Background/aim: Age related macular degeneration (AMD) is the leading cause of severe vision impairment and blindness in older people throughout the developed world and currently affects around 420 000 UK citizens. Choroidal neovascularisation (CNV) is treatable with photodynamic therapy (PDT) but is expensive at over £1200 per treatment. The aim of this study was to assess the cost utility of PDT for better eye, predominantly classic, subfoveal choroidal neovascular lesions secondary to AMD. Methods: Cost utility analysis (CUA) was conducted to estimate the cost effectiveness of PDT for scenarios involving reasonable (6/12) and poor (6/60) visual acuity. The models incorporated data from the Treatment of Age-related Macular Degeneration with PDT (TAP) Study and patient based utilities. The incremental CUA was based on decision analytical models, comparing treatment to a placebo comparator. Extensive one way sensitivity analysis of parameters was conducted to determine the robustness of the model. A discount rate of 6% was used for costs and quality adjusted life years (QALY). Results: Model 1: in people with reasonable initial visual acuity, the cost utility of treating applicable neovascular AMD lesions was £31 607 per QALY saved, with a sensitivity analysis range from £25 285 to £37 928. Model 2: in people with poor initial visual acuity, the cost utility was £63 214 per QALY saved, with a sensitivity analysis range from £54 183 to £75 856. Conclusions: PDT treatment is the only available treatment for some forms of neovascular (''wet'') AMD. Under these assumptions, PDT can be considered moderately cost effective for those with reasonable visual acuity but less cost effective for those with initial poor visual acuity. These findings have implications for ophthalmic practice and healthcare planning.
Aim: To assess the cost effectiveness of high dose zinc and antioxidants for delaying and reducing the progression of early age related macular degeneration (AMD). Background: AMD is the leading cause of severe vision impairment and blindness in older people throughout the developed world. It currently affects around 420 000 people in the United Kingdom. Methods: A cost utility analysis (CUA) was conducted to estimate the cost per quality adjusted life year (QALY) for screening a cohort of men and women, aged 55 years and over, for early AMD and then treating them with zinc and antioxidants. The incremental CUA was based on a decision analytic model, comparing screening with a no screening comparator (current practice). Extensive one way sensitivity analysis of parameters was conducted to determine the robustness of the model. Results: In this model the cost effectiveness of screening for early AMD was £22 722 per quality adjusted life year (QALY) saved. The cost per QALY decreased to £18 948 if photodynamic therapy with verteporfin savings were included. Conclusions: Screening for, and prophylactic treatment of, early AMD is estimated to cost around £22 700 per QALY saved. This cost falls within accepted levels to warrant further investigation. These findings have implications for ophthalmic practice and healthcare planning.I ndividuals with vision impairment experience reduced quality of life, difficulties with activities of daily living, and may be socially isolated. 1Age related macular degeneration (AMD) is the leading cause of severe visual impairment for older people in the developed world. 2 In the United Kingdom the disease affects around 420 000 people and an estimated 214 000 people have registrable vision impairment secondary to AMD.3 Those with visual impairment or blindness use considerable healthcare resources. They also require community support services to maintain independent living in the community. 6 With an ageing population the burden of disease from AMD is expected to increase over time.There are limited options for the treatment of AMD. Laser is effective, but only in around 15% of neovascular AMD cases.7 Photodynamic therapy (PDT) with verteporfin is applicable in a higher percentage of situations 8 but is expensive at around £4800 per patient. 9The National Institute for Clinical Excellence (NICE) is examining its cost effectiveness and it is not currently available on the National Health Service.Smoking is the most important modifiable risk factor for AMD.10 Current smokers develop AMD three to four times more frequently and 10 years earlier than non-smokers. 12However, the ongoing reductions in the prevalence of smoking in developed countries [13][14][15] will not be anywhere near large enough to dramatically alter the incidence of AMD.Research has been conducted into ways of preventing the progression of early AMD. The US National Eye Institute funded the Age Related Eye Disease Study (AREDS), a double masked prospective clinical trial, examined the potential benefit of a prophylacti...
Short exposure of LECs to DDW induced extensive and rapid cell lysis. Distilled-deonized water may be a useful agent for instillation in the capsular bag during sealed-capsule irrigation to prevent posterior capsule opacification.
The purpose of this report was to: (i) outline the potential value of health economic studies into age-related macular degeneration (AMD); (ii) provide an overview of health economic studies pertinent to AMD; and (iii) outline the basic frame work of cost-of-illness studies (a useful first step in applying economic methods). The detection and management of sensory loss in the elderly plays a key role in the Australian Government's Healthy Ageing Strategy. Age-related macular degeneration is currently the leading cause of blindness in elderly Australians. Although a large proportion of AMD cases remain untreatable, the introduction of photo-dynamic therapy provides a relatively expensive and possibly cost-effective innovation for others. Antioxidant therapy has also been proven effective in reducing progression of early to late disease. The discipline of economics can contribute to an understanding of AMD prevention and treatment through: (i) describing the current burden of disease; (ii) predicting the changes in the burden of disease over time, and (iii) evaluating the efficiency of different interventions. Cost-of-illness studies have been performed in many fields of medicine. Little work, however, has been done on describing the economic impact from AMD. A number of different economic evaluation methods can be used in judging the efficiency of possible interventions to reduce the disease burden of AMD. Although complementary in nature, each has specific uses and limitations. Studies of the economic impact of eye diseases are both feasible and necessary for informed health care decision-making.
An observational case report of corneal perforation following scleral indentation in a patient with previously undiagnosed pellucid marginal degeneration is presented. Clinical examination, investigations, and subsequent management of this unwarranted and rare complication are described and discussed. The case highlights the need for thorough anterior segment examination before indirect ophthalmoscopy particularly in the presence of ectatic corneal pathology in which case scleral indentation should be avoided.
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