NICE update: guideline targets macular degeneration

The guideline (NG82) also raises awareness that anti-VEGF treatment for patients with late AMD (wet active) and visual acuity better than 6/12 is clinically effective and may be cost-effective depending on the regimen used.

AMD is the commonest cause of severe visual impairment in older adults in the developed world. The two main late AMD phenotypes – geographic atrophy and exudative AMD – are responsible for two-thirds of registrations of visual impairment or blindness in the UK. It is estimated a quarter of a million older adults in the UK alone suffer from blindness due to this condition.

There has been a significant increase in hospital activity in England for treatment and monitoring people with a primary diagnosis of AMD from less than 10,000 visits in 2005/06 to over 75,000 in 2013/14. The most common primary procedure in hospital visits of people with a primary diagnosis of macular degeneration involves intravitreal injection.

About 80% of people with late AMD (wet active) have visual acuity between 6/12 and 6/96. In current practice anti-VEGF treatments (anti–vascular endothelial growth factor therapy given as intravitreal injections) tends to be in line with NICE guidance on ranibizumab and pegaptanib (TA155) and aflibercept (TA294). 

More prescribing is anticipated as a result of the guideline recommending treatment for people with late AMD (wet active), and visual acuity not within the range 6/12 to 6/96. However, earlier prescribing (for people with visual acuity better than 6/12) should require less treatment overall.

A small resource impact is anticipated occurring gradually over the next five years – a resource impact report and template are available on the NICE website. List prices of anti-VEGF treatments included in the template have discounts in commercial confidence.

Age-related macular degeneration services are commissioned by clinical commissioning groups (CCGs). Providers are NHS hospital trusts and community optometrists.