Moorfields AMD Database Report 2 - Fellow Eye Involvement with Neovascular Age-related Macular Degeneration

Background/AimsNeovascular age-related macular degeneration (nAMD) is frequently bilateral, and previous reports on fellow eyes have assumed sequential treatment after a period of treatment of the first eye only. The aim of our study was to analyse baseline characteristics and visual acuity (VA) outcomes of fellow eye involvement with nAMD, specifically differentiating between sequential and non-sequential (due to macular scarring in the first eye) anti-vascular endothelial growth factor treatment and timelines for fellow eye involvement.\n\nMethodsRetrospective, electronic medical record database study of the Moorfields AMD database of 8174 eyes/120,756 single entries with data extracted between October 21, 2008 and August 9, 2018. The dataset for analysis consisted of 1180 sequential, 413 nonsequential, and 1110 unilateral eyes.\n\nResultsMean VA of sequentially treated fellow eyes at baseline was significantly higher (62{+/-}13), VA gain over two years lower (0.65{+/-}14), and proportion of eyes with good VA ([≥]20/40 or 70 letters) higher (46%) than the respective first eyes (baseline VA 54{+/-}16, VA gain at two years 5.6{+/-}15, percentage of eyes with good VA 38%). Non-sequential fellow eyes showed baseline characteristics and VA outcomes similar to first eyes. Fellow eye involvement rate was 32% at two years, and median time interval to fellow eye involvement was 71 (IQR 27-147) weeks.\n\nConclusionThis reports shows sequentially treated nAMD fellow eyes have better baseline and final VA than non-sequentially treated eyes after 2 years of treatment. Sequentially treated eyes also had a greater proportion with good VA after 2 years of treatment.\n\nPRECISDepending on age, fellow eye involvement occurs in 32% of patients with neovascular AMD by two years. Fellow eyes generally maintain better vision, except in cases where late-stage disease in the first eye was untreated.

epidemiology↗

bioRxiv2018

One and Two Year Visual Outcomes from the Moorfields AMD Database - an Open Science Resource for the Study of Neovascular Age-related Macular Degeneration

ObjectivesTo analyse treatment outcomes and share clinical data from a large, single-center, well-curated database (8174 eyes / 6664 patients with 120,756 single entries) of patients with neovascular age related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (VEGF). By making our depersonalised raw data openly available, we aim to stimulate further research in AMD, as well as setting a precedent for future work in this area.\n\nSettingRetrospective, comparative, non-randomised electronic medical record (EMR) database cohort study of the UK Moorfields AMD database with data extracted between 2008 and 2018.\n\nParticipants3357 eyes/patients (61% female). Extraction criteria were [≥] 1 ranibizumab or aflibercept injection, entry of \"AMD\" in the diagnosis field of the EMR, and a minimum of one year of follow-up. Exclusion criteria were unknown date of first injection and treatment outside of routine clinical care at Moorfields before the first recorded injection in the database.\n\nMain outcome measuresPrimary outcome measure was change in VA at one and two years from baseline as measured in Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Secondary outcomes were the number of injections and predictive factors for VA gain.\n\nResultsMean VA gain at one-year and two years were +5.5{+/-}0.5 and +4.9{+/-}0.68 letters respectively. Fifty-four percent of eyes gained [≥]5 letters at two years, 63% had stable VA ({+/-}[≤]14 letters), forty-four percent of eyes maintained good VA ([≥]70 letters). Patients received a mean of 7.7{+/-}0.06 injections during year one and 13.0{+/-}0.2 injections over two years.\n\nYounger age, lower baseline VA, and more injections were associated with higher VA gain at two years.\n\nConclusionThis study benchmarks high quality EMR study results of real life AMD treatment and promotes open science in clinical AMD research by making the underlying data publicly available.\n\nStrengths and limitations of this study- Large sample size, retrospective, single centre, electronic medical record database study\n- High quality real life data\n- Open science approach with sharing of depersonalised raw data

epidemiology↗