The Royal College of Ophthalmologists National Ophthalmology Database Age-related Macular Degeneration Audit: Report 1, Associations with socio-economic deprivation in neovascular age-related macular degeneration

Background: Early diagnosis and treatment of neovascular age-related macular degeneration (NvAMD) improve vision outcomes. This analysis investigates associations of English indices of multiple deprivation 2019 (IMD2019) with baseline characteristics, key care processes and visual acuity (VA) outcomes for NvAMD in the National Ophthalmology Database (NOD). Methods : Eligible eyes started treatment for NvAMD in England between 01/04/2020 and 31/03/2023. Participating centres with ≥25 eyes with baseline VA and IMD2019 data were included. Results: Eligible for analysis were 48 583 eyes from 60 English centres. Median age at start of treatment ranged from 79-82 years between deciles 1 (most deprived) to 10 (least deprived). Median baseline VA ranged from 56 to 60 ETDRS letters for deciles 1 to 10. After one year of treatment (-28 to +84 days), the median number of injections administered ranged from 7-8 for deciles 1 to 10. Loss to follow-up was observed in 13.7% in decile 1, and 11.8% in decile 10. Median VA ranged from 61 to 65 ETDRS letters for deciles 1 to 10. A good VA outcome (≥70 ETDRS letters) was achieved by 35.9% of eyes in decile 1 and 45.5% in decile 10. A poor VA outcome, (decrease of ≥10 ETDRS letters from baseline) was experienced by 18.4% of eyes in decile 1 and 14.5% in decile 10. Conclusions: Patients starting NHS-funded treatment in England for NvAMD and living in areas of higher socio-economic deprivation were typically younger, had lower baseline acuity and achieved worse VA outcomes than those from lower deprivation areas, despite receiving similar treatment.