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. Annual number 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. Current study: 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. Yearly incidence of blindness from AMD
Aldersjusteret

15. Yearly incidence of blindness from other causes
Incidens-rate
Incidens-rate-ratio P
2000
17.6
ref -
2001
19.7
1.12
.16
2002
21.6
1.23
.0079
2003
16.5
0.94
.48
2004
13.3
0.76
.0018
2005
15.9
0.91
.26
2006
12.8
0.73
.0004
2007
12.7
.0002
2008
14.4
0.82
.020
2009
13.2
0.75
.0009
2010
11.7
0.67
<.0001
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)
Den praktiserende lægesynes måske ikke det går så godt, ser de afsluttede håbløsetilfælde. 16

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 17

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: impact on health care system

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 with geographic atrophy
Tør amd udvikler sig i 2 retningen, begge medfører svagsynethed. Våd AMD og tør amd med nethindesvind. NOGEN KALDER REN TØR AMD UDEN GA ELLER CNV FOR TIDLIG 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