Incidence and Real-world Clinical Practice of Exudative Age-related Macular Degeneration: A Nationwide Population-Based Cohort Study

Abstract

Purpose

To elucidate the incidence and treatment pattern of active exudative age-related macular degeneration (AMD).

Design

A population-based cohort study conducted using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), a national claims database managed by the Japanese Ministry of Health, Labour, and Welfare (MHLW).

Subjects

The entire Japanese population aged 40 years or older (76 million people).

Methods

With the permission of the MHLW, we accessed the complete NDB dataset and identified patients newly diagnosed with active exudative AMD between 2011 and 2018. The incidence of active exudative AMD was categorized by age and sex per year between 2011 and 2018; moreover, details regarding first-line therapy and number of anti-VEGF injections per elapsed year since initial treatment were obtained and changes in treatment pattern were investigated.

Main Outcome Measures

Incidence rate of active exudative AMD.

Results

During the specified 8-year period, 246,064 incident cases of active exudative AMD were identified; 61.4% of these patients were men. The overall incidence rate in the general population aged 40 years or older was 40.66 per 100,000 person-years (95% CI, 40.49–40.82), that in men was 53.22 (95% CI, 52.95–53.49), and that in women was 29.78 (95% CI, 26.60–29.98). Mean age of onset was lower in men than in women (72.51 ± 10.50 years vs. 73.90 ± 10.46 years). Among newly diagnosed active exudative AMD patients, 92.9% received anti-VEGF injections for initial treatments, while 1.8% underwent combination therapy with photodynamic therapy. The number of anti-VEGF injections in the first year (0–12 months), second year (13–24 months), and third year (25–36 months) after the initial injection was 3.66 ± 2.30, 1.39 ± 2.20, and 1.23 ± 2.19, respectively. Patients who received fewer injections in the first year received fewer injections in subsequent years, and vice versa.

Conclusions

This is the largest population-based study on the detailed epidemiology and real-world treatment patterns of active exudative AMD. Our results can be a fundamental information to ensure healthy eyes and promote well-being for all at all ages.