The role of social deprivation in severe neovascular age-related macular degeneration. 
Advances in therapy have improved outcomes for patients with neovascular age-related macular degeneration (nAMD).  Prompt access to treatment is a priority and may be used as a key performance indicator.  In this study, we investigate how social deprivation may impact on access to services, treatment and visual impairment registration.  Patients were identified retrospectively through the Certificate of Visual Impairment system for the University Hospitals Birmingham Medical Retina service.  The Index of Multiple Deprivation (IMD) 2007 score was calculated for each patient.  The impact of deprivation, age, gender and ethnicity on key stages in the care pathway was assessed.  120 patients were identified.  Patients with greater social deprivation were under-represented, had worse visual acuity at first presentation (correlation of the better-seeing eye with IMD 0.225 (p=0.013)) and had sight-impairment registration earlier (correlation -0.246; p=0.007).  Deprivation did not affect time to first appointment, and was not associated with a higher rate of non-attendance.  The late presentation and under-representation of patients with greater social deprivation is a serious concern.  Our study strongly suggests that this vulnerable group is encountering barriers in accessing treatment in nAMD, and that these occur prior to entry into the Hospital Eye Service.