“We have to explore this issue,” said Robert Campbell, an ophthalmologist at the Queen’s School of Medicine and the study’s lead author. “There are ramifications of this huge upswing in a procedure that several years ago we rarely performed.”
The procedure involves monthly injections by specially trained ophthalmologists into the eyes of patients suffering from age-related macular degeneration.
There are now two drugs – Lucentis and Avastin – that improve vision in a significant number of people with age-related macular degeneration. But there are 13 million people in Ontario and only about 400 ophthalmologists.
With ophthalmologists now devoting a huge amount of extra time to this procedure, overall access to eye care, which is already strained, is coming under even greater pressure.
Data from the Ontario Health Insurance Plan between 2000 and 2008 reveals that between 2005 and November 2007 the rate of intravitreal injections grew eight-fold – from 3.5 to 25.9 injections per 100,000 Ontarians per month. In 2007, 50 per cent of intravitreal injections were performed by just three per cent of Ontario’s ophthalmologists.
“We knew that anecdotally there had been a huge increase in the number of intravitreal injections and this study finally gives us quantitative data,” Dr. Campbell says. “We now know exactly how large the upswing has been to date.”
Dr. Campbell feels that it is likely that all provinces in Canada are experiencing similar increases in the need for these specialized therapies, so trying to make them available across wide geographic areas is another concern.
The study is published in this month’s issue of Archives of Ophthalmology.
The research team includes Queen’s researchers Marlo Whitehead, Sudeep Gill (Providence Care hospital in Kingston), Susan Bronskill and Chaim Bell (University of Toronto), and J. Michael Paterson (McMaster University).