HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Bandello, F. Articles by Berdeaux, G. Search for Related Content PubMed PubMed Citation Articles by Bandello, F. Articles by Berdeaux, G.

Public Health Impact of Neovascular Age-Related Macular Degeneration Treatments Extrapolated from Visual Acuity

¹From the Department of Ophthalmology, University of Udine, Udine, Italy; ²Cemka-Eval, Bourg-la-Reine, France; ³Alcon France, Rueil-Malmaison, France; and ⁴Conservatoire National des Arts et Métiers de Paris, Paris, France.

PURPOSE. To estimate the potential public health impact of treatment with new medications intended to preserve vision in patients with neovascular age-related macular degeneration (AMD).

METHODS. A Markov model was used to simulate the natural history of AMD over the lifetime of patients with diagnosed neovascular AMD from clinical trials and epidemiologic surveys. It applied to a cohort of patients aged 75 years, with newly diagnosed neovascular AMD in one eye, whose visual acuity was 0.7 logMAR. Probabilities were calculated for the risk of AMD in the remaining eye and for premature mortality. Results of the model were expressed as the duration of low vision (worse eye VA>1.0 and better eye VA>0.7 logMAR) and blindness (bilateral VA >1.0 logMAR). Health consequences of blindness and low vision were estimated for depression, hip fractures, institutionalization, and life expectancy.

RESULTS. For AMD patients with a 50% probability of VA >1.0 logMAR at 1 year, in one eye, the probability of lifetime bilateral blindness was >47%. The patients would live approximately 7 years with monocular vision >1.0 logMAR and an additional 4 years with bilateral blindness and a >15% probability of depression due to AMD. Life expectancy was decreased by approximately 2 years, >90/1000 patients would sustain a new hip fracture, and 1.5% of the patients would require institutional care for visual impairment due to AMD. To achieve a defined public health outcome (visual impairment and consequent comorbidity), it was necessary for the VA effectiveness of new treatments to increase in parallel with disease severity.

CONCLUSIONS. Comorbidity related to visual impairment contributes significantly to the public health impact of AMD. Aggressive lesions need highly effective treatments. Models may be used to compare the public health impact of placebo-controlled clinical trial results.

This article has been cited by other articles:

				E Loane, C Kelliher, S Beatty, and J M Nolan The rationale and evidence base for a protective role of macular pigment in age-related maculopathy Br. J. Ophthalmol., September 1, 2008; 92(9): 1163 - 1168. [Abstract] [Full Text] [PDF]