NICE gives positive recommendation to dexamethasone for the treatment of common eye condition in final guidance
NICE has recommended dexamethasone (Ozurdex, Allergan) intravitreal implant, for the treatment of macular oedema following central retinal vein occlusion (CRVO)i in final guidance published today (27 July). The guidance also recommends dexamethasone following branch retinal vein occlusion (BRVO)ii when:
- treatment with laser photocoagulationiii has not been beneficial, or
- treatment with laser photocoagulation is not considered suitable because of the extent of macular haemorrhage.
The macular is the central part of the retina, responsible for seeing colour and fine detail. Macular oedema is where fluid collects in the retina at the macular area, and can lead to severe visual impairment. For people affected, straight lines may appear wavy, vision may be blurred, or they may be particularly sensitive to light. RVO is a common cause of reduced vision due to retinal vascular disease. It is classified into BRVO and CRVO. The incidence of RVO increases with age. Other risk factors for RVO include high blood pressure, high cholesterol, glaucoma, thrombophiliaiv and diabetes.
The dexamethasone implant is injected into the eye once every six months and works by suppressing inflammation.
Dr Carole Longson, Health Technology Evaluation Centre Director at NICE said: “RVO can be debilitating and can have a significant impact on everyday life. NICE is therefore pleased to recommend dexamethasone intravitreal implant for this condition. Today's guidance provides clear advice to the NHS and patients, no matter where they live in England and Wales, on how this treatment can add value. I am sure all those affected will welcome this decision.”
The final guidance is available from Wednesday 27 July.
This is NICE's final guidance on this technology and now replaces local recommendations across the country.
Notes to Editors
1. The final guidance is available from Wednesday 27 July
3. Dexamethasone intravitreal implant (Ozurdex, Allergan) is a potent corticosteroid (a type of medication that contains steroids) that suppresses inflammation in the eye by inhibiting oedema, fibrinv deposition, capillary leakage and phagocyticvi migration.
4. Dexamethasone intravitreal implant has a marketing authorisation for the treatment of adult patients with macular oedema following either branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).
5. The cost of a 700-microgram implant and applicator is £870.00 (BNF, edition 61), excluding VAT. One dexamethasone intravitreal implant is administered every 6 months in the affected eye and up to six implants may be given. Costs may vary in different settings because of negotiated procurement discounts.
6. No prevalence or incidence data has been identified for England and Wales; however a recent US study reported a 15 year incidence of 500 new cases per 100,000 population for CRVO and 1800 cases per 100,000 population for BRVO.
7. Thrombosis of the retinal veins causes an increase in retinal capillary pressure, resulting in the capillaries being more permeable, and the discharge of blood and plasma into the retina. This leads to the development of macular oedema and varying levels of ischaemia (a restriction in blood supply) through non-perfusion of capillariesvii.
i. CRVO results from thrombosis of the central retinal vein where it passes through the back of the optic nerve through a mesh-like structure called the lamina cribrosa.
ii. BRVO is caused by venous thrombosis at an arteriovenous crossing (where an artery and vein share a common lining of connective tissue).
iii. Laser photocoagulation is a type of surgery whereby a laser is used to finely cauterize blood vessels in the eye.
iv. Thrombophilia is a condition where the blood has an increased tendency to form clots. Blood clots can cause problems such as deep vein thrombosis (DVT) or pulmonary embolus (PE).
v. A fibrin is a protein that is produced in response to bleeding; it is the major component of the blood clot.
vi.A phagocytic cell is a white blood cell that protects the body from harmful material or bacteria.
vii.These changes trigger an increased amount of vascular endothelial growth factor (VEGF), which increases vascular permeability and new vessels developing.
1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
2. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
3. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.
4. NICE provides advice and support on putting NICE guidance and standards into practice throughits implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 03 August 2011