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The effects of technological advances on outcomes for elderly persons with exudative age-related macular degeneration.

Publication ,  Journal Article
Sloan, FA; Hanrahan, BW
Published in: JAMA ophthalmology
April 2014

IMPORTANCE Exudative age-related macular degeneration (ARMD) is the major cause of blindness among US elderly. Developing effective therapies for this disease has been difficult. OBJECTIVES To assess the effects of introducing new therapies for treating exudative ARMD on vision of the affected population and other outcomes among Medicare beneficiaries newly diagnosed as having ARMD. DESIGN The study used data from a 5% sample of Medicare claims and enrollment data with a combination of a regression discontinuity design and propensity score matching to assess the effects on the introduction or receipt of new technologies on study outcomes during a 2-year follow-up period. SETTING AND PARTICIPANTS The analysis was based on longitudinal data for the United States, January 1, 1994, to December 31, 2011, for Medicare beneficiaries with fee-for-service coverage. The sample was limited to beneficiaries 68 years or older newly diagnosed as having exudative ARMD as indicated by beneficiaries having no claims with this diagnosis in a 3-year look-back period. EXPOSURES The comparisons with vision outcomes were after vs before the introduction of photodynamic therapy and anti-vascular endothelial growth factor (VEGF) therapy. The comparisons for depression and long-term care facility admission were between beneficiaries newly diagnosed as having exudative ARMD who received photodynamic therapy or anti-VEGF therapy compared with beneficiaries having the diagnosis who received no therapy for this disease. MAIN OUTCOMES AND MEASURES Onset of decrease in vision, vision loss or blindness, depression, and admission to a long-term care facility. RESULTS Among beneficiaries newly diagnosed as having exudative ARMD, the introduction of anti-VEGF therapy reduced vision loss by 41% (95% CI, 52%-68%) and onset of severe vision loss and blindness by 46% (95% CI, 47%-63%). Such beneficiaries who received anti-VEGF therapy and were not admitted to a long-term care facility during the look-back period were 19% (95% CI, 72%-91%) less likely on average to be admitted to a long-term care facility during the follow-up period. CONCLUSIONS AND RELEVANCE This study demonstrates gains in population vision from the introduction of anti-VEGF therapy for patients 68 years or older with an exudative ARMD diagnosis in community-based settings in the United States.

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Published In

JAMA ophthalmology

DOI

EISSN

2168-6173

ISSN

2168-6165

Publication Date

April 2014

Volume

132

Issue

4

Start / End Page

456 / 463

Related Subject Headings

  • Wet Macular Degeneration
  • Visual Acuity
  • Vascular Endothelial Growth Factor A
  • United States
  • Treatment Outcome
  • Photochemotherapy
  • Ophthalmology & Optometry
  • Medicare
  • Male
  • Long-Term Care
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Sloan, F. A., & Hanrahan, B. W. (2014). The effects of technological advances on outcomes for elderly persons with exudative age-related macular degeneration. JAMA Ophthalmology, 132(4), 456–463. https://doi.org/10.1001/jamaophthalmol.2013.7647
Sloan, Frank A., and Brian W. Hanrahan. “The effects of technological advances on outcomes for elderly persons with exudative age-related macular degeneration.JAMA Ophthalmology 132, no. 4 (April 2014): 456–63. https://doi.org/10.1001/jamaophthalmol.2013.7647.
Sloan, Frank A., and Brian W. Hanrahan. “The effects of technological advances on outcomes for elderly persons with exudative age-related macular degeneration.JAMA Ophthalmology, vol. 132, no. 4, Apr. 2014, pp. 456–63. Epmc, doi:10.1001/jamaophthalmol.2013.7647.

Published In

JAMA ophthalmology

DOI

EISSN

2168-6173

ISSN

2168-6165

Publication Date

April 2014

Volume

132

Issue

4

Start / End Page

456 / 463

Related Subject Headings

  • Wet Macular Degeneration
  • Visual Acuity
  • Vascular Endothelial Growth Factor A
  • United States
  • Treatment Outcome
  • Photochemotherapy
  • Ophthalmology & Optometry
  • Medicare
  • Male
  • Long-Term Care