OBJECTIVES

: It has been reported that inadequate clinic capacity in the hospital eye service (HES) in the UK NHS has “threatened optimal care and access to potentially sight-saving treatment for patients with nAMD”. The Nd:YAG capsulotomy procedure places a resource burden on the HES. The condition it treats, Posterior capsule opacification (PCO) (most common post-cataract surgery complication) is heavily influenced by intraocular lens (IOL) choice for cataract surgery. The objective was to estimate potential cases of legal blindness (Visual acuity (VA) of 20/200 Snellen) and costs avoided if out-patient appointments were used administrating Anti-VEGF injections to nAMD patients rather than performing unwanted Nd:YAG procedures for PCO.

METHODS

: The expected number of avoided Nd:YAG procedures was calculated applying published 3-year incidence rates (AcrySof: 2.4% v average rate: 6.4%) to annual cataract procedures estimates. Assuming 15.9 injections over 3-years per person, we simulated worsening to/improving from VA of 20/200 in the same number of patients without and with this treatment using a simple two-state 3-year Markov model. We applied published rates of worsening to/improving from VA of 20/200, annual cost of blindness of £6,957 per the NICE Macular degeneration guideline, and 3.5% discount rate.

RESULTS

: Total number of Nd:YAG procedures avoided assuming rates associated with AcrySof IOLs (compared to the average rate) over 3-years were estimated at 19,237. Over the same period, assuming these outpatient appointments were allocated to administer Anti-VEGF injections to nAMD patients, our model estimates 844 cases of legal blindness could be avoided – resulting in averting potential costs associated with blindness of £9.5 million over 3-years.

CONCLUSIONS

: The evidence suggests that choosing AcrySof IOLs for cataract surgery reduces the requirement for Nd:YAG capsulotomy procedures. These resources could be reallocated in the HES in the NHS – offering a potential opportunity to alleviate the rapidly growing demand on services for treating nAMD.