treatment of amd i denmark inger christine munch, md roskilde hospital michael larsen glostrup...
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Treatment of AMD i Denmark
Inger Christine Munch, MDRoskilde HospitalMichael Larsen
Glostrup Hospital
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17MAY 2010 Copenhagen, meeting at the Danish Society of the Blind
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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
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Årsag?
Have the ophthalmologists stopped encouraging the newly legally blind to join the society?
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- 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 …
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Annual number of new members of the Danish Society of the Blind
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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
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- Membership censored; only by referral from an ophthalmologist- Not obligatory reporting
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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
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Current study: Incidence and cause of blindness 2000-2010
Dias 11
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Denmark: dramatic reduction in AMD-associated blindness
Annual incidence of legal blindness per 100,000 inhabitants aged ≥50 years
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Yearly incidence of blindness from AMD
Year Incidens-
rate Incidens-rate-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
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Yearly incidence of blindness from other causes
YearIncidens-
rateIncidens-rate-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
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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)
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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
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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
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Israel: Yearly incidence of blindness, all causes
Et fald på 51% fra 1999 til 2008Annual incidence of legal blindness per 100,000 inhabitants
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Israel: Dramatic reduction in AMD-associated blindness
Annual incidence of legal blindness per 100,000 inhabitants
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Change % in annual rate of blindness due to AMD
-1.3
-12.2
-16
-12
-8
-4
0
1999–2003 2004–2009
%, adjusted for age and sex
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Other causes of blindness
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Israel, 4 most frequent causes of blindness
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Incident blindness in Danmark : AMD the most frequent cause
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Wet AMD therapy: impact on health care system
2007 2008 2009 2010 2011
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Denmark: dramatic reduction in AMD-associated blindness
Annual incidence of legal blindness per 100,000 inhabitants aged ≥50 years
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AMD: It’s in your blood
• Approximately 50% of the risk is attributable to genetic factors at the population level
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Dry AMD
Wet AMD Dry AMD with geographic atrophy
Vision loss
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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
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• 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
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Denmark: dramatic reduction in AMD-associated blindness
Annual incidence of legal blindness per 100,000 inhabitants aged ≥50 years