Claire Gill, Catherine Hewitt, Ada Keding, Richard Gale
Neovascular age-related Macular Degeneration (nAMD) represents one of the leading causes of blindness in both developed and developing countries. This paper examines inequalities and variations in visual outcomes for people being treated for nAMD, the reasons behind any variation. nAMD began to be treated via intraocular injections With Anti-Vascular Endothelial Growth Factors (anti-VEGF) after 2006. This paper draws on the landmark trials that first established the safety and efficacy of anti-VEGF therapy for nAMD. Using a systematic review previously published by the authors, this paper investigated whether there were factors that could be identified from the dataset that influenced how effective anti-VEGF therapy is in reducing visual loss in patients with nAMD. This paper highlights the importance of being able to identify modifiable factors, such as number of anti-VEGF injections received, that could lead to better visual outcomes for these patients. This paper then goes on to examine levels of variation in visual outcome in nAMD nationally in the UK, as well as further investigating any influencing factors that could not be identified in the previously published systematic review. This was done using a large real-world dataset of over 26,00 patients from seven hospitals. These highlighted significant levels of variation, but struggled to identify definitively further influencing factors, such as ethnicity or social deprivation. This could be because there genuinely was not an associated relationship between these factors and visual outcomes, but certainly in the case of ethnicity, it is particularly apparent that there was an overwhelmingly white population, so there may have not been enough ethnic variation to detect any effect of ethnicity.