Imagine a place where patients with neovascular age-related macular degeneration (nAMD) can maintain good vision 10 or more years from diagnosis.
That place is Australia. Widely considered as among the best in the world for nAMD management, patients can continue to live full and active lives long with the help of early diagnosis and regular intravitreal anti-VEGF treatments.
The introduction in 2007 of ranibizumab intravitreal injections, and the subsequent approval of aflibercept, was a revolution in preventing vision loss in Australia.
From 2007 to 2016, the estimated incidence of registered blindness in Western Australia declined from 55.9 to 8.27 cases per 100,000 person-years and the mean age of those registering blind increased from 83.4 to 86.8 years. Blindness in over-50s due to AMD peaked at 77% in 2006 and declined to 41% by 2016.1
A publication from the Fight Retinal Blindness! registry reported 132 eyes of 117 Australian and New Zealand patients on average maintained their baseline visual acuity after 10 years treatment.2 Importantly, 42% of treated eyes had 6/12 or better visual acuity, up from 36% a decade before.
But these outcomes are the exception. Numerous barriers exist between patients and successful long-term outcomes, leading instead for many to irreversible vision loss and blindness.
Current estimates suggest 156,000 Australians are living with nAMD.3 Only an estimated 51,000 are receiving treatment for their disease.4
It is unknown how many develop nAMD but do not seek expert eye care. It is not known how many are referred by their optometrist but do not visit an ophthalmologist for diagnosis. And it is not known how many diagnosed patients forego sight-saving treatment.
MDFA is currently piloting a program with Optometrists that specifically aims to support patients commencing intravitreal treatment via the MDFA My Eyes program.
For those who do start anti-VEGF treatment, patients face substantial hurdles to continuing treatment. The burden of frequent injections – on average 7–8 each year for each eye, but more for many – and the associated out-of-pocket expenses and travel are significant concerns.
More than 50% of patients stop treatment within 5 years. The proposed 69% cut in the MBS rebate for intravitreal injections would lead an additional 47,000 patients to stop treatment and develop severe vision loss or blindness within 5 years.5
As we move into 2022, Macula Month coincides with the next Federal Election and PBAC review of two potential new treatments for nAMD. MDFA continues our advocacy in support of affordable access to care for patients with nAMD, and to seek solutions to increase long term adherence and persistence to treatment.
Posted: 21 February 2022
References
1. Heath Jeffery et al. Incidence of Newly Registered Blindness From Age-Related Macular Degeneration in Australia Over a 21-Year Period: 1996–2016. Asia Pac J Ophthalmol 2021; 10: 442-449. doi_10.1097_APO.0000000000000415
2. Gillies et al Am J Ophthalmol 2020 210 116-124. doi_10.1016_j.ajo.2019.10.007
3. Deloitte Access Economics and Macular Degeneration Foundation (2011). Eye on the future – A clear outlook on age-related macular degeneration.
4. DUSC (2018). Ranibizumab and Aflibercept: Analysis of Use for AMD, DMO, BRVO and CRVO. Accessed at https://www.pbs.gov.au/pbs/industry/listing/participants/public-release-docs/2018-05/ranibizumab_and_aflibercept__analysis_of_use_for_amd%2C_dmo%2C_b
5. PwC (2019). Impact of IVI rebate changes. Report commissioned by Macular Disease Foundation Australia.
In the lab: Professor Erica Fletcher
MDFA funding has allowed Professor Erica Fletcher to take strides towards identifying people at risk of age-related macular degeneration.
