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Original article
Anti-VEGF intervention in neovascular AMD: benefits and risks restated as natural frequencies
  1. Louis Clearkin1,2,
  2. Balasubramanian Ramasamy1,
  3. James Wason3,
  4. Stephenie Tiew1
  1. 1Eye Department, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
  2. 2Institute for Risk andUncertainty, University of Liverpool, Liverpool, UK
  3. 3MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
  1. Correspondence to Louis Clearkin; clearl{at}liv.ac.uk

Abstract

Objective Clear information is essential to properly determine preference in medical intervention. In neovascular age-related macular degeneration, patients need to understand the balance of risk and benefit of anti-vascular endothelial growth factor (VEGF) treatment. This balance is altered by the number of injections administered.

Methods Natural frequencies, displayed as pictographically as icon arrays, are used to show material outcomes from the MARINA and HARBOR (12 months) trials. We also calculated the number needed to treat (NNT) and number needed to harm (NNH).

Results MARINA 24-month data show the absolute risk reduction is 37% and the NNT is 3; meaning for one patient to benefit three need to be treated.

12 months’ HARBOR data show that compared with as-needed treatment, scheduled monthly injection treatment increases the number of patients achieving a better visual outcome. The number of patients suffering harm is also increased by the additional injections.

Conclusion Displaying MARINA and HARBOR trial data as natural frequencies, with numbers needed to treat and harm, communicates complimentary information on the positive and negative aspects of anti-VEGF treatment.

  • macula
  • neovascularisation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjophth-2018-000257

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    Footnotes

    • Contributors Conception or design of the work: LC, BR, JW, ST. Data collection: LC, BR. Data analysis and interpretation: LC, BR, JW, ST. Drafting the article: LC. Critical revision of the article: LC, BR, JW, ST. Final approval of the version to be published: LC, BR, JW, ST.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.