Medicare Patients with nAMD Endure Significant Disease Burden

Vincent Garmo, MHS

Credit: LinkedIn

A significant disease burden persists among patients with vision-threatening retinal diseases (VTDRs), particularly neovascular age-related macular degeneration (nAMD), despite the availability of anti-vascular endothelial growth factor (VEGF) therapies, according to new findings.¹

The nationally representative, retrospective, cross-sectional, population-based comparison study showed patients with nAMD demonstrated greater vision impairment and worse functional status, compared with a similar population of Medicare beneficiaries, from 2006 to 2018.

“These findings suggest there is still significant disease burden in patients with VTDRs, especially nAMD,” wrote the investigative team, led by Vincent Garmo, MHS, director of health economics and outcomes research, Genentech. “Patients with nAMD continue to experience more vision loss and reported a lot of trouble seeing and blindness significantly more often than patients in the control cohort even though most nAMD patients (75%) received anti-VEGF treatment.”

Vision problems have been linked with an increased risk of falls and fractures, as well as a higher fear of falling, in older adults, leading to activity limitation and decreased quality of life.² Other data have shown significant psychological distress in adults with vision impairment, as patients with nAMD experience a notably high risk of depression.³

However, there is a lack of data on the relationship between VTDRs and a patient’s functional status relative to the Medicare population without retinal diseases.¹ In the current study, Garmo and colleagues evaluated the differences in self-reported survey data among Medicare beneficiaries with nAMD, diabetic macular edema (DME), or retinal vein occlusion (RVO).

The team analyzed pooled cross-sectional Medicare Current Beneficiary Survey (MCBS) data linked with Medicare Fee-for-Service claims data from 2006 to 2013 and 2015 to 2018. Outcomes of interest ranged from vision function and loss to overall functioning assessed by difficulties with activities of daily living (ADLs), instrumental ADLs (iADLs), anxiety and depression, and falls and fractures.

Participants for the analysis were community-dwelling adult Medicare beneficiaries with nAMD (n = 1,228), DME (n = 101), or RVO (n = 251). Outcomes, assessed from both MCBS questionnaires and Medicare claims data, were compared with community-dwelling beneficiaries without any VTRDs (n = 104,088), controlling for demographic and clinical differences.

Overall, those in the nAMD cohort were significantly older (83 vs. 72 years) and contained a significantly higher proportion of female patients (61.6% vs. 55.7%; P = .0035), than the control population. Anti-VEGF therapy use was significantly higher (P <.0001) in all 3 VTDR cohorts than the control cohort.

After adjustment for covariates, investigators found individuals with nAMD (odds ratio [OR], 6.14; 95% CI, 5.16 - 7.30; P <.0001) or DME (OR, 3.88; 95% CI, 1.58 - 9.52; P <.01) were more likely to report “a lot of trouble seeing/blindness” than the control cohort. Those with nAMD were also more likely to report difficulties with ADL or iADL (OR, 1.22; 95% CI, 1.03 - 1.45; P < .05), with walking or doing heavy housework being the most reported difficulties.

Overall, patients with nAMD exhibited a greater likelihood of diagnosed vision loss, even after adjustment for characteristics, including the presence of a cataract or glaucoma (OR, 5.39; 95% CI, 4.06 - 7.16; P <.001), compared with control. There were no differences observed for the DME or RVO cohorts, respectively.

After adjustment for age, sex, race or ethnicity, poverty status, comorbidities, or other relevant covariates, Garmo and colleagues found the VTDRs of interest were not significantly associated with anxiety or depression, falls, or fractures.

Noting the significant disease burden faced by patients with nAMD, the team pointed to the poor response to available treatment options in nAMD and the heavy treatment burden related to frequent anti-VEGF injections as relevant factors.

“Solutions for improving vision and functional status in patients living with retinal diseases include facilitating greater patient education and care coordination to facilitate early screening of at-risk patients to prevent irreversible disease progression, as well as improving access to available treatments,” investigators wrote.

References

1. _{Garmo V, Zhao X, Ng CD, et al. The Association of Retinal Disease with Vision Impairment and Functional Status in Medicare Patients. J Health Econ Outcomes Res. 2024;11(1):94-102. Published 2024 Mar 29. doi:10.36469/001c.93022}
2. _{Ehrlich JR, Hassan SE, Stagg BC. Prevalence of Falls and Fall-Related Outcomes in Older Adults with Self-Reported Vision Impairment. J Am Geriatr Soc. 2019;67(2):239-245. doi:10.1111/jgs.15628}
3. _{Lundeen EA, Saydah S, Ehrlich JR, Saaddine J. Self-Reported Vision Impairment and Psychological Distress in U.S. Adults. Ophthalmic Epidemiol. 2022;29(2):171-181. doi:10.1080/09286586.2021.1918177}