The Royal College of Ophthalmologists National Ophthalmology Database Age-Related Macular Degeneration Audit, Report 2: Baseline Characteristics, the Care Pathway and 12-Month Visual Acuity and Safety Outcomes for 54,882 Eyes Starting Treatment for Neovascular Age-Related Macular Degeneration.

INTRODUCTION

Real-world datasets typically involve diverse patient populations and provide valuable insights into how therapies work in routine clinical practice. This study reports aggregate data from the United Kingdom age-related macular degeneration (AMD) Audit, focussing on baseline characteristics, treatment and 1-year acuity and safety outcomes for eyes starting treatment for neovascular AMD between April 2021 and March 2023.

METHODS

Anonymised demographic and clinical data, collected as part of routine clinical care, were extracted from electronic medical records at participating centres providing NHS-funded treatment. Analyses were restricted to eyes with baseline visual acuity recorded at treatment initiation.

RESULTS

Analysis included 54,882 eyes of 48,371 patients from 78 participating treatment centres. Just over 60% were female and the median age at the start of treatment was 79.9 years for first treated eyes and 82.2 years for second treated eyes. Median baseline acuity was 60 ETDRS letters (interquartile range (IQR) = 44-70) and 28.1% of eyes had "good" acuity, defined as ≥70 ETDRS letters. The initial three injections, during the loading phase of monthly treatment, were given within 10 weeks in 64% of eyes and the median number of injections in the first 12 months was 6 (IQR 4-8). The median interval between injections at the end of the first year of treatment was 8 weeks (IQR 6-12 weeks). Trained non-medical healthcare professionals administered at least 72% of injections. Median acuity after 12 months was 65 ETDRS letters (IQR 48-75) and 43.1% had "good" visual acuity. The incidence of intra-ocular inflammation and presumed infectious endophthalmitis after each injection were 0.03% (1 in 3,176) and 0.014% (1 in 7,013) respectively. There was no difference in the incidence of either complication by profession of the injector.

CONCLUSION

Aggregate data from the UK AMD Audit provides real-world evidence and a benchmark against which other countries and centres can compare local performance and outcomes. Almost 91% of eyes retained stable acuity and avoided moderate visual loss after 12 months of treatment. The best acuity outcomes were obtained in younger patients and in eyes treated second, with good baseline acuity, prompt completion of the loading phase of treatment and receiving more injections during the first 12 months of treatment.