Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
Genentech, South San Francisco, CA, USA.
Eye (Lond). 2023 Jun;37(8):1652-1658. doi: 10.1038/s41433-022-02208-x. Epub 2022 Aug 26.
To determine baseline visual acuity before the start of treatment for neovascular age-related macular degeneration (AMD), compare median and visual acuity states between treatment sites and investigate the association of socio-demographic and clinical characteristics with baseline acuity.
Anonymised demographic and clinical data, collected as part of routine clinical care, were extracted from electronic medical records at treating National Health Service (NHS) Trusts. Analyses were restricted to eyes with baseline visual acuity recorded at treatment initiation. Associations with baseline acuity were investigated using multivariate linear regression.
Analysis included 12,414 eyes of 9116 patients at 13 NHS Trusts. Median baseline acuity was LogMAR 0.46 (interquartile range = 0.26-0.80) and 34.5% of eyes had good acuity, defined as LogMAR ≤0.3. Baseline acuity was positively associated with second-treated eye status, younger age, lower socio-economic deprivation, independent living, and female sex. There was little evidence of association between baseline acuity and distance to the nearest treatment centre, systemic or ocular co-morbidity. Despite case-mix adjustments, there was evidence of significant variation of baseline visual acuity between sites.
Despite access to publicly funded treatment within the NHS, variation in visual acuity at the start of neovascular AMD treatment persists. Identifying the characteristics associated with poor baseline acuity, targeted health awareness campaigns, professional education, and pathway re-design may help to improve baseline acuity, the first eye gap, and visual acuity outcomes.
在新生血管性年龄相关性黄斑变性（AMD）开始治疗之前确定基线视力，比较治疗部位之间的中位数和视力状态，并研究社会人口统计学和临床特征与基线视力的相关性。
从治疗性国家卫生服务（NHS）信托机构的电子病历中提取作为常规临床护理一部分收集的匿名人口统计学和临床数据。分析仅限于在治疗开始时记录有基线视力的眼睛。使用多元线性回归研究与基线视力的相关性。
分析包括 13 家 NHS 信托机构的 9116 名患者的 12414 只眼睛。中位数基线视力为 LogMAR 0.46（四分位距=0.26-0.80），34.5%的眼睛视力良好，定义为 LogMAR≤0.3。基线视力与第二只治疗眼的状态、年龄较小、社会经济贫困程度较低、独立生活和女性性别呈正相关。基线视力与最近治疗中心的距离、全身或眼部合并症之间几乎没有关联的证据。尽管进行了病例组合调整，但仍有证据表明各站点之间的基线视力存在显著差异。
尽管在 NHS 中可以获得公共资助的治疗，但新生血管性 AMD 治疗开始时视力的差异仍然存在。确定与较差基线视力相关的特征、有针对性的健康意识宣传、专业教育和途径重新设计可能有助于提高基线视力、第一只眼差距和视力结果。
