Treatment of AMD i Denmark

1. Treatment of AMD i Denmark Inger Christine Munch, MD Roskilde Hospital Michael Larsen Glostrup Hospital

2. 17MAY 2010 Copenhagen, meeting at the Danish Society of the Blind

3. 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

4. Årsag? Have the ophthalmologists stopped encouraging the newly legally blind to join the society?

5. 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 …

6. Annualnumber of new members of the Danish Society of the Blind

7. 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

8. - Membership censored; only by referral from an ophthalmologist- Not obligatory reporting

10. 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

11. Currentstudy: Incidence and cause of blindness 2000-2010

13. Denmark: dramatic reduction in AMD-associated blindness Annual incidence of legal blindness per 100,000 inhabitants aged ≥50 years

14. Yearlyincidence of blindness from AMD Aldersjusteret

15. Yearlyincidence of blindness from othercauses Aldersjusteret

16. 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)

17. 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

19. 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

21. Israel: Yearly incidence of blindness, all causes Et fald på 51% fra 1999 til 2008 Annual incidence of legal blindness per 100,000 inhabitants

22. Israel: Dramatic reduction in AMD-associated blindness Annual incidence of legal blindness per 100,000 inhabitants

23. Change % in annual rate of blindness due to AMD %, adjusted for age and sex

24. Other causes of blindness

25. Israel, 4 most frequent causes of blindness

26. Incident blindness in Danmark : AMD the most frequent cause Number of new members >50 years of age

27. Wet AMD therapy: impactonhealthcare system 2007 2008 2009 2010 2011

28. Denmark: dramatic reduction in AMD-associated blindness Annual incidence of legal blindness per 100,000 inhabitants aged ≥50 years

29. AMD: It’s in your blood • Approximately 50% of the risk is attributable to genetic factors at the population level

30. Dry AMD Wet AMD Dry AMD with geographic atrophy Vision loss

31. 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

32. 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

33. Denmark: dramatic reduction in AMD-associated blindness Annual incidence of legal blindness per 100,000 inhabitants aged ≥50 years