Dr Robert Finger
About 5,000 Australians a year with wet age-related macular degeneration may be missing out on injections to delay AMD progression, a study has estimated.
Centre for Eye Research Australia and Macular Disease Foundation Australia have joined forces to determine why so many may be missing out on injections to treat their condition.
Head of Population Health at the Centre for Eye Research Australia, ophthalmologist Dr Robert Finger, found a ‘large discrepancy’ between the number of people expected to receive Lucentis injections and the number who actually received them.
Dr Finger, a medical retinal specialist, treats patients with AMD and diabetic retinopathy at the Royal Victorian Eye and Ear Hospital and the Royal Melbourne Hospital.
He analysed Medicare data from 2012 to determine who started Lucentis injections for neovascular AMD. The period was before Eylea was listed on the Pharmaceutical Benefits Scheme so only data for those receiving Lucentis was reviewed.
‘We compared this to how many people we thought should have started the treatment based on incidence figures and other findings from the renowned Blue Mountains Eye Study,’ Dr Finger said.
‘Comparing PBS data and population-based incidence, there is a large gap between people receiving treatment and those who are in need of treatment.
‘We found a large discrepancy as we would have expected about 20,000 people to develop neovascular AMD per year but PBS data revealed that less than 10,000 people were going on the treatment per year.
‘Based on conservative estimates, we estimate there is a gap of more than 5,000 cases [of patients who are not receiving injections for neovascular AMD].’
Researchers used the conservative estimate of 5,000 missing out rather than 10,000 to account for a small proportion of patients who would have used Avastin and because the Blue Mountains Eye Study was only in one region and incidence figures may be different elsewhere in Australia.
Dr Finger will conduct a more complete analysis of additional and more recent data obtained from Medicare. He has begun analysis of this data but it is too early to tell why patients were not receiving therapeutic injections.
Concerns in Victoria
Macular Disease Foundation Australia CEO Julie Heraghty said the foundation had been concerned for some time about the uptake of treatment for wet AMD, especially in Victoria, and had begun initial analysis of the data.
‘Combining our forces with CERA will enable this very important study which is critical to help us see gaps in treatment and determine whether people not accessing treatment is more of a problem in rural areas or in different states,’ she said.
‘It will help find regions where there are bigger discrepancies than others, which will enable the foundation to target those areas for awareness-raising for early detection, symptom recognition, early diagnosis and treatment.
‘Every person with wet AMD who needs treatment should have access to that treatment as it could save their sight.’
Dr Finger said most AMD patients were elderly and some were in nursing homes.
‘It is more difficult for them to access services as they are not very mobile so they may be falling through the cracks,’ he said. ‘They might be hesitant to go to a new doctor or a big hospital.
‘I think it also likely that access may be a major reason why people miss out as people are not likely to be misdiagnosed because optometrists are generally the first port of call and once an optometrist sees a fundus shot they can usually tell the patient has AMD and refer them for treatment.’
Ms Heraghty said a key message of the foundation was to have your eyes tested and macula checked. ‘The use of an Amsler grid to self-monitor at home between visits to the eye-care professional is also critical,’ she said.
‘Often people don’t notice loss of vision in one eye as long as their vision is good in the other and the Amsler grid can help support early detection, rapid diagnosis and sight-saving treatment.’
The study will also help determine the barriers to treatment such as availability, cost (gap fees), the need for ongoing monitoring and treatment, and perceptions that intraocular injections are uncomfortable.
Originally from Germany, Dr Finger is the fourth recipient of the University of Melbourne’s Annemarie Mankiewicz-Zelkin Fellowship. This is helping to fund the research along with a clinical investigatorship from the Sylvia and Charles Viertel Charitable Foundation and funding from Macular Disease Foundation Australia.