Transcript Treatment of AMD from a clinical peprspective

Treatment of AMD i Denmark
Inger Christine Munch, MD
Roskilde Hospital
Michael Larsen
Glostrup Hospital
17MAY 2010 Copenhagen, meeting
at the Danish Society of the Blind
The president and vice president of
the Danish Society of the Blind
discussed whether a marked recent
decrease in the number of new
members was the result of changing
referral practices among the Danish
ophthalmologists
Årsag?
Have the ophthalmologists stopped
encouraging the newly legally blind
to join the society?
- or is blindness decreaseing, perhaps
as a consequence of better
treatment of wet AMD, the leading
cause of blindness in Denmark?
- Let us look at the numbers …
Annual number of new members of
the Danish Society of the Blind
Is there a national register of
handicaps in Denmark?
There is no such register
The membership statistics of the Danish Society
of the Blind is the only good source of
blindness statistics in Denmark
- Membership censored; only by
referral from an ophthalmologist
- Not obligatory reporting
Criteria for membership
• BCVA (best corrected visual acuity) in the best
eye ≤ 0.1 (6/60)
• Visual field defects that cause an equivalent
degree of disability, e.g. homonymous
hemianopsia
Current study: Incidence and cause
of blindness 2000-2010
Dias 11
Denmark: dramatic reduction in
AMD-associated blindness
Annual incidence of
legal blindness per
100,000 inhabitants
aged ≥50 years
Yearly incidence of blindness from
AMD
Year
Incidensrate
Incidensrate-ratio
P
2000
52.2
ref
-
2001
57.9
1.10
.023
2002
57.3
1.09
.052
2003
54.4
1.04
.35
2004
47.7
0.92
.077
2005
46.4
0.89
.020
2006
48.5
0.94
.16
2007
39.0
0.75
<.0001
2008
34.3
0.66
<.0001
2009
32.0
0.62
<.0001
2010
25.7
0.50
<.0001
Aldersjusteret
Yearly incidence of blindness from
other causes
Year
Incidensrate
Incidensrate-ratio
P
2000
17.6
ref
-
2001
19.7
1.12
.16
2002
21.6
1.23
.0079
2003
16.5
0.94
.48
2004
13.3
0.76
.0018
2005
15.9
0.91
.26
2006
12.8
0.73
.0004
2007
12.7
0.73
.0002
2008
14.4
0.82
.020
2009
13.2
0.75
.0009
2010
11.7
0.67
<.0001
Aldersjusteret
Do the changes in annual new
members of the Danish Society of
the Blind reflect changes in the
incidence blindness?
• Physicians’ referral practices may have changed
• Patient preferences may have changed
(Referral is not mandated by law)
Control study: Referral patterns at the Glostrup
Hospital
2325 patients in current treatment with VEGF-inhibitors
• 68 legally blind could potentially have been referred
• 54 (86%) had actually been referred to the Danish
Society of the blind
Israel
• Population of 7.3 mill. in 2008
• National register of the blind, obligatory
referral
• BCVA in best eye ≤ 0.05 (3/60)
• Visual field < 20° in best eye
Israel: Yearly incidence of
blindness, all causes
Et fald
Annual incidence
of
legal blindness per
100,000 inhabitants
på 51% fra 1999 til 2008
Israel: Dramatic reduction in AMDassociated blindness
Annual incidence of
legal blindness per
100,000 inhabitants
Change % in annual rate of blindness
due to AMD
1999–2003 2004–2009
0
-4
-1.3
-8
-12
-12.2
-16
%, adjusted for age and sex
Other causes of blindness
Israel, 4 most frequent
causes of blindness
Number of new members >50 years of age
Incident blindness in Danmark :
AMD the most frequent cause
Wet AMD therapy:
impact on health care system
2007
2008
2009
2010
2011
Denmark: dramatic reduction in
AMD-associated blindness
Annual incidence of
legal blindness per
100,000 inhabitants
aged ≥50 years
AMD: It’s in your blood
• Approximately 50% of the risk is attributable
to genetic factors at the population level
Dry AMD
Wet AMD
Dry AMD with
geographic atrophy
Vision loss
Caveat!
• Anti-VEGF therapy does not address the
fundamental pathogenesis of AMD
• It is foreseeable that the immediate benefit of
wet AMD therapy may be overtaken in the
long run by geographic atrophy of the RPE and
the retinal photoreceptors
• No treatment for drusen-AMD
• No treatment for geographic atrophy
• No treatment for fibrosis
• Need for repeated treatment in wet AMD:
–
–
–
–
cumulative risk of complications
discomfort
inconvenience
costs
Denmark: dramatic reduction in
AMD-associated blindness
Annual incidence of
legal blindness per
100,000 inhabitants
aged ≥50 years