Comparison of Neovascular Age-Related Macular Degeneration Populations in the United States

Comparison of Neovascular Age-Related Macular Degeneration Populations in the United States by Susan Lynette Coultas MS, University of North Texas, 1985 BS, Texas Wesleyan University, 1983 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University December 2016 Abstract Age-related macular degeneration (AMD) is one of the leading causes of blindness in the United States in people who are 50 and older. The safety and efficacy of aflibercept for the treatment of late stage neovascular AMD (NAMD) has been demonstrated by clinical trials among several populations; however, it is unclear whether all NAMD patients respond in the same manner as was studied in the clinical trials. The purpose of this study was to examine if populations of patients treated with aflibercept for the treatment of NAMD were significantly different from one another in terms of health characteristics, treatment regimens, and treatment outcomes. The burden of treatment theory was used to guide this study. Data collected from electronic medical records were used to investigate NAMD characteristics 199 patients from 3 private, retinal practices in the United States. Data were analyzed using one-way ANOVA, c, Spearman’s correlation, and point-Age-related macular degeneration (AMD) is one of the leading causes of blindness in the United States in people who are 50 and older. The safety and efficacy of aflibercept for the treatment of late stage neovascular AMD (NAMD) has been demonstrated by clinical trials among several populations; however, it is unclear whether all NAMD patients respond in the same manner as was studied in the clinical trials. The purpose of this study was to examine if populations of patients treated with aflibercept for the treatment of NAMD were significantly different from one another in terms of health characteristics, treatment regimens, and treatment outcomes. The burden of treatment theory was used to guide this study. Data collected from electronic medical records were used to investigate NAMD characteristics 199 patients from 3 private, retinal practices in the United States. Data were analyzed using one-way ANOVA, c, Spearman’s correlation, and pointbiserial correlation tests. The results of this study showed the specific retinal practice populations of NAMD patients treated with aflibercept were generally similar with respect to selected health characteristics, treatment regimens, and treatment outcomes. By using the information reported from this research, public health initiatives can be developed that focus on the need for early detection of AMD to capture changes that represent NAMD and move to early treatment for better outcomes. The positive social change that could result from this research is that retinal specialists may gain insight into the use and outcomes of aflibercept treatment. Comparison of Neovascular Age-Related Macular Degeneration Populations in the United States by Susan Lynette Coultas MS, University of North Texas, 1985 BS, Texas Wesleyan University, 1983 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University December 2016 Dedication This dissertation and the work that has gone into earning my Ph.D. in Public Health, Epidemiology is dedicated in loving memory to my father, John Coultas, who showed me his love for learning throughout his life and instilled that love in me. He weathered the loss of his hearing and then his sight to NAMD with courage and strength and a touch of humor. My father was the kindest man I have ever known, and I know his spirit has been and will continue to guide me through the remainder of my life. As well, this work is dedicated to my mother, Odessa Coultas, who loves language and grammar and syntax and words and all things written. She taught me so many things about speaking and writing well.not the least of which was that if a phrase is awkward to read or speak.say it in a different way. That’s a lesson I have applied to many aspects of my life.do not let your life be awkward (AWK). Finally, I dedicate this work to my wife, Jill Coultas. Jill has been my greatest advocate for completing this process. When I was ready to quit, she stood beside me and helped me see that I could finish. When I felt hopeless, she gave me hope. She listened to my ramblings about what I was doing in my research project and always acted interested. Jill, I know the time I have spent on this degree has not been easy for you, and I am truly grateful to have had your loving support. Now, we get to play! Acknowledgments I would like to thank Dr. Diana Naser for her support as the Chair of my Dissertation Committee. Dr. Naser is wise, kind, and supportive, and she understands the anxiety of her students and helps make the path a little easier. Appreciation is extended to Dr. F. Benjamin Beatty for serving as my committee member and Dr. Gudeta Fufaa for serving as my URR committee member. Appreciation is also extended to Dr. David Boyer, Dr. Carl Baker, and Dr. Thomas Hull and their practice personnel who assisted in obtaining the data needed for this project. I would further like to acknowledge the support of Dr. Steve Crockett and Mrs. Kay Hart (in memoriam). Both wonderful statisticians shared their love and understanding of statistics with me and turned my eye to the wealth of knowledge that can be gained by understanding the field of statistics. My good dissertation buddy, Dr. Carol von Michaelis, should be acknowledged too. She sent text messages to me on a regular basis with the express intent of keeping me moving. Thanks! That meant the world to me. Finally, I would like to acknowledge the support of my mentor, Dr. Kim Brazzell. He is truly a good friend as well as a strong advocate for and willing participant in most my crazy ideas.