RCOphth NOD AMD Audit year 3 annual report
Source: data.gov.uk (2025-09-18)

RCOphth NOD National Age-related Macular Degeneration (AMD) Audit Year 3 data. The data is for the second prospective year of the National Age-related Macular Degeneration Audit corresponding to the 2022 NHS year (01/04/2022 to 31/03/2023). The data was collected as part of routine clinical care on electronic medical record systems in 73 participating centres. Results are for eyes starting treatment for neovascular age-related macular degeneration in the 2022 NHS year, with results for their first year of treatment and at one year after starting treatment. No results are produced for centres with <25 eyes with the relevant data. Results at one year after starting treatment are only produced for centres with at least 25 eyes completing one year of treatment. Comprehensive information regarding the eligibility criteria used in the National Age-related Macular Degeneration Audit can be found on the audit website (www.nodaudit.org.uk). Results are provided for contributing English and Scottish NHS Trusts, Northern Irish Health and Social Care Trusts, Welsh Health Boards, Independent Sector Treatment Centres (ISTC), and one centre from Guernsey. Results for Moorfields Eye Hospital NHS Foundation Trust include data for patients treated in Croydon Health Services NHS Trust. Results for Moorfields Eye Centre at Bedfordshire Hospitals NHS Foundation Trust are for patients treated in Bedford Hospital from the Bedfordshire Hospitals NHS Foundation Trust, as the ophthalmology service within Bedford Hospital is governed by Moorfields Eye Hospital NHS Foundation Trust.

The Third Report of Age-related
Macular Degeneration Audit (AMD)
Patients starting treatment for
neovascular AMD in the 2022 NHS year
(01 April 2022 to 31 March 2023)
Published March 2025
National Ophthalmology
Database Audit

The Royal College of Ophthalmologists (RCOphth) is the professional body for
eye doctors, who are medically qualified and have undergone or are undergoing
specialist training in the treatment and management of eye disease, including
surgery. As an independent charity, we pride ourselves on providing impartial and
clinically based evidence, putting patient care and safety at the heart of everything
we do. Ophthalmologists are at the forefront of eye health services because of their
extensive training and experience. The Royal College of Ophthalmologists received
its Royal Charter in 1988 and has a membership of over 4,000 surgeons of all grades.
We are not a regulatory body, but we work collaboratively with government,
health and charity organisations to recommend and support improvements in
the coordination and management of eye care both nationally and regionally.
Document authors:
Marta H. Gruszka-Goh
Martin McKibbin
Michael Burdon
© The Royal College of Ophthalmologists 2025. All rights reserved.
For permission to reproduce any of the content contained herein please contact xxx@xxx.xx
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Foreword
4
Funding
5
Report at a glance
6
1. Introduction
7
2. Audit participation and framework
8
3. Methodology
9
4. Eligibility, data quality and follow-up
10
5. Results
15

5.1. What was the baseline visual acuity for first and second eyes?
16

5.2. How many patients started treatment within 14 days of referral from primary care?
18

5.3. How many patients completed their initial loading phase of three injections

within ten weeks?
20

5.4. How often is planned treatment or follow-up delayed by at least two weeks on more

than one occasion during the first year of treatment?
22

5.5. How many injections are given in first and second years of treatment? Which staff are

giving the injections? What are the average intervals between treatments at the end

of the first and second years?
22

5.6. What are the visual acuity outcomes after one and two years of treatment?
26

5.7. How frequent are the most serious complications of intravitreal injections?
33
6. Summary of key points
36
7. Acknowledgements
40
8. Appendices
41

Appendix 1: Data for participating centres
41

Appendix 2: Visual acuity conversion table
42

Appendix 3: Glossary
43
9. References
44
Contents
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

This third annual NOD AMD report is a hugely important resource. It tells us that only 40% of
patients started treatment within 14 days of referral. This is not good enough. It is particularly
disappointing to see that the performance against relevant care quality markers has actually
deteriorated in the last year. RCOphth has repeatedly warned policymakers that more must be
done to ensure support is there for those at most risk of irreversible sight loss. Now we have the
data to underline the urgency of the issue. Investment in improving the capacity of ophthalmology
services is essential, including clinic and theatre space, the workforce and IT infrastructure.
It is more encouraging to see that the number of injections given by doctors has decreased from
25% to 21%. I hope we will see this number come down further. It makes little economic sense to
use doctors as injectors when we are so short of trained ophthalmologists and given our non-
doctor groups are so proficient at service delivery with adequate ophthalmology supervision.
The economic case for shorter acting biosimilars compared to existing longer acting injections
remains controversial. I am looking forward to this National Audit helping us to decide which
strategy gives the best results and offers the best value for money in real world conditions.
I want to congratulate and thank all those involved in running this audit and contributing data.
I would encourage as many hospitals as possible to join and would hope that commissioners will
insist that services must submit data going forwards. Every year this data gets more interesting,
I am looking forward to what it shows next year.

Ben Burton
President, The Royal College of Ophthalmologists
Foreword
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Funding
Roche Products Limited have provided funding to support the conduct of this study. Roche Products
Limited has had no further involvement in the project. The project has been supported by an
unrestricted, hands-off grant provided by Bayer plc. Bayer plc has no involvement whatsoever in the
development or implementation of the project. We are grateful for the funding received from these
organisations. We also receive ongoing support through subscription fees from participating hospitals.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Median visual acuity
Proportion of eyes with acuity
≥70 ETDRS letters
Proportion of eyes with an
increase of ≥15 ETDRS letters
Summary data for eyes starting treatment for neovascular AMD in the 2022 NHS year
Improved for:
Data quality on recording of visual acuity at both
baseline and month 12
Safety and incidence of presumed infectious
endophthalmitis
Both adjusted visual acuity outcomes after 12
months of treatment
Deteriorated for:
Data quality on recording of date of referral from
primary care
Starting treatment within 14 days of referral
Completing the first 3 monthly injections within 10
weeks
Performance against quality markers
Number of patients
23,390
Number of eyes
25,660
No. of participating centres
73
Median age at the start of
treatment in the first eye
Median baseline acuity
Proportion of eyes with
baseline acuity ≥70 ETDRS
letters
Proportion of eyes with
baseline acuity ≤25 ETDRS
letters
Proportion of centres with zero
cases of presumed infectious
endophthalmitis
Percentage of eyes starting
treatment within 14 days of
primary care referral
Percentage of eyes completing
the first 3 injections within 10
weeks
Median number of injections in
first year of treatment
Median interval between
injections at the end of the
first year
Proportion of injections given
by trained, non-medical staff
7
80 years
Baseline characteristics
Care pathway
Visual acuity outcomes after 12 months
Safety outcomes
Report at a glance
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1. Introduction
Age-related macular degeneration (AMD) is a progressive disorder of the centre of the retina (the
macula). The two late forms of AMD, namely geographic atrophy (formerly “dry” AMD) and macular
neovascularisation (formerly “wet” AMD) account for most of the associated sight impairment.
Neovascular AMD (NvAMD) is the more rapidly progressive form of AMD. It is characterised by
the development of new and abnormal blood vessels below and within the retina, causing sight
impairment by a combination of fluid leakage, bleeding and scar formation. Untreated, around half of
affected eyes will experience a significant decrease (≥ 15 ETDRS letters) in vision after 12 months, and
a similar proportion would be classified as legally blind (≤35 ETDRS letters) in the same time period.1
NvAMD is common, affecting 1.2% of people aged 65 years or over, rising to 6.3% of those aged 80
years or over, with an estimated 40,000 new cases per year in the United Kingdom.2
NvAMD is treated with repeated injection into the vitreous of drugs that inhibit new blood vessel
formation and leakage. Treatment is usually given with an initial loading phase of monthly intravitreal
injections, followed by further treatment, often at extended intervals, in an ongoing maintenance
phase. Clinical trials and real-world datasets have shown this treatment is effective in maintaining
vision over several years, with many patients experiencing an initial improvement.3,4 Starting treatment
quickly, when vision is still “good”, helps to maintain this level of function. In contrast, eyes with “poor”
vision at the start of treatment often experience some initial improvement but rarely achieve “good”
levels of vision after treatment.5 Prompt completion of the initial, loading phase of monthly treatment
and ongoing treatment, based on an assessment of disease activity through regular monitoring, with
few delays have been shown to improve outcomes and are recommended by National Institute for
Health and Care Excellence (NICE) Guidance (NG82) and Quality Standard (QS180).
NvAMD treatment is of great benefit to patients in terms of maintaining their quality of life and
independence. There are also benefits to the wider society with reductions in the costs of providing care
and support to elderly people with severe sight impairment. However, treatment is demanding, both for
patients who will have multiple appointments for assessment and injection over several years and for
the ophthalmology centres that provide the service. The treatment is also expensive, with an estimated
annual cost of £350 million for anti-VEGF therapies for NvAMD in England alone.
NICE has approved treatment for NvAMD, based on the treatment results obtained in clinical trials.
Given the significant demands on patients and ophthalmology providers and the high cost of
treatment, it is essential the AMD services in the United Kingdom are regularly audited to ensure the
outcomes for patients are in line with expectations and the care they receive is both safe and of high
quality. This Third National Ophthalmology Database Audit of AMD services throughout the United
Kingdom is based on seven key questions that assess the quality and safety of service delivery, and
visual outcomes. The quality standards against which treatment is assessed have been determined
either by NICE Guidance (NG82) and Quality Standard (QS180) or by members of the NOD AMD
Audit advisory group.
By enabling providers and commissioners to benchmark local performance against regional peers,
national standards and quality markers, and to identify areas in which improvement may be needed,
the audit aims to reduce variation in the delivery of care and improve visual acuity outcomes.
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2. Audit participation and framework
Participation in the audit is open to all providers of NHS-funded NvAMD treatment, NHS trusts
and independent sector organisations, provided permission for data extraction and transfer to
NOD was given by clinical leads / medical directors and Caldicott guardians or other equivalent.
All eyes with a recorded diagnosis of NvAMD and starting treatment in the relevant NHS years are
eligible for inclusion. Exclusion criteria include eyes with any prior treatment for NvAMD before the
relevant NHS year, eyes receiving any clinical trial drugs and eyes from patients aged <55 years at
the start of treatment.
For this report, data recorded into electronic medical record (EMR) systems as part of routine clinical
care at participating centres was submitted to the National Ophthalmology Database and analysed.
Data was available for reporting from 74 centres, with representation from the Channel Islands,
England, Northern Ireland, Scotland and Wales. Details of each participating centre, the EMR used,
and the year three data is available on the National Ophthalmology Database website.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

3. Methodology
Detailed descriptions of the audit methodology, covering the small numbers policy, Limitations,
Data Cleaning, Definitions, Statistical modelling and Quality markers are available elsewhere and can
be accessed at NOD Audit AMD Full Annual Report 2024 and AMD Audit Visual Outcomes Statistical
Model 2024.
Context
This third annual report focusses on the baseline characteristics, care pathway and 12-month visual
acuity and safety outcomes for the eyes of patients starting treatment in the 2022 NHS year (April 2022
to March 2023). (Two-year outcomes are also reported for eyes starting treatment in the 2021 NHS year
(April 2021 to March 2022)). During the 2022 NHS year, available treatments for NvAMD included Eylea
(aflibercept) 2mg, Avastin (bevacizumab) 1.25mg, Beovu (brolucizumab) 6mg, Vabysmo (faricimab) 6mg
and ranibizumab 0.5mg, both as the originator product (Lucentis) and as biosimilar preparations.
Changes to definitions since the last annual report:
i. The date of referral from primary care is needed to determine whether treatment was started
within 14 days of the referral being received. In prior annual reports, all referrals were included,
even though these were often many months earlier and it was not possible to identify why the
referral was made. In this report, only referrals received within 90 days of the start of treatment
are considered likely to have been for suspected NvAMD and are included in the analysis.
ii. The intervals between injections at the end of the first and second years of treatment have been
changed to the following: 4 weeks (defined as 1 to 35 days), 6 weeks (36 to 49 days), 8 weeks (50
to 63 days), 10 weeks (64 to 77 days), 12 weeks (78 to 91 days), 14 weeks (92 to 105 days), 16 weeks
(106 to 119 days), 18 weeks (120 to 133 days) and 20 weeks (134 days or more).
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

4. Eligibility, data quality and follow-up
Eligibility
For this third annual report, the number of centres, patients and eyes at the different stages of the analysis
is shown in Figure 1. The number at each stage varies because of data quality and application of the
small numbers policy. The focus for this report is on baseline characteristics, the care pathway and the
12-month treatment outcomes for eyes starting treatment in the 2022 NHS year but 24-month outcome
data are also presented for eyes starting treatment in the 2021 NHS year.
Data quality
The data analysed for the AMD Audit is recorded within EMRs at participating centres as part of routine
clinical care. Good data quality is essential to ensure the results of analysis are valid. No external
validation of data quality and completeness is possible or available. Prior to the publication of each
annual report, participating centres are contacted and invited to review the number of eyes and
patients starting treatment in the relevant NHS year, baseline visual acuity and the elements of the
care pathway in the NOD dataset for that centre. When there appears to be a significant discrepancy
between the expected data and that in the NOD dataset, centres can request their data is removed
from the annual report.
Prior to publication of this third annual report, clinicians at a single centre asked for its data to be
removed, following concerns that the number of eyes completing the initial three injections within ten
weeks at the start of treatment was lower than expected. At present, validation of much of the data in
the AMD Audit annual reports is neither easy nor quick. The report on intravitreal injections in version
9.2.3 or higher of OpenEyes and a planned upgrade to the Audit Suite in the mediSIGHT EMR will make
the process much quicker for the centres using these EMRs.
For the 25,660 eyes of 23,390 patients starting treatment in the 2022 NHS year, data recording for sex,
ethnicity, referral from primary care, visual acuity at baseline only and both baseline and month 12 are
shown in Table 1. Comparative figures for the 2021 NHS year are also available but the number and
location of the centres is different for the two years.
Between providers the overall proportion of eyes with referral data recorded in the EMR within 90 days
of the start of treatment ranged from 0% to 100%. Data quality for recording of referral dates was very
good (100% of eyes) for centres using custom or in-house EMRs. By contrast, 83.3% of centres using
Open Eyes and 14.1% of the Medisoft or mediSIGHT centres did not record any referral data. For the eyes
with referral information, 4,502 (80.2%) were first treated eyes, 293 (5.2%) were second treated eyes
and 819 (14.6%) were immediately sequential bilateral intravitreal treatment (ISBIVT) eyes.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510
Table 1: Reported data quality
Available data
Year 2022
Number (%)
Year 2021
Number (%)
Sex
25,048 (97.6)
25,674 (97.7)
Ethnicity
16,285 (63.5)
17,019 (64.8)
Referral within 90 days
5,614 (21.9)
5,881 (22.4)
Visual acuity at baseline
24,288 (94.6)
24,876 (94.7)
Visual acuity at baseline and after 12 months of treatment
18,659 (72.7)
19,255 (73.3)

Figure 1: The number of centres and eyes at different stages of analysis
74 Centres provided
data for year 2022:
67 Centres from England
1 Centre from Guernsey
3 Centres from Northern Ireland
2 Centres from Scotland
1 Centre from Wales
n= 25,980 Eyes
59 NHS Centres
24,001 Eyes
74 Centres submitted data for >25 eligible eyes
n= 25,980 Eyes
74 Centres submitted data for
the year 3 AMD Audit
14 ISTC Centres
+ 1 Guernsey
1,979 Eyes
1 Centre requested non-reporting
of their data for year 3 of the audit
Reporting of baseline characteristics
73 Centres and 25,660 Eyes
Reporting of baseline visual acuity
69 Centres and 24,231 Eyes
Starting treatment within 14 days of referral analysis
37 Centres and 5,614 Eyes
Reporting of follow up
12 months: 73 Centres and 25,660 Eyes
24 months: 67 Centres and 26,271 Eyes
Visual acuity state:
6 months: 73 Centres and 18,784 Eyes
12 months: 70 Centres and 19,555 Eyes
24 months: 60 Centres and 14,491 Eyes
Visual acuity change:
6 months: 72 Centres and 16,376 Eyes
12 months: 68 Centres and 18,659 Eyes
24 months: 59 Centres and 13,810 Eyes
Statistical modelling:
"Good" acuity outcome
67 Centres and 18,659 Eyes
"Poor" acuity outcome
67 Centres and 17,136 Eyes
Reporting of visual acuity outcomes
73 Centres contributed data towards
the year 3 AMD Audit dataset
n= 25,660 Eyes
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Changes in data quality over time
Several quality markers were introduced in the second annual report, covering performance in
relation to data quality, aspects of the care pathway and adjusted visual acuity outcomes. The quality
markers were derived from performance observed for eyes starting treatment in the 2021 NHS year.
“Acceptable” performance was that achieved by 50% of providers in the 2021 audit. These centres
were felt to be providing a good quality service, and all centres were encouraged to meet this level
of performance in future audit cycles. “Desirable” performance was that achieved by the top 25%
of providers in the 2021 audit. These centres were felt to be providing an excellent service and to be
examples of best practice. With data now available in three annual reports, centres are encouraged to
compare and track local performance with peers, aggregate results and the new quality markers and
to implement change, when necessary. Over time, it is expected that relevant levels of performance for
each quality marker will improve.
Data quality performance markers are available for the proportion of eyes with the date of referral from
primary care recorded within three months of starting treatment and for the recording of visual acuity
in the windows for both the baseline and 12-month visits. Comparing the performance in the second
and third annual reports:
The proportion of eyes with a referral from primary care recorded within 90 days of starting
treatment
• The proportion of centres meeting an acceptable level of performance decreased from 55.3% in
the 2021 year to 48.6% in the 2022 NHS year*
• The proportion of centres meeting a desirable able level of performance decreased from 23.7% in
the 2021 year to 21.6% in the 2022 NHS year*
* Data from the second annual report has been included for comparison but re-calculated for the new
definition. The number and location of the participating centres was different for the two years.
Recording of visual acuity recording within the windows for both the baseline and month 12 visits
• The proportion of centres meeting an acceptable level of performance increased from 50% in the
2021 year to 54.8% in 2022 NHS year
• The proportion of centres meeting a desirable level of performance increased from 25% in the
2021 year to 42.5% in the 2022 NHS year
Follow-up to months 12 and 24 after the start of treatment
High rates of follow-up to months 12 and 24 are required to add credibility to the visual acuity
outcomes after treatment. Prior annual reports have shown patients lost to follow-up were more likely
to be older and to have worse baseline visual acuity. Both factors are associated with poor visual
acuity outcomes. Loss to follow-up within the time windows for each milestone visit may be the result
of death, comorbidity, holiday, caregiver availability, perceived treatment failure, treatment burden,
poor patient experience or provider factors, such as clinic administration, lack of capacity or a change
in the EMR. In this situation, data may have been submitted from a prior EMR but with the follow-up
milestone visits recorded in the newer, replacement EMR. Some of the patients may also have started
treatment in one location and moved to another for ongoing treatment. At present, NOD cannot link
patients’ data when treatment is provided at more than one organisation.
Of the 25,660 eligible eyes starting treatment in the 2022 NHS year, 4,936 (19.2%) eyes did not have
a follow-up visit recorded within the month 12 visit window. Patient death was the reason for lack of
follow-up for 585 eyes (11.9% of the eyes without follow-up to month 12). For the other patients / eyes,
no reason for loss of follow-up at month 12 was identifiable.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

The percentage of eyes lost to follow-up within one year of treatment varied between centres (range;
4.9% to 100.0%). Three (4.1%) centres had a loss to follow-up rate more than 50.0% and ten (13.7.1%)
centres more than 25.0%, Figure 2a.
Of the 26,271 eligible eyes starting treatment in the 2021 NHS year from 67 centres and eligible for
analysis in the month 24 outcomes, 4,177 (15.9%) did not have a follow-up recorded in the month 12
visit window and 10,429 (39.7%) eyes did not have a follow-up visit recorded within the month 24 visit
window. Patient death was the reason for loss to follow-up for 1,400 eyes, with death occurring in 718
patients in year one and in in 682 patients in year two. For the remaining patients / eyes, no reason for
loss of follow-up data at month 24 was identifiable.
The percentage of eyes lost to follow-up within two years of treatment varied between centres (range:
20.0% to 100.0%). Nine (13.4%) centres had a loss to follow-up rate more than 50% and 59 (88.1%)
centres more than 25%, Figure 2b.
Figure 2a: Kaplan-Meier curve for percentage of eyes starting treatment in the 2022 NHS year without
a recorded follow-up visit in the month 12 visit window by participating centre
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Figure 2b: Kaplan-Meier curve for percentage of eyes starting treatment in the 2021 NHS year without
a recorded follow-up visit in the month 24 visit window by participating centre
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

5. Results and key questions
Baseline characteristics for patients and eyes starting treatment in the 2022 NHS year:
Baseline characteristics are reported for 25,660 eligible eyes from 23,390 individual patients starting
treatment in the 2022 NHS year. When sex and ethnicity were recorded, the majority were female
(59.9%) and Caucasian (90.1%). The number of first, second and immediately sequential bilateral
intravitreal treatment (ISBIVT) eyes was 17,707 (69.0%), 4,973 (19.4%) and 2,980 (11.6%) respectively.
The median age in years of the patients at the start of treatment of their first, second and ISBIVT eyes
was 80.4 (IQR; 74.5 – 86.0), 82.3 (IQR; 76.9 – 87.0) and 81.0 (IQR; 74.8 – 86.4) respectively.
The number of eligible eyes at each centre varied considerably, with a median of 462 eyes (IQR; 308 –
679) starting treatment.
The English index of multiple deprivation (IMD) was calculated for 16,669 patients from 61 participating
English centres with data recorded on the Medisoft or mediSIGHT EMRs from 57 centres, Open Eyes
from three centres and data from one in-house database centre. All centres, except 11, treated patients
in the most deprived national decile of social deprivation (decile 1) and all centres treated patients in
the least deprived national decile of social deprivation (decile 10). There was notable variation in the
median English national decile of social deprivation for the patient population at different centres,
Figure 3. Results for social deprivation are only produced for English centres as different indices are
used in the other home nations and too few centres in Northern Ireland, Wales and Scotland submitted
data to be representative of results for these nations. A separate analysis of the impact of IMD on eyes
starting treatment for NvAMD is in progress. Results from this analysis will be presented at the 2025
RCOphth Annual Congress with a publication to follow.
Figure 3: Median and IQR national deciles of social deprivation by participating centre in England –
ordered by median national decile within each centre
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

5.1 What was the baseline distance visual acuity for first and second eyes?
Introduction
Distance visual acuity is the standard measure of visual function reported in clinical trials and real-
world datasets. In routine clinical practice, it is typically measured using habitual spectacle or contact
lens correction using an ETDRS chart. Appendix 2 shows the relationship between ETDRS letter score,
LogMAR and Snellen visual acuities.
Why this is important?
• Published evidence and prior reports of the AMD Audit have shown the best visual acuity
outcomes are obtained when treatment is started when visual acuity remains good.
• NICE Guidance and Quality Standards recommend starting treatment, when appropriate,
within 14 days of referral from primary care and screening fellow eyes for signs of NvAMD during
treatment of the first eye. Baseline acuity for first and second eyes may therefore be a marker
of the effectiveness of local primary care referral pathways, triage of referrals, screening of the
second eye and compliance with NICE recommendations.
Aggregate results
The median baseline visual acuity was 60 ETDRS letters (IQR: 45 to 70 letters). The proportion of eyes
in each visual acuity category is shown in Table 2. The majority (72.0%) of eyes had a baseline acuity
between 25-70 letters, the original NICE guideline for treatment (Snellen equivalent 6/12 to 6/96). The
proportion of eyes with “good” acuity (≥70 ETDRS letters) has increased since the first annual report.
The median baseline acuity was eight ETDRS letters lower in first treated eyes than in second treated
eyes. See Table 3. This suggests that first eye treatment may be initiated at a more advanced stage
of visual loss or that second treated eyes are identified, diagnosed and treated at an earlier stage of
disease development. While the baseline acuity for second treated and ISBIVT eyes has not changed
since the first annual report, there has been a modest increase in the baseline acuity of first treated
eyes, with a corresponding decrease in the “first eye gap”, the difference in acuity between first and
second treated eyes.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510
Table 2. Categories of baseline visual acuity for each year of the AMD Audit
Baseline ETDRS visual acuity
2022 (n=24,231)
2021 (n=24,876)
2020 (n=18,961)
Percentage of eyes
Percentage of eyes
Percentage of eyes
Baseline visual acuity category
≤25
9.5
9.3
8.6
26-35
8.5
8.8
9.2
36 – 55
26.7
28.3
28.9
56 – 69
27.0
26.5
26.3
≥70
28.3
27.1
26.9

Variation in performance
• Median baseline visual acuity varied from 27 to 68 ETDRS letters between centres and was
between 26-35 ETDRS letters in a single (1.4%) centre, between 36-55 letters in seven (10.1%)
centres and between 56-69 letters in 61 (88.4%) centres. No centres had a median baseline acuity
of ≤25 or ≥70 ETDRS letters.
• The percentage of centres with median baseline visual acuity above 55 letters has increased over
time from 68% in year 2020 to 79% in year 2021 and 88% in year 2022.
• There was no clinically significant difference in median baseline visual acuity between the sexes.
Median acuity at baseline was worse with increasing age, decreasing from 62 letters for patients
aged under 70 years to 55 letters for those aged 80 or more years.
Limitations
Recording of baseline visual acuity was good and there are no significant concerns in relation to data
quality.
Interpretation
There is significant and possibly unwarranted or excessive variation in baseline visual acuities between
treatment centres.
The increase in the proportion of eyes with “good” baseline acuity and the decrease in the first eye gap
suggest a trend to earlier diagnosis and treatment.
Table 3. Baseline visual acuity by treated eye status for each year of the AMD Audit
Baseline ETDRS visual acuity
2022 (n=24,231)
2021 (n=24,876)
2020 (n=18,961)
Percentage
of eyes
Median
(IQR)
Percentage
of eyes
Median
(IQR)
Percentage
of eyes
Median
(IQR)
Treated eye
First eyes
68.9
57 (40-69)
70.0
55 (40-69)
66.2
55 (40-68)
Second eyes
19.6
65 (55-73)
17.8
65 (53-73)
21.2
65 (52-71)
ISBIVT eyes
11.5
60 (42-70)
12.2
60 (43-70)
12.6
60 (44-70)
Overall
100.0
60 (45-70)
100.0
60 (44-70)
100.0
60 (44-70)

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Recommendations
All providers are encouraged to work with commissioners and primary and secondary care colleagues
to develop referral and treatment pathways that enable treatment to be started quickly, when visual
acuity is still good. Dedicated referral pathways for patients with suspected neovascular AMD should
be promoted locally and be triaged daily.
Although more than 28% of eyes had “good” visual acuity (≥70 ETDRS letters) at the start of treatment,
18% of eyes had baseline visual acuity worse than 35 ETDRS letters and almost 10% had acuity of 25
letters or worse. Prior analysis has found only a minority of these eyes achieve a good visual acuity after
12 months of treatment. Data from the AMD Audit should be used to give patients accurate information
on the treatment burden and expected visual acuity outcomes in eyes with poor visual acuity at the
time of diagnosis. This will help them make an informed decision about starting treatment.
5.2 How many patients started treatment within 14 days of referral from primary care?
Introduction
When NvAMD develops in the first eye, patients typically present to their high-street optometrist and
are referred directly for secondary care assessment and diagnosis, usually via a dedicated referral
pathway. The NICE Quality Standard on Serious Eye Disorders recommends treatment should be
started, when appropriate, within 14 days of receipt of the referral from primary care as an example of
best practice to help patients retain their eyesight. Capture of the date of receipt of the primary care
referral within the EMR is required to identify whether this recommendation was met. Referral data is
most likely to be available for patients with a new NvAMD diagnosis. Other patients with NvAMD in
the first eye may present directly to an acute referral clinic or be identified during review within another
ophthalmology secondary care pathway. During treatment of the first eye, monitoring of both eyes is
recommended by NICE (QS180) to identify second eye disease as quickly as possible. For these patients,
there may be no referral from primary care.
Why this is important?
• Published clinical trials and prior reports of the AMD Audit have shown the best visual acuity
outcomes are obtained when treatment is started quickly, and visual acuity is still good.
Aggregate results
• Referral data within 90 days of the start of treatment was available for 5,614 eyes (21.9%),
of which 4,502 (80.2%) were first treated eyes.
• For the eyes with referral data, the median time between receipt of referral and the start of
treatment was 19 days (IQR 9 to 39) and the intervals between receipt of the referral from primary
care and the start of treatment are shown in Table 4.
• Performance against the relevant care pathway quality markers has deteriorated with 48.6%
and 21.6% of centres achieving the acceptable and desirable levels of performance for starting
treatment within 14 days of primary care referral, compared to 55.3%* and 23.7%* in the second
annual report.
*Performance recalculated for the 2021 NHS year given the change in the definition.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Table 4: Time from referral to first injection
Time from referral to first injection (days)
Number of eyes (%)
≤14
2,261 (40.3%)
15-28
1,401 (25.0%)
29-90
1,952 (34.8%)
Number of eyes with referral data
5,614

Variation in performance
• The proportion of eyes starting treatment within 14 and between 0-28 days of referral from
primary care varied between providers from 1.8% to 84.5% and from 14.3% to 91.5% respectively.
The median time from receipt of referral to the start of treatment also varied between providers
from 0 to 49 days.
• The proportion of eyes starting treatment within 14 days of referral was broadly similar for first,
second and ISBIVT eyes. The median time from referral to the start of treatment was five days
shorter for first treated eyes than second treated eyes.
• The proportion of eyes starting treatment within 14 days of referral was lower in the eyes of the
youngest patients. The median time from referral to the start of treatment was four days shorter
for the oldest patients (aged over 85 years) compared to the youngest (aged under 70 years).
Limitations
• Referral data within three months of the start of treatment was available for only 21.9% of all eyes.
• Given the low levels of recording of referral information within the EMR of some providers,
there are concerns these figures may not provide an accurate reflection of real-world practice.
Self-reported data submitted to GIRFT suggests higher levels of performance. The low levels
of data recording also mean it is not possible to draw firm conclusions around whether the
proportion of eyes starting treatment within 14 days of referral is changing over time.
Interpretation
• The quality of the data available to assess how many patients started treatment within 14 days
is poor.
• The available evidence suggests only two-fifths of eyes start treatment within 14 days of referral
from primary care and there is considerable variation between providers.
Recommendations
• All providers should ensure referral data is recorded accurately within their EMR and are
encouraged to work with EMR providers to ensure recording of the date of referral from primary
care is easy and can be done at the same time as recording other, relevant clinical information.
• Providers should use a multidisciplinary workforce to ensure there is sufficient capacity to triage
referrals and start treatment quickly, when the visual acuity is expected to be good.
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5.3 How many patients completed their initial loading phase of three injections within ten weeks?
Introduction
Current clinical practice for the treatment of eyes with NvAMD involves an initial, loading phase of three
or four injections at fixed monthly intervals, followed by an ongoing, maintenance phase of treatment
at longer intervals, according to the response to treatment.
Statistical modelling in the year two report of the UK AMD Audit found the odds ratio of a “good” acuity
outcome after 12 months of treatment was almost 40% greater in eyes that completed their initial
three-monthly injections within ten weeks. The odds ratio of a “poor” visual acuity outcome was also
reduced by 12% in the same eyes.
The new care pathway quality markers for the treatment of neovascular AMD state providers should
ensure the first, three monthly injections at the start of treatment are given within ten weeks in ≥75%
and ≥83% of eyes for acceptable and desirable performance.
Why this is important?
• Eyes completing the initial three injections, during the loading phase of monthly treatment, quickly
have better visual acuity outcomes than eyes with slower or no completion of the loading phase.
Aggregate results
• For the 25,660 eyes that started NvAMD treatment in the 2022 NHS year, 16,631 (64.8%) eyes
completed the initial three anti-VEGF injections during the loading phase of treatment within ten
weeks of the first injection. A further 2,754 (10.7%) eyes completed the first three injections within
ten to 12 weeks and 1,808 (7.1%) eyes completed these injections within 12 to 16 weeks. There were
2,294 (8.9%) eyes for which it took more than 16 weeks for the first three anti-VEGF injections to
be given. An additional 2,173 (8.5%) eyes received fewer than three injections during the first year
of treatment.
• Performance against the relevant care pathway quality markers deteriorated with 41.1% and
19.2% achieving the acceptable and desirable levels of performance for completing the initial
three injections within ten weeks of the start of treatment, compared to 50% and 25% in the
second annual report.
Variation in performance
• The proportion of eyes completing the initial three injections during the loading phase of
treatment within ten weeks varied between centres and ranged from 1.3% to 93.0%. There were
12 (16.4%) centres with <50% eyes, 30 (41.1%) centres with ≥75% and four (5.5%) centres with ≥90%
eyes completing the loading phase within ten weeks, Figure 4.
• The percentage of eyes completing the initial three injections within ten weeks was 65.9% for first
treated eyes, 63.2% for second treated eyes and 60.9% for ISBIVT eyes.
• The percentage of eyes completing the initial three injections within ten weeks was 64.1% for the
patients aged over under 70 years, 68.6% for patients aged 70-74 years, 68.3% for patients aged
75-79 years, 67.3% for patients aged 80-84 years and 59.9% for patients 85 years and older.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Figure 4: Percentage of eyes completing the initial three-monthly injections during the loading phase of
treatment within 10 weeks of the first injection. (Participating centres are ordered in descending order.)
Limitations
• Recording of the dates of intravitreal injections within the EMRs is usually good and there are no
significant concerns in relation to data quality at most centres.
Interpretation
• There is significant variation between providers in their ability to complete the initial three-
monthly injections during the loading phase of treatment within ten weeks.
• This variation in performance almost certainly reflects variation in local capacity and the
organisation of local services.
Recommendations
• Providers should use a multidisciplinary workforce to ensure there is sufficient capacity to start
treatment and complete the loading phase of monthly treatment quickly but without delaying
follow-up of other patients during the subsequent maintenance phase.
• As delivery of the first three injections within ten weeks appears to be lower for patients in whom
both eyes start treatment at the same time, providers are encouraged to offer treatment of both
eyes on the same day and to ensure the patient experience of treatment, and the immediate post-
operative period, is optimal.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

5.4 How often is planned treatment or follow-up delayed by at least two weeks on more than one
occasion during the first year of treatment?
Introduction
After the initial loading phase of monthly treatment, further treatment is typically given at longer
intervals during the maintenance phase of treatment. These intervals are decided according to the
response to treatment and the presence or absence of signs of active disease. Delay to the planned
treatment intervals can lead to poor visual acuity outcomes and are a cause of concern to patients. The
NICE Quality Standard on Serious Eye Disorders recommends monitoring the proportion of scheduled
appointments that are cancelled or delayed by the provider.
Why this is important?
• Non-adherence with NvAMD treatment, defined as having two or more planned appointments
delayed by more than two weeks in a period of 12 months, is often associated with poor visual
acuity outcomes.
Aggregate results
• Using the data submitted to the National Ophthalmology Database, it was not possible to
identify delays to the planned follow-up and whether these were the result of patient or hospital
factors.
Recommendations
• Providers should ensure there is capacity for follow-up of adults with NvAMD at intervals
determined by the healthcare professional responsible for planning their care.
• Healthcare professionals should work with EMR providers to ensure the planned follow-up
intervals for monitoring or treatment are easy to record within the EMR and included in the data
submitted to the NOD.
5.5 How many injections are given in first and second years of treatment? Which staff are giving
the injections? What are the average intervals between treatments at the end of the first and
second years?
Introduction
Neovascular AMD is a chronic disease, and treatment often needs to be given at regular intervals and
over several years to maintain visual function. After the initial loading phase of monthly treatment,
many patients can be treated at longer intervals according to the response to treatment. Newer
treatment plans, including “treat and extend”, and therapies that may be longer acting can help to
reduce the treatment burden.
Both Vabysmo (faricimab) and the biosimilar forms of ranibizumab (including Ongavia and Byooviz)
were licensed and made available for use within the NHS during Summer 2022. Clinical staff will
typically use available data from clinical trials and real-world practice to select a first line therapy.
Drug cost and local commissioning policy will also influence the choice of first-line therapy and explain
any variation in drug usage between centres.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Why this is important?
• Real world studies and prior UK AMD Audit reports have shown the number of injections in the
first year of treatment is associated with visual acuity outcomes. Under-treatment may be a
marker of inadequate capacity, sub-optimal treatment or non-compliance with treatment and is
often associated with poor visual acuity outcomes.
Aggregate results
• For the 25,660 eyes starting treatment for NvAMD in the 2022 NHS year, a total of 171,800
injections were administered. The proportion of injections administered for each anti-VEGF
medicine was: 72.7% with Eylea (aflibercept), 11.2% with Lucentis (ranibizumab), 9.1% with
Vabysmo (faricimab), 4.5% with Avastin (bevacizumab), 1.5% with Byooviz (a ranibizumab
biosimilar) and less than 1.0% each with Beovu (brolucizumab) and Ongavia (another
ranibizumab biosimilar).
• For all eyes, the median number of injections in the first 12 and 24 months of treatment was 7
(IQR 4 to 9) and 9 (IQR 5 to 12) respectively.
• The median interval between intravitreal injections at the end of the first year of treatment was
ten weeks. The proportion of eyes treated at different intervals at the end of the first year is shown
in Table 5. The results were analogous for the eyes finishing the second year of treatment.
• Doctors administered 21.0%, nurses administered 65.2% and other healthcare professionals
administered 8.3% of all the injections. For 5.5% of the injections, the profession of the person
administering the intravitreal injection was not recorded.
Table 5. Intervals between injections one and two years after starting treatment
First year of treatment
Second year of treatment
Year 2022 (n=20,341)
Year 2021 (n=21,559)
Year 2021 (n=15,661)
Time between injections
at one year
Percentage
of eyes
Percentage
of eyes
Percentage
of eyes
4 weeks
15.4
17.0
12.5
6 weeks
11.7
13.1
10.7
8 weeks
20.6
21.0
19.6
10 weeks
14.9
14.4
12.8
12 weeks
15.2
13.2
14.3
14 weeks
8.4
7.0
8.4
16 weeks
5.0
4.2
8.0
18 weeks
2.5
2.6
3.2
20 weeks
6.3
7.6
10.6

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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Variation in performance
• The median value for the median number of anti-VEGF injections per eye administered within the
first 12 months at each centre ranged between three and ten, Figure 5.
• For the eyes remaining on the same treatment and persisting with treatment to month 12 the
median number of injections varied depending on the injected drug from six to eight injections,
Table 6.
• The intervals between treatments differed between drugs from eight to ten weeks at the end
of the first year of treatment and between eight and 12 weeks at the end of the second year of
treatment, Table 6.
• The median number of injections at one year was lower (six injections) for the eyes of patients
aged over 85 years at the start of the treatment, compared to the other age groups (seven
injections). The median time between injections was longer by two weeks (ten weeks) for patients
80 years and over at the start of the treatment, compared to the other age groups, (eight weeks).
• Almost 25% of all centres used a biosimilar medicine for injection. The median proportion of
injections involving a biosimilar medicine was 1.5% in these centres and it varied from less than
0.1% to 46.7% of injections per centre. Two centres used biosimilar medicines for more than 25.0%
of injections.
• The proportion of anti-VEGF injections given by different professionals varied between centres
and ranged from 0.0%-93.6% for doctors, 0.0%-99.7% nurses, 0.0%-90.5% other healthcare
professionals and 0.0%-100.0% for unrecorded professionals, Figure 6.
Figure 5: Median number of anti-VEGF injections over a year by participating centre
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Figure 6: Percentage of anti-VEGF injections administered over a year by profession of the injector and for
each participating centre
Table 6. Median intervals between injections after one and two years of starting treatment by drug
First year of treatment
Second year of treatment
Year 2022 (n=20,724)
Year 2021 (n=15,842)
Drug
Median number of
injections during first
year of treatment
Median (IQR) interval
between injections
at the end of the first
year of treatment
(weeks)
Median number of
injections during
first two years of
treatment
Median (IQR) interval
between injections at
the end of the second
year of treatment
(weeks)
Eylea
7.0
10 (8-12)
11.0
10 (8-14)
Lucentis
6.0
8 (4-12)
9.0
10 (6-14)
Avastin
6.0
8 (4-10)
9.0
8 (6-12)
Beovu
7.0
10 (8-12)
9.0
12 (8-16)
Faricimab
8.0
10 (8-14)
n/a
n/a
Ongavia
8.0
8 (6-12)
n/a
n/a
Byooviz
8.0
8 (6-12)
n/a
n/a

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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Limitations
• Data quality within EMRs for recording the drug(s) used for treatment is good. Some of the
variation in drug usage between centres may be the result of local commissioning policy.
Interpretation
• There is unwarranted variation between centres in the median number of injections in the first
year of treatment.
• Uptake of the biosimilar forms of ranibizumab was slow, with no usage in 75% of centres.
Biosimilar products are typically available at a significant discount to the originator product,
but their introduction requires the provision of additional information to patients and may also
require time to re-consent.
Recommendations
• After the initial, monthly injections during the loading phase of treatment, providers are
encouraged to adopt a treat and extend regime, in which the interval between treatments
is extended according to control of disease activity and the need for monthly monitoring
is removed.
• Providers should use a multidisciplinary workforce both to make treatment decisions and to
deliver treatment. This will help ensure that there is capacity at all stages of the care pathway.
• Providers are encouraged to use clinical trial data and real-world evidence to produce local
guidance on extending and/or reducing treatment intervals. Regular review and re-enforcement
of local guidance is needed to ensure compliance.
• Providers and local commissioners should meet and agree a plan for the use of longer-
acting therapies, the licensed preparation of bevacizumab and the biosimilar preparations of
aflibercept, before the latter becomes available in 2025.
5.6 What are the visual acuity outcomes after one and two years of treatment?
Introduction
Without treatment, NvAMD leads to irreversible sight impairment, difficulty with many aspects of
daily living and loss of independence. A meta-analysis of untreated eyes found almost 50% of eyes
experienced a “significant” decrease (≥ 15 ETDRS letters) in vision after 12 months and a similar
proportion would be classified as legally blind (≤35 ETDRS letters) after 12 months.1,2 The primary goal
of treatment is to maintain vision and reduce the risk of further visual loss. Many patients experience
an initial improvement in vision after the loading phase of treatment, followed by stable or a gradual
decrease over subsequent years.3,4 Bigger visual acuity gains are seen in eyes with lower baseline visual
acuity. By contrast, eyes with high levels of baseline acuity do not experience visual acuity gains but
usually retain a high level of visual acuity after 12 months of treatment. Adjustment of visual acuity
outcomes for differences in the baseline characteristics of the patients in each centre enables a more
meaningful comparison of acuity outcomes.
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Why this is important?
• Distance visual acuity is the main functional outcome measure of response to treatment and is
associated with quality of life and independent living.
• The new adjusted visual acuity outcome quality markers for the treatment of neovascular AMD
state providers should aim to achieve:

“Good” visual acuity (≥70 ETDRS letters) after 12 months of treatment in ≥41% and ≥46%

of eyes for acceptable and desirable performance.

“Poor” visual acuity outcomes (decrease from baseline of ≥10 ETDRS letters) after 12 months

of treatment in fewer than <14% and < 12% of eyes for acceptable and desirable performance
Results
Best measured visual acuity state at month 12
The median visual acuity at one year was 65 ETDRS letters (IQR: 49 to 75 letters). The acuity at one year
was ≤25 letters in 1,698 (8.7%) eyes, 26 - 35 letters in 1,284 (6.6%) eyes, 36 - 55 letters in 3,717 (19.0%)
eyes, 56 - 69 letters in 4,422 (22.6%) eyes and ≥70 letters in 8,434 (43.1%) eyes.
Best measured visual acuity state at month 24
The median visual acuity after two years of treatment was 65 ETDRS letters (IQR: 45 to 75 letters).
The acuity at two years was ≤25 letters in 1,402 (9.7%) eyes, between 26 - 35 letters in 1,013(7.0%) eyes,
between 36 - 55 letters in 2,877 (19.9%) eyes, between 56 - 69 letters in 3,237 (22.3%) eyes and ≥70
letters in 5,962 (41.1%) eyes.
Change in best measured visual acuity 0-12 months
The median change in acuity from baseline was a four ETDRS letter gain (IQR: 4 letter loss to 11 letter
gain). Median visual acuity change varied by baseline visual acuity, Figure 7. Overall, 16,996 (91.1%)
eyes maintained stable acuity at 12 months and avoided a loss of ≥15 ETDRS letters (3 LogMAR lines).
A gain of ≥15 ETDRS letters from baseline was experienced by 3,676 (19.7%) eyes, Table 7.
Change in best measured visual acuity 6-12 months
The median change in acuity from months 6 to 12 was a zero ETDRS letter change (IQR: 5 letter loss to
5 letter gain). The median VA at one year was the same or better than the median VA at six months for
12,118 (74.0%) eyes. A loss of ≥15 ETDRS letters (3 LogMAR lines) was experienced by 1,154 (7.1%) eyes
and gain of ≥15 ETDRS letters (+3 LogMAR lines) by 806 (4.9%) of eyes, Table 7.
Change in best measured visual acuity at 24 months
The median change in acuity from baseline was a two ETDRS letter gain (IQR: 6 letter loss to 11 letter
gain). Overall, 11,778 eyes (85.3%) of eyes maintained stable acuity at 24 months and avoided a loss of
≥15 ETDRS letters (3 LogMAR lines). A gain of ≥15 ETDRS letters was experienced by 2,825 (20.5%) eyes,
Table 7.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Figure 7: Median visual acuity over the first year of treatment by baseline acuity category
Table 7: Change in best measured visual acuity over time
Percentage of eyes
gaining ETDRS letters
Percentage of eyes
losing ETDRS letters
Time period
Median
Change (IQR)
5-9
letters
10-14
letters
≥15
letters
5-9
letters
10-14
letters
≥15
letters
0-12 months
4 (-4, 11)
16.9
11.8
19.7
9.9
5.1
9.1
6-12 months
0 (-5, 5)
15.1
6.0
4.9
15.9
6.8
7.1
0-24 months
2 (-6, 11)
14.4
11.0
20.5
10.2
6.1
14.7

“Good” visual acuity state at 12 months
The proportion of eyes with “good” visual acuity (≥70 ETDRS letters) after the first year of treatment
was 43.1%. “Good” visual acuity at 12 months was more common in eyes with better levels of acuity
at baseline, in second treated eyes and in younger patients, Table 8.
For the eyes with a baseline acuity of ≥70 letters, 78.6% of eyes maintained this level of vision
after one year of treatment. In contrast, for the eyes with baseline acuity ≤25 letters, only 4.2%
achieved “good” visual acuity after 12 months of treatment, though almost half achieved some
level of visual improvement.
For the second treated eyes, there was a higher proportion of eyes with vision ≥70 letters at one year
(50.5%) compared to first treated eyes (41.9%) and ISBIVT eyes (38.2%).
For the eyes of people aged <70 years at the start of treatment, 55.7% had “good” vision at one year,
compared to 33.2% of eyes of people aged 85 or older, Table 8.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Adjusted visual acuity outcomes
• “Good” visual acuity state
The mean adjusted value for the proportion of eyes achieving a “good” acuity state was 41.8%.
Performance against the relevant care pathway quality markers for “good” visual acuity state
after 12 months of treatment has improved with 67.2% and 34.3% of centres achieving the
acceptable and desirable levels of performance, compared to 50.8% and 26.2% in the year 2021.
• “Poor” visual acuity outcome
The mean adjusted value for the proportion of eyes having a “poor” acuity outcome was 12.5%.
Performance against the relevant care pathway quality markers for “poor” visual acuity outcome
after 12 months of treatment has improved with 82.1% and 55.2% of centres achieving the
acceptable and desirable levels of performance, compared to 75.4% and 50.8% in the year 2021.
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Table 8: The percentage of eyes with visual acuity in specific categories after 12 months of treatment
according to baseline visual acuity, treated eye status and age category
One year ETDRS letter visual acuity
Row %
Number of eyes
≤25
26-35
36 – 55
56 – 69
≥70
Baseline ETDRS
visual acuity
≤25
1,460
53.4
12.5
23.3
6.7
4.2
26 - 35
1,444
23.1
16.3
43.6
11.2
5.8
36 – 55
4,984
6.5
5.5
41.3
25.7
21.0
56 – 69
5,227
2.0
0.8
14.4
34.2
48.5
≥70
5,544
0.7
0.4
4.3
16.0
78.6
Treated eye
First eyes
12,717
9.0
4.2
22.4
22.5
41.9
Second eyes
3,911
5.8
2.7
18.1
22.9
50.5
ISBIVT eyes
2,031
10.2
5.6
23.1
22.9
38.2
Age in years at
first injection
<70
2,295
6.5
2.8
16.8
18.3
55.7
70 – 74
2,474
6.3
3.3
18.4
20.1
52.0
75 – 79
4,036
6.6
4.3
20.1
21.7
47.2
80 – 84
4,507
8.7
3.7
21.9
25.1
40.7
≥85
5,347
11.6
5.1
25.8
24.2
33.2
Overall
18,659
8.5
4.1
21.5
22.6
43.3

Variation in performance
• Unadjusted visual acuity outcomes, including change and state, varied markedly between
centres. See Figure 8. A single centre had median acuity at 12 months of ≤35 ETDRS letters but
almost 20% of centres had median acuities of ≥ 70 ETDRS letters.
• “Good” visual acuity after 12 months of treatment was more common both in second treated
eyes than in first and ISBIVT eyes and in the eyes of patients who were younger at the start of
treatment.
• Eyes with baseline acuity of 25 letters or lower rarely achieved a “good” visual acuity state after
12 months of treatment, although more than half experienced some increase in acuity.
Adjusted Visual Acuity Outcomes
• “Good” visual acuity state
After adjustment for differences in baseline characteristics and the care pathway, the percentage
of eyes with “good” vision at month 12 varied between 67 centres, ranging from 12.5% to 53.4%,
Figure 9. Five (7.5%) of centres achieved outcomes that were significantly better than (three
standard deviations above) the mean score and six (9.0%) had outcomes that were significantly
worse (three standard deviations below) than the mean.
Figure 8: Median and IQR change in visual acuity from baseline to one year for participating centres,
ordered by centre median visual acuity change
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Figure 9: Adjusted percentage of eyes achieving a “good” acuity state for each participating centre
for the 2022 NHS year
• “Poor” visual acuity outcome
After adjustment, the percentage of eyes with “poor” visual acuity (≥10 ETDRS letter decrease)
state at month 12 varied between 67 centres, ranging from 3.0% to 19.7%, Figure 10. Ten (15.0%)
centres achieved outcomes that were significantly better than (three standard deviations below)
the mean score and none had a level of performance that was significantly worse than (three
standard deviations above) the mean.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Figure 10: Adjusted percentage of eyes with a “poor” acuity outcome for each participating centre
for the 2022 NHS year
Limitations
Recording of visual acuity at baseline was good but with loss to follow-up and non-recording of
visual acuity at month 12, analysis of visual acuity change was only possible for 76.7% of the eyes with
baseline acuity recorded.
Interpretation
• Compared to the natural history of untreated eyes in clinical trials, visual acuity outcomes
are better with treatment. However, in real-world practice, acuity outcomes rarely achieve
those observed in the treatment arms of randomised clinical trials, most likely as a result of
undertreatment or disrupted follow-up and the development of outer retinal atrophy and fibrosis.
• Eyes with low levels of vision at the start of treatment often achieve the biggest gains in acuity
but rarely reach a “good” visual acuity state. In contrast, eyes with “good” acuity at the start of
treatment may not experience an increase in acuity but the majority retain a “good” acuity state.
Recommendations
• Clinicians should use the AMD Audit dataset and the updated NHS England Decision Support
Tool to give patients with poor acuity at the start of treatment an accurate idea of the likely visual
acuity outcomes after treatment. This will help them make an informed choice about starting
treatment.
• Providers are encouraged to compare the local care pathway with that in the centres with
adjusted acuity outcomes that are better than expected and implement any necessary changes
to try to deliver better acuity outcomes.
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5.7 How frequent are the most serious complications of intravitreal injections?
Introduction
The two most serious and sight-threatening complications of intravitreal injection are:
• Intra-ocular inflammation (IOI) whereby there is an inflammatory reaction to a drug or other
agent introduced into the eye
• Presumed infectious endophthalmitis (PIE) whereby an infection in the eye secondary to the
introduction of bacteria or fungi into the vitreous cavity during treatment is suspected. The
infection may or may not be confirmed by subsequent investigation.
Both IOI and PIE need to be identified and treated quickly to minimise the chance of a poor treatment
outcome.
Why this is important?
• A high incidence of IOI may indicate issues with a particular drug and a high incidence of PIE may
indicate poor adherence to standard aseptic practice.
• The new care pathway quality marker relating to the incidence of PIE states providers should
record all cases of PIE within the EMR, review each case internally, disseminate learning
outcomes and ensure the incidence is lower than one case for every 6,000 injections
Aggregate results
• The 25,660 eyes starting treatment in the 2022 NHS year received 171,800 intravitreal injections.
IOI was reported as a post-operative ocular complication in 57 eyes of 55 patients. This gives a
rate of 2.2 IOI cases per 1,000 eyes per year and 2.0 IOI cases per 6,000 injections.
• In the same period, there were 24 cases of PIE in 22 eyes of 22 patients. This gives a rate of 0.9 PIE
cases per 1,000 eyes per year of treatment and 0.8 PIE cases per 6,000 injections, Figure 11.
Variation in performance
• Among the 73 participating centres, 44 (60.3%) had zero cases of IOI and the incidence of IOI
ranged from 0 to 22 cases per 6,000 injections
• Among the 73 participating centres, 60 (82.2%) had zero cases of PIE and the incidence of PIE
ranged from 0 to 15 cases per 6,000 injections.
• Performance against the relevant quality marker for safety has improved with 82.2% of providers
achieving the acceptable level of performance relating to the incidence of PIE, compared to
71.2% in the second annual report.
• The incidence of IOI and PIE by drug injected is shown in Table 9. There were no clinically
significant differences in the incidence of PIE by the profession of the injector.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

0.8 PIE cases
per 6,000 injections
2.0 IOI cases
per 6,000 injections
0.9 PIE cases
per 1,000 eyes
2.2 IOI cases
per 1,000 eyes
Figure 11: Safety outcomes
Number of eyes
n = 25,660
Intraocular Inflammation
n = 57
Presumed Infectious Endophthalmitis
n = 24
Complications
Table 9: Safety outcomes by injected drug
Drug
Number of
injections
% of
injections
Incidence of IOI*
(per 6,000 injections)
Incidence of PIE*
(per 6,000 injections)
Eylea
124,960
72.7
1.7
0.5
Lucentis
19,178
11.2
0.9
0.9
Avastin
7,662
4.5
4.7
3.9
Beovu
501
0.3
35.9
0.0
Vabysmo
15,560
9.1
2.7
1.2
Ongavia
1,296
0.8
0.0
0.0
Byooviz
2,643
1.5
4.5
4.5
Overall
171,800
100
2.0
0.8

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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Limitations
To ensure identification of as many cases as possible, PIE is counted when recorded in the EMR as a
complication of prior treatment, an indication for new treatment, when either an anterior chamber
tap or vitreous biopsy are performed or when intravitreal antibiotics are given within 42 days of a prior
intravitreal injection. Case ascertainment is higher when the initial treatment and identification or
management of the complication take place within the same centre. Both PIE and IOI may originate
after treatment in one centre but be managed by staff at a second centre. In this situation, the
complication may not be recorded. (Without a record of the prior intravitreal injection, the complication
would not be attributed to the second centre.) For the AMD audit, it is not currently possible to match
records for patients with initial and subsequent treatment in different organisations, although an
application for exemption from Section 251 of the NHS Act 2006 has been approved. This would allow
collection of identifiable information in the NOD dataset and linkage of patients attending more than
one centre for treatment.
Interpretation
• Treatment with intravitreal injection continues to be safe with a low incidence of both IOI and PIE.
More than 80% of centres had zero cases of PIE during the first year of treatment but almost 20%
of centres had an incidence of PIE in excess of the quality marker of 1 case per 6000 injections.
• The use of pre-filled syringes may, in part, explain the lower incidence of PIE after injection of
Eylea (aflibercept) and Lucentis (ranibizumab). The cause of the higher incidence of PIE in eyes
treated with Avastin (bevacizumab) and Byooviz (ranibizumab biosimilar) is not clear. In some
published series the need for an additional compounding step to make Avastin (bevacizumab)
suitable for intravitreal injection has been identified as a possible factor.
• The higher incidence of IOI following the use of Beovu (brolucizumab) has been widely reported
in post-marketing, real-world studies.
Recommendations
• Given the need for long-term therapy, patients should be informed of the risk both for each
injection and over the first year of treatment. Clinicians should utilise the checklist and
recommendations relating to consent for intravitreal injections on the Royal College of
Ophthalmologists website.
• Providers should record all cases of IOI and PIE within the EMR, review each case internally,
disseminate learning and track the incidence over time.

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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

6. Summary and key points
Participation
Since the first report of the AMD Audit, the number of participating centres with data included in the
analysis has increased from 63 to 73, suggesting widespread acceptance of the value of the audit and
the validity of the findings. With more than 23,000 patients in this year’s analysis, the dataset for the UK
AMD Audit is one of the largest sources of real-world data. Commissioners are encouraged to require
all providers of NvAMD treatment to use electronic medical records to collect clinical data as part of
routine care, participate in national audit and demonstrate commitment to high quality care and good
professional practice.
Data quality
Data quality is generally high, except for recording of ethnicity, the date of referral from primary care
and the planned follow-up interval. Data quality may appear poor when centres start to use an EMR
for the first time or move from one EMR to another. Loss to follow-up, after both 12 and 24 months of
treatment, remains a cause of concern. Prior reports have found that loss to follow-up is associated
with increasing age at baseline and lower levels of acuity. Access to high quality information about
the treatment burden and expected outcomes, particularly for patients with poor baseline acuity,
and a positive patient experience are expected to improve persistence with treatment.
When a new or replacement EMR is introduced in a centre or when patients’ care is transferred
from another location, staff should be encouraged to record prior treatment accurately. This will
help prevent the eyes that have already been treated from being identified as treatment naïve.
Similarly, when the initial, monthly phase of injection treatment is completed by a second provider,
this information should be available in the EMR of the initial provider. Providers should ensure EMRs
facilitate collection of relevant data as part of routine care and work with EMR providers to resolve
any issues with data quality. Providers are encouraged to use the latest versions of the commercial
EMRs to ensure data quality is high and there are options to validate NOD data in each audit cycle.
Baseline characteristics
Median baseline visual acuity remained 60 ETDRS letters but ranged from 27 to 68 between
participating centres. More than 28% of eyes have “good” acuity (≥70 ETDRS letters) at the start
of treatment, but almost 10% have baseline acuity the same or worse than the initial lower limit of
25 letters suggested by NICE. The proportion of eyes with “good” acuity at the start of treatment is
increasing and the “first eye gap” is reducing, suggesting a trend to earlier diagnosis and the start
of treatment.
As baseline acuity is closely linked to acuity outcomes after 12 and 24 months, providers are
encouraged to work with commissioners and primary and secondary care colleagues to develop
referral and treatment pathways that enable treatment to be started quickly, when visual acuity is still
good. Dedicated referral pathways for patients with suspected neovascular AMD should be promoted
locally and be triaged daily.
Care pathway
The overall proportion of eyes starting treatment within 14 days of referral from primary care was
40%, but this ranged from 2% to 85% between centres. Although the date of referral from primary care
was recorded within 90 days of the start of treatment for only 22% eyes, these figures suggest a key
recommendation from NICE Guidance (NG82) is not being met.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

The initial three, monthly injections during the loading phase of treatment were given within ten weeks
of the start of treatment in almost 65% of eyes but performance against the relevant quality markers
has deteriorated since last year. Delivery of this key part of the care pathway was also worse for
patients who were older and/or who started treatment in both eyes. Between centres, the proportion
of eyes receiving the first three injections within ten weeks ranged from 1% to 93%.
The median number of injections from baseline to the end of the first year of treatment was seven
(range 1 to 14) and the median interval between treatments at the end of the first year was ten weeks.
During the 2022 NHS year, only 2% of injections involved a biosimilar medication and 75% of centres
had zero usage of biosimilars. Nurses and other, trained, non-medical, healthcare professionals gave
at least 73% of injections.
For the eyes remaining on the same treatment and persisting with treatment to month 12, the median
number of injections varied by the drug injected from six to eight. The median intervals between
treatments weeks at the end of the first year of treatment were longer at 10 weeks for Eylea (aflibercept)
and Vabysmo (faricimab) than at 8 weeks for Lucentis (ranibizumab).
The treatment of NvAMD requires investment in resource and capacity at treatment centres and
ongoing commitment by patients and their carers. The best visual acuity outcomes are obtained when
treatment is started quickly, when visual acuity remains good, and when the first three injections during
the initial, loading phase of monthly treatment are completed within ten weeks of the first injection.
Providers should utilise a multidisciplinary workforce to ensure sufficient capacity to deliver these key
elements of the care pathway, but without causing delays elsewhere.
Visual acuity outcomes
Vision typically improves after the start of treatment and then stabilises. Median visual acuity was 65
letters at the end of the first year of treatment. Compared to the natural history of untreated eyes in
clinical trials, treatment reduces the proportion of eyes with significant visual loss (≥ 15 ETDRS letters)
at the end of the first year from 50% to 10% and with legal blindness from 50% to 15%.
After the first 12 months of treatment, the proportion of eyes with “good” visual acuity increased to 43%
and the proportion with “poor” visual acuity decreased from 18% to 15%. Most eyes with “good” vision
at the start of treatment retained this level of vision but a “good” acuity state was only achieved in 5%
of eyes with “poor” acuity at the start of treatment.
Prior statistical modelling and the data in this report have shown the best visual acuity outcomes are
achieved in younger patients, in eyes with good baseline acuity and no other ocular disease at baseline
and with prompt completion of the initial phase of monthly treatment. In addition to offering prompt
initial assessment and starting treatment quickly, providers should ensure the initial, loading phase of
monthly treatment is completed quickly. Novel pathways to deliver this phase of treatment and close
working with administration colleagues may be helpful.
Real-world outcomes from the AMD audit should be used during the initial consultation with
new patients to help them and their carers make an informed decision about starting treatment,
particularly in eyes with “poor” baseline visual acuity. For eyes with acuity ≤25 ETDRS letters at
baseline, almost half of eyes keep this level of vision after 12 months of treatment and only 4% achieve
a “good” visual acuity state.
A decrease of 15 or more letters from baseline will often be secondary to the development or
permanent structural damage and/or non-responsiveness to treatment. This should prompt an open
and honest discussion with the patient about the uncertain benefits of continued treatment and the
opportunity to pause or stop treatment.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Safety:
Treatment of NvAMD is safe and both intraocular inflammation and presumed infectious
endophthalmitis are rare complications of intravitreal injection.
Given the need for ongoing treatment, patients should be informed of the risk of serious complications
both for each injection and over the first year of treatment. Centres should monitor the incidence of
IOI and PIE and review local practice with colleagues from infection prevention when the incidence
appears to be higher than expected. Thirteen centres had an incidence of PIE in excess of the quality
marker of one case per 6000 injections.
Variation between centres:
There is considerable variation in data quality, baseline characteristics, the care pathway and visual
acuity outcomes between providers of treatment. In clinical practice, unwarranted or excessive
variation from best practice can lead to inefficiency and waste and result in poor outcomes for patients.
Performance against the quality markers introduced in the second annual report is mixed but has
improved for recording of visual acuity, having a low rate of PIE after injection and for adjusted “good”
or “poor” acuity outcomes.
Statistical modelling of “good” (≥ 70 ETDRS letters) and “poor” (decrease of ≥ 10 ETDRS letter from
baseline) acuity outcomes after the first 12 months of treatment enables a comparison of the results of
treatment in the participating centres after adjustment for differences in the baseline patient and eye
characteristics. Five centres were found to be high outliers in the “good” acuity outcome model and ten
were found to be low outliers in the “poor” acuity outcome model. These centres are delivering better
acuity outcomes than expected. Conversely, six centres were found to be low outliers in the “good”
acuity outcome model. These centres are delivering worse acuity outcomes than expected.
Providers should meet as a department, with colleagues from Clinical Audit / Clinical Effectiveness
/ Quality Improvement, to benchmark local data quality and performance in the AMD Audit reports
against peers, national results and the new quality markers and to track performance over time, using
the NOD Audit website and reports. Areas where local practice is of high quality should be noted,
shared internally and celebrated. When areas for improvement are identified, nominated clinical
and quality improvements leads should engage with stakeholders, and use quality improvement
methodology to deliver an impact on local pathways and outcomes. It is often helpful to focus on
“Just one thing”, implement the change and remeasure performance over a period of six to 12 months.
When more than one provider is commissioned to provide treatment, commissioners are encouraged to
meet with them as a group, compare performance between providers against benchmarks, adopt best
practice and reduce variation in the quality and outcomes of care.
Sustainability:
In 2022, the NHS became the first health system to embed net zero into legislation, through the
Health and Care Act 2022. Supporting the NHS response to climate change is a responsibility for
all staff. Providers of NvAMD treatment should utilise available published and online resources,
including the Sustainability section of the Royal College of Ophthalmologists website and through
Eye Sustain website.
The contents of sterile, intravitreal injection packs should be reviewed to ensure all the items in
each pack are needed. Items that are never used should be removed to reduce waste and cut costs.
Given the volume of injections, even small reductions in the cost of sterile gloves and packs can
deliver significant savings. Every effort should be made to reduce the use of single use plastics when,
for example, cardboard alternatives exist and to recycle as much of the packs contents as possible.
Separation of waste into clinical (yellow), domestic (black) and mixed recycling (clear) waste bags
will deliver financial savings and ensure that more waste is made available for recycling.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Care pathways and staff timetables should also be reviewed to reduce un-necessary travel by patients,
carers and staff where possible and to reduce the greenhouse gas emissions. A one-stop service, in
which patients are assessed and treated, when needed, on the same day is associated with fewer clinic
appointments and reduced patient travel. When patients require treatment to both eyes, the default
pathway should be to offer bilateral treatment at the same visit.
Biosimilar forms of originator products are often available at a significant cost saving. For eyes
receiving maintenance therapy at regular, but longer, intervals, switching to a biosimilar preparation,
where available, would yield cost savings. For eyes that require, regular but frequent treatment
with traditional therapies, a switch to a potentially, longer-acting therapy may be a consideration.
Commissioners and providers are encouraged to meet and agree local policy around the use of
biosimilars and therapies that may be longer acting.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

7. Acknowledgements
The NOD AMD Audit is supported and advised by a multi-disciplinary advisory group. The members of
the advisory group are listed below, and their invaluable help is acknowledged.
Person
Role
Organisation
Martin McKibbin
Chair
Royal College of Ophthalmologists
Matt Broom
Lay Group Representative
Royal College of Ophthalmologists
Geraldine Hoad
Patient Representative
The Macular Society
Samer Elsherbiny
Consultant Ophthalmologist
Royal College of Ophthalmologists
Narendra Dhingra
Consultant Ophthalmologist
Royal College of Ophthalmologists
Hemal Mehta
Consultant Ophthalmologist
Royal College of Ophthalmologists
Sajjad Mahmood
Consultant Ophthalmologist
Royal College of Ophthalmologists
Ian Pearce
Consultant Ophthalmologist
Royal College of Ophthalmologists
Aleksandra
Mankowska
Practicing Optometrist
The College of Optometrists
Gabriela Czanner
Independent Statistician
Ophthalmic Statistics Group
Tendai Gwenhure
Ophthalmic Nursing Representative
The Royal College of Nursing
Bahadur Dehar
Clinical Effectiveness Project
Facilitator
Sandwell and West Birmingham/
N-QI-CAN representative
Paul Donachie
Senior Medical Statistician
Gloucestershire Hospitals NHS
Foundation Trust
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

8. Appendices

Appendix 1: Data for participating centres
The following provider-level results from year 3 of the UK AMD Audit are available on the NOD website.
1. Participating AMD treatment providers, including ICB details for England, and the Electronic
Medical Record used at each location
2. The number of eligible patients and eyes per centre
3. Data quality: The proportion of eyes with referral data and visual acuity measurements at both
baseline and after 12 months of treatment
4. Baseline visual acuity
5. Key care processes: proportion of eyes starting treatment within 14 days of referral,
completing the first 3 planned monthly injections <10 weeks, median number of injections
and the percentage of injections given by different professional groups
6. Crude visual acuity outcomes at 12 and 24 months
7. Adjusted visual acuity outcomes at 12 months
8. Complications
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

ETDRS Letters
LogMAR Value
Snellen
VA Interpretation
100
-0.30
6/3
“Good” VA
95
-0.20
6/3.75
90
-0.10
6/5
85
0.00
6/6
80
0.10
6/7.5
75
0.20
6/9
70
0.30
6/12
65
0.40
6/15
60
0.50
6/18
55
0.60
6/24
50
0.70
6/30
45
0.80
6/36
40
0.90
6/48
35
1.00
6/60
“Poor” VA
30
1.10
5/60 or 6/76
25
1.20
4/60 or 6/96
20
1.30
3/60 or 6/120
15
1.40
6/152
10
1.50
6/192
5
1.60
6/240
0
1.70
6/304
Appendix 2: Visual acuity conversion table
Visual acuity is traditionally measured by the ability to distinguish letters or numbers at a given
distance according to a fixed standard. In this report, visual acuity is reported using ETDRS letters.
A “normal“ visual acuity would be 85 ETDRS letters, with the number of letters read increasing when
visual acuity improves. A visual acuity of 70 ETDRS letters would be at the boundary for driving a car
in the UK and is described here as ‘good’ vision. A visual acuity of 35 or fewer ETDRS letters in the
better-seeing eye would be at the level of certification as having sight impairment, when combined
with a central field defect, and is described in the report as “poor” vision.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

Appendix 3: Glossary
Abbreviation
Description
AMD
Age-related Macular Degeneration
Anti-VEGF
Drug blocking the action of vascular endothelial growth factor
CI
Confidence Interval
EMR
Electronic Medical Record
ETDRS
Early Treatment Diabetic Retinopathy Study
IMD
Index of Multiple Deprivation
IOI
Intraocular Inflammation
IQR
Inter Quartile Range
ISBIVT
Immediate Sequential Bilateral Intravitreal Treatment
LogMAR
Logarithm of the Minimum Angle of Resolution
NHS
National Health Service
NICE
National Institute for Health and Care Excellence
NOD
National Ophthalmology Database
NvAMD
Neovascular Age-related Macular Degeneration
OCT
Optical Coherence Tomography
PIE
Presumed Infectious Endophthalmitis
RCOphth
The Royal College of Ophthalmologists
UK
United Kingdom
VA
Visual acuity
VEGF
Vascular Endothelial Growth Factor
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9. References
1.
Wong TY, Chakravarthy U, Klein R, Mitchell P et al. The natural history and prognosis of
neovascular age-related macular degeneration: a systematic review of the literature and
meta-analysis. Ophthalmology. 2008 Jan;115(1):116-26.
2. Owen CG, Jarrar Z, Wormald R, Cook DG, et al. The estimated prevalence and incidence of late
stage age related macular degeneration in the UK. Br J Ophthalmol. 2012 May;96(5):752-6.
3. Chakravarthy U, Harding SP, Rogers CA, Downes SM et al. Alternative treatments to inhibit VEGF in
age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial.
Lancet.2013;382(9900):1258-67.
4. Ying GS, Maguire MG, Daniel E, Ferris FL et al. Association of Baseline Characteristics and Early
Vision Response with 2-Year Vision Outcomes in the Comparison of AMD Treatments Trials (CATT).
Ophthalmology. 2015;122(12):2523-31.
5. Weber M, Dominguez M, Coscas F, Faure C et al. Impact of intravitreal aflibercept dosing regimens
in treatment-naïve patients with neovascular age-related macular degeneration: 2-year results of
RAINBOW.BMC Ophthalmol. 2020;20(1):206.
6. Hanhart J, Wiener R, Totah H, Gelman E et al. Effects of delay in anti-vascular endothelial growth
factor intravitreal injections for neovascular age-related macular degeneration. Graefes Arch Clin
Exp Ophthalmol 2022;260(6):1907-1914.
7. Chandra S, Gurudas S, Burton BJL, Menon G et al. Associations of presenting visual acuity with
morphological changes on OCT in neovascular age-related macular degeneration: PRECISE
Study Report 2. Eye (Lond). 38, 757–765 (2024).
8. Zarranz-Ventura J, Escobar-Barranco JJ, Gómez-Baldó L, Gallego-Pinazo R; Study Investigators.
Reasons for Delayed Anti-VEGF Treatment During COVID-19 Lockdown and Clinical Impact in
Neovascular Age-Related Macular Degeneration. Ophthalmol Ther. 2023;12(5):2537-2555.
9. Eter N, Hasanbasic Z, Keramas G, Rech C et al. PERSEUS 24-month analysis: a prospective
non-interventional study to assess the effectiveness of intravitreal aflibercept in routine clinical
practice in Germany in patients with neovascular age-related macular degeneration. Graefes
Arch Clin Exp Ophthalmol. 2021;259(8):2213-2223.
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NOD Year Three Report of the Age-related Macular Degeneration Audit 2025/NOD/510

National Ophthalmology Database Audit
The Royal College of Ophthalmologists
18 Stephenson Way, London NW1 2HD
T. xx-xxxx-xxxx
xxx@xxx.xx
nodaudit.org.uk