Transcript Slide 1

The
Macular Assessment
Program
1
Note to MAP Participant …
• The Executive Summary, slide 4-18, can be used
as a stand-alone core group of slides if you wish.
• The remainder of the deck expands on the
‘Perception vs Reality’ comparative data of the
MAP participants. Add any of these slides to the
Executive Summary to support or enhance the
presentation.
• In addition, there are ‘Supplementary Slides’ at
the end that illustrate the national aggregate
results for each question asked in MAP.
2
Macular Assessment Program
The Results Agenda
1. Objective / Background
2. Executive Summary
3. The Prevalence of AMD in Canada
4. Perception vs Reality: Comparing the optometrists’
perceptions to the assessments’ reality
5. Weighing the Risk Factors: Identifying level of
importance
6. Intervention and follow-up
7. Conclusions
3
Executive Summary
4
Macular Assessment Program
Objective
• The overall objective of the Macular Assessment
Program (MAP) was to raise the awareness of risk for
Age-related Macular Degeneration (AMD) and the
need for screening certain individuals
– Identified patients at risk for AMD
– Illustrated the prevalence of the condition within participating
optometrists’ practice
5
Macular Assessment Program
Background
• The Assessment was conducted during the months of
February, March, and April of 2013.
• 290 optometrists from across Canada participated:
– BC; AB; SK; MN; ON; Qc; NB; NS; PE; NL
• The number of patients assessed: 4,955
6
Macular Assessment Program
Background
• The collection of the data was strictly anonymous
• No patient identifiers were collected
• 3rd party was responsible for data collection and
management of all aggregate reports.
• The sponsor or its Sales Representatives have NO
access to individual practitioner results
7
Profile of the Participants
Optometrist Profile
• 59% of optometrists indicated that they have been in
practice for more than 10 years
• 79% of optometrists indicated that they practice as a
group, with approximately 3 optometrists in a group
practice
• 57% of optometrists have 10,000 patients or more in
their practice, of which 41% have >15,000 patients
o 27% of patients are over 65
o 12% of patients are over 75
8
Awareness of the Risk for AMD
According to optometrists’ opinions:
• Based on the responses collected in the Practice Profile
questionnaire, optometrists believed that 26% of their patients were
at risk of AMD (Slide 22)
• However, during the AMD risk assessment, optometrists
diagnosed 34% of the patients with dry AMD (Slide 23)
Frequency of AMD Being Diagnosed (Slide 33)
• 64% of patients assessed at high risk were later diagnosed with
dry AMD (Assessed n=1,025 / diagnosed n=781)
• 36% of patients assessed at moderate risk were later diagnosed
with dry AMD (Assessed n=1,948 / diagnosed n=734)
• 15% of patients assessed at low risk were diagnosed with dry AMD
(Assessed n=1,985 / diagnosed n=314)
9
Predictive Risk Factors
Associated with AMD
Risk Factors for AMD
• From the table below, significant risk factors were identified at three
stages of the MAP:
1.
2.
3.
Practice Profile: which risk factors the optometrists’ feel are most
important
Risk Assessment: which risk factors were most frequently associated
with the patients’ assessed level of risk
AMD Diagnosis: which risk factors were most frequently associated
with those patients diagnosed with AMD
Non-modifiable risk factors





Age
Family History
Gender
Eye Colour
Ethnicity
Modifiable risk factors








Smoker
Sun Exposure
Healthy Diet
Obesity
Exercise
High Blood Pressure
High Cholesterol
Cardiovascular Disease
10
Predictive Risk Factors
Associated with AMD
Practice Profile:
• The Practice Profile questionnaire revealed optometrists consider the
five most important risk factors for AMD as:
Age
Smoking
Family History
Sun Exposure
Diet
Risk Assessment:
• The most significant risk factors that optometrists indicated while
establishing their patients’ assessment of risk were:
Age
Family History
High BP
Smoking
Sun Exposure
AMD Diagnosis: (Slides 26/29)
• The most significant risk factors that were associated with patients
diagnosed with AMD were:
Age
Family History
Activity Level
Sun Exposure
Eye Colour
11
Predictive Risk Factors
Associated with AMD
• The MAP findings suggest that the risk factors associated
the with the AMD Diagnosed patients could be
considered as a predictive model (Slides 36-43)
• Overall, there was broad agreement:
− Age and Family History were two of the most important factors
• However, there were a few important differences:
− Optometrists believed that Smoking was very important, but
the AMD Diagnosed predictive model found it was the 8th most
statistically significant variable
− Optometrists believed Activity Level was of moderate
importance, but the AMD Diagnosed predictive model found it to
be the 3rd most statistically significant variable
12
Predictive Risk Factors
Associated with AMD
Top 10 Risk Factor Statistical Significance Ranking
AMD
Optometrists’
Risk Factor
Risk Factor
Diagnosed
Assessment
Age
Age
1
1
Family History
Family History
2
2
High Blood Pressure
Activity Level
3
3
Smoking
Sun Exposure
4
4
Sun Exposure
Eye Color
5
5
Cardiovascular Disease
Cardiovascular Disease
6
6
Activity Level
High Blood Pressure
7
7
Eye Color
Smoking
8
8
Ethnicity
Diet
9
9
Diet
BP Treatment
10
10
13
When Diagnosis of AMD is Determined
• Optometrists reported that they consult with patients on the
modifiable risk factors more than 70% of the time.
• Consultation does not vary between Patients at risk of
AMD and those diagnosed with AMD
58%
Percentage of time Consulting
60%
47%
32%
31%
28%
27%
20%
12% 11%
0%
Exercise Regularly
Maintain a Healthy
Weight
Keep blood pressure
controlled
Patients With AMD
Smoking Cessation
Lessen exposure to
sunlight, wear
sunglasses and hats
Patients At Risk
14
When Diagnosis of AMD is Determined
• Following diagnosis in the AMD Risk Assessment, the
following medications/supplements were prescribed to
patients with AMD
• PRN ™ Eye Omega Advantage
• PRN ™ Macular Vitamin Benefit
• Macula 2 ™ Essentials
• Macula 2 ™ Omega-3
• Private Label/Generic Store brands
• Referral for injectable medication
15
When Diagnosis of AMD is Determined
Referring patients with AMD
‒ The percentage of ODs that refer a patient to an ophthalmologist
or retina specialist increases by the stage of AMD
100%
59%
50%
32%
15%
0%
Stage 1
Stage 2
Stage 3
‒ The number of referred patients with stage 2 or stage 3 AMD is
statistically higher than for stage 1 AMD
16
Patient Follow-up
Follow-up period for patients with AMD
• The percentage of Optometrists that schedule a follow up visit within
3-6 months increases by the stage of AMD
• For stage 3 AMD patients, 44% of follow ups are within the next 6
months
Follow-up period for patients at High Risk of AMD
• The percentage of Optometrists that schedule a follow up visit within
6 months increases by level of risk for AMD
• For patients with high risk of AMD, 61% of follow ups are between
6 to 12 months and just 11% are more than 12 months
17
MAP Summary
•
Optometrists perception of risk and prevalence of AMD in their practice is
much lower than reality:
•
•
•
Optometrists were able, for the most part, to predict AMD. However,
comparing the risk factors associated with their assessment of risk to the
risk factors associated with the patients diagnosis with AMD, the weight of
importance of the latter should be considered:
•
•
ODs believe that 26% of their patients were at risk of AMD and 10% had AMD
However, optometrists diagnosed 34% of the MAP patients with dry AMD
The 5 most significant risk factors that were associated with patients diagnosed
with AMD were: Age; Family History; Activity Level; Sun Exposure; Eye Colour
It is not until a diagnosis of Stage 2 or 3 AMD is confirmed that the majority
of optometrists refer patients to an ophthalmologist or retina specialist .
Only 15% of MAP patients diagnosed with Stage 1 AMD were referred.
• Vitalux® plus Omega-3 is the supplement most recommended for
patients with dry AMD
18
The Prevalence
of AMD in Canada
19
Aging Canadian Population
• Proportion of older adults is increasing more rapidly than
all other age groups1:
– 2009: 1 in 7 was >65 (4.7 million)
– 2036: 1 in 4 will be >65 (10.4 million)
• Due to:
– Lower birth rate2
– Longer life expectancy2
• With aging population expect increased incidence of AMD
References:
1. Statistics Canada. An aging population. 2010. Available at: http://www.statcan.gc.ca/pub/11-402-x/2010000/chap/pop/pop02-eng.htm. Accessed February 29th, 2012.
2. Turcotte M, Schellenberg G. Portrait of Seniors in Canada 2006. Ottawa; Statistics Canada. Catalogue no. 89-519-XIE. February 2007.
20
AMD in Canada
Estimated number of Canadians affected by AMD:3
Percentage (%)
of Canadians with AMD
Number
of Canadians with AMD¶
43-53
8.5
467,500
55-64
14.4
529,126
65-74
19.4
440,768
≥75
36.8
748,512
Age (Years)
Estimated Total
2,185,906
It is estimated that 78,000 new AMD patients and 10,000 new wet AMD will be
diagnosed each year.
¶Extrapolated
from Beaver Dam Eye Study 1988-19904
Population statistics for age groups <65: Statistics Canada 2006 Census; For age groups >65, Statistics Canada
projections (medium growth), 2005.
References:
8.
Klein R, Klein BE, Linton KL. Prevalence of age-related maculopathy: The Beaver Dam Eye Study. Ophthalmology. 1992; 99: 933-943.
12.
Somani S, Hoskin-Mott A, Mishra A, et al. Managing patients at risk for age-related macular degeneration: a Canadian strategy. Canadian Journal of Optometry. 2009: 71(2) 14-20.
21
Perception vs Reality:
Optometrists’ perceptions vs the
Assessments’ reality
22
AMD in Practice
Practice Profile: Optometrists perceive that:
• 26% of their patients are at risk of AMD and 10% already have AMD
30%
Means of Responses
26%
25%
20%
15%
10%
10%
5%
0%
At Risk of AMD
Have AMD
Response Options
OD8 (Profile). Approximately what percentage of all of your patients do you think are at risk of AMD? What percentage currently have AMD?
(n=290)
23
AMD in Practice
Percentage of Patients with this
condition
Perception vs Reality
• AMD Risk Assessment: approximately 20% of patients are at high
risk of AMD and 34% have AMD
34%
35%
30%
26%
25%
20%
20%
15%
10%
10%
5%
0%
At Risk of AMD
AMD Risk Assessment
OD8 (Profile). Approximately what percentage of all of your patients do you think are at risk of AMD? (n=290)
Q15 (Assessment). Based on your assessment what do you feel is this patient’s level of risk for AMD? (n=4955)
Q17 (Assessment). According to the AREDS Study, how would you classify this patient’s stage of AMD? (n=1662)
Have AMD
Practice Profile
24
Non-Modifiable Risk Factors
Practice Profile: Optometrists perceive that:
•
Age (9.2) and family history of AMD (9.0) are the most important
risk factors for AMD
Ethnicity (7.2) and eye colour (7.1) are moderately important
•
Means of Responses
10
9.2
8
9.0
6.8
7.1
7.2
5
3
0
Age
Family history of
Gender
Light Eye Colour
AMD
Response Options
Ethnicity
OD10 (Profile). On a scale of 1 (Not at all important) to 10 (Very important), how important are the following risk factors for AMD? (n=290)
25
Non-Modifiable Risk Factors
Practice Profile: Optometrists perceive that:
•
Age (9.2) and family history of AMD (9.0) are the most important
risk factors for AMD
Ethnicity (7.2) and eye colour (7.1) are moderately important
•
Means of Responses
• 10Although
indicated
as moderately important by the
9.2
9.0
optometrists, 56% and 88% of the MAP patients
7.2
8
diagnosed
with AMD have6.8light eye7.1colour and
are
Caucasian
5
3
0
Age
Family history of
Gender
Light Eye Colour
AMD
Response Options
Ethnicity
OD10 (Profile). On a scale of 1 (Not at all important) to 10 (Very important), how important are the following risk factors for AMD? (n=290)
26
Non-Modifiable Risk Factors
In Patients Diagnosed With AMD
Perception vs Reality
• AMD Risk Assessment: Although indicated as moderately important
by the optometrists, 56% and 88% of patients diagnosed with AMD
have light eye colour and are Caucasian
9.2
10
9.0
88%
6.8
61%
50%
7.1
7.2
56%
47%
5
25%
0%
0
Age (>75)
Famly History (Yes)
Gender (Female)
Patients Diagnosed With Dry AMD (Assessment)
Eye Colour (Light)
Ethnicity (Caucasian)
Reported importance of factors
Percentage of Patients with this
condition
100%
Perception of importance (Profile)
OD10 (Profile). On a scale of 1 (Not at all important) to 10 (Very important), how important are the following risk factors for AMD? (n=290)
Q2-Q6 (Assessment). Age, Family History, Gender, Eye Colour, Ethnicity (n=1662)
27
Modifiable Risk Factors
Practice Profile: Optometrists perceive that:
• Smoker (9.1), high sun exposure (8.4) and unhealthy diet (8.0) are the
most important risk factors for AMD
• Obesity (7.3) and cardiovascular disease (7.2) are moderately important
10.0
9.1
Means of Responses
8.4
8.0
7.3
7.5
7.0
7.0
7.0
7.2
Lack Of
Exercise
High blood
pressure
High
Cholestrol
Cardiovascular
Diesease
5.0
2.5
0.0
Smoker
High Sun
Exposure
Unhealthy diet
Obesity
Response Options
OD10 (Profile). On a scale of 1 (Not at all important) to 10 (Very important), how important are the following risk factors for AMD? (n=290)
28
Modifiable Risk Factors
Practice Profile: Optometrists perceive that:
• Smoker (9.1), high sun exposure (8.4) and unhealthy diet (8.0) are the
most important risk factors for AMD
• Obesity (7.3) and cardiovascular disease (7.2) are moderately important
Means of Responses
•10.0Although
smoking, high sun exposure, and an
9.1
8.0
unhealthy 8.4
diet were
indicated as very important by
7.3
7.2
7.0
7.0
7.0
7.5
the optometrists, a large portion of MAP patients
diagnosed with AMD are inactive, and have high
5.0
blood pressure and high cholesterol
2.5
0.0
Smoker
High Sun
Exposure
Unhealthy diet
Obesity
Lack Of
Exercise
High blood
pressure
High
Cholestrol
Cardiovascular
Diesease
Response Options
OD10 (Profile). On a scale of 1 (Not at all important) to 10 (Very important), how important are the following risk factors for AMD? (n=290)
29
Modifiable Risk Factors
In Diagnosed Patients
100%
10
9.1
8.0
8.0
7.0
7.0
7.0
7.2
7.2
56%
50%
5
38%
39%
24%
11%
14%
8%
Reported importance of factors
Percentage of Patients with this
condition
Perception vs Reality
• AMD Risk Assessment: Although viewed as moderately important, a
large portion of MAP patients diagnosed with AMD are inactive, and
have high blood pressure and high cholesterol.
3%
0%
0
Smoker
(Current)
Sun Exposure Unhealthy Diet
(High)
(Poor)
Obesity
(Obese)
Lack of
High Blood
High
Exercise (In- Pressure (yes) Cholesterol
active)
(Yes)
Patients Diagnosed With Dry AMD (Assessment)
History Of
CVD (Yes)
Perception of importance (Profile)
OD10 (Profile). On a scale of 1 (Not at all important) to 10 (Very important), how important are the following risk factors for AMD? (n=290)
Q7-Q14 (Assessment). Smoker, Sun Exposure, Healthy Diet, Obesity, Exercise, High Blood Pressure,, High Cholesterol, CVD (n=1662)
30
Smoking In Diagnosed Patients
•
Percentage of Patients with this
condition
•
Practice Profile: smoking is perceived to be one of the most important
factors
AMD Risk Assessment: approximately 40% of patients are past and
current smokers
100%
50%
30%
11%
0%
Current Smoker
Past Smoker
Patients Diagnosed With Dry AMD (Assessment)
OD10 (Profile). On a scale of 1 (Not at all important) to 10 (Very important), how important are the following risk factors for AMD? (n=290)
Q7 (Assessment). Smoker (n=1662)
31
Tests To Diagnose AMD
•
Practice Profile: majority of optometrists indicated they diagnose patients
for AMD by using dilated eye exam, retinal digital photography, visual
acuity and Amsler grid
•
•
AMD Risk Assessment: patients were diagnosed using similar tests.
Perceived usage of these tests are significantly higher
Percentage of Use
100%
99%
90%
90% 90%
90%
84%
76%
62%
50%
35%
21%
0%
Dilated Eye
Exam
Retinal Digital
Photography
Optical
coherence
tomography
Visual acuity
AMD Risk Assessment
Amsler grid
2% 1%
-- --
Angiography
Annidis
3%
8%
Other
Practice Profile
OD11 (Profile). How do you diagnose patients for AMD? Select all that apply (n=290)
Q16 (Assessment). Which test(s) will you utilize to establish an AMD diagnosis? Please select all that apply. (n=4955)
32
Weighing the Risk Factors:
Identifying level of importance
33
Risk vs Diagnosis
•
•
•
64% of patients assessed as High Risk were later diagnosed with AMD
36% of patients assessed as Moderate Risk were later diagnosed with AMD
15% of patients assessed as Low Risk were later diagnosed with AMD
AMD Risk assessed vs Diagnosed
64% diagnosed
with AMD
15% diagnosed
with AMD
21%
40%
Low
Moderate
36% diagnosed
with AMD
39%
Q15 (Assessment). Based on your assessment what do you feel is this patient’s level of risk for AMD? (n=4955)
Q17 (Assessment). According to the AREDS Study, how would you classify this patient’s stage of AMD (n=4955)
High
34
Risk vs Diagnosis
•
•
•
High Risk: 1025 patients - 781 were later diagnosed with AMD
Moderate Risk: 1948 patients - 734 were later diagnosed with AMD
Low Risk: 1982 patients - 314 were later diagnosed with AMD
Percentage Of Patients
50.0%
Moderate Risk= 1948 patients
(Diagnosed with AMD=734,
Negative=1097, n/a=117)
High Risk= 1025 patients
(Diagnosed with AMD=781,
Negative=228, n/a=15)
25.0%
Low Risk= 1982 patients
(Diagnosed with AMD=314,
Negative=1428, n/a=240)
39.3%
40.0%
Moderate
Low
20.7%
0.0%
High
Response Options
Q15 (Assessment). Based on your assessment what do you feel is this patient’s level of risk for AMD (n=4955)
35
Diagnosis Patients: AREDS Stage
•
•
1662 patients diagnosed with dry AMD, 167 patients with wet AMD
‒
83% of patients with stage 3 are more than 75 years old
‒
22% of patients with stage 3 AMD have family history
‒
60% of patients with stage 2 AMD have light eye colour
2753 patients did not have AMD
Percentage Of Patients
80.0%
High Risk= 228 patients
Negative=
2753 patients
55.6%
40.0%
Moderate Risk= 1097 patients
Low Risk= 1428 patients
Stage1=
1128 patients
22.8%
Stage2=
372 patients
7.5%
7.5%
Stage3=
162 patients
3.3%
3.4%
Stage 2
Stage 3
Wet AMD
0.0%
n/a for this
patient
Negative
Stage 1
Q17 (Assessment). According to the AREDS Study, how would you classify this patient’s stage of AMD (n=4955)
36
AMD Outcome Prediction Models
• Using ‘multivariate logistic regression’ MAP bio-statisticians
are analyzing the MAP findings to develop an AMD Outcome
Prediction ‘Tool’
• All Risk Factors included in the AMD assessment
questionnaire were considered as inputs for two Prediction
models:
1. Model for Optometrist Assessment of AMD risk
• Interprets how the optometrists’ used risk factors to assess AMD
risk
2. Model for Dry and Wet AMD Diagnosis
• Estimate the probability of AMD and the relative probability of
the AREDS stages of AMD
• In following slides AMD Diagnosis means Dry and Wet AMD
37
Outcome prediction models: Results
• Both models identified a number of risk factors as
significant in predicting patient outcomes with respect
to AMD
– 11 of 16 possible risk factors were included in the Optometrists
Risk assessment model
– 10 of 16 possible risk factors were included in the AMD
diagnosis model
(both outline on the next 2 slides)
– The significant risk factors for each model were ranked
according to statistical significance of impact (p-value)
• The description for each significant attribute indicates the direction of impact
on expected AMD outcome
38
Key Impact Risk Factors:
Optometrists’ Assessment of Risk Prior to Diagnosis
Optometrist Risk Assessment Model
Rank
Variable
Description of Impact on AMD Risk
P-Value
1
Age
As age increases, risk of AMD increases
<.001
2
Family History
Patient's with family history of AMD have an increased risk for AMD
<.001
3
Blood Pressure
<.001
4
Smoking
5
Sun Exposure
6
Cardiovascular Disease
7
Activity Level
High blood pressure is associated with an increased AMD risk
Non-smokers (at least 10 years) are associated with a decreased risk for
AMD
Low sun exposure is associated with a decreased risk for AMD
Diagnosis of cardiovascular disease is associated with an increased risk for
AMD
Active patients have a decreased risk for AMD
8
Eye Color
Light eye color is associated with an increased risk of AMD
<.001
9
Ethnicity
Asian:Pacific ethncity is associated with a decrease risk of AMD
<.01
10
Diet
A healthy diet is associated with a decreased risk of AMD
<.01
11
Weight
Obese or overweight patients have an increased risk for AMD
<.05
Cholesterol
Gender
<.001
<.001
<.001
<.001
Risk Factors that are not significant
Cholesterol Treatment
BP Treatment
Cardiovascular disease treatment
n = 3,012 (269 distinct physicians)
Note: patients with “Moderate” risk scores were excluded from this model
Note: This ranks the statistical importance of the risk factor and not the clinical importance.
39
Key Impact Risk Factors:
AMD Diagnosis
AMD Diagnosis Model
Rank
Variable
Description of Impact on AMD Risk
P-Value
1
Age
As age increases, risk of AMD increases
<.001
2
Family History
Patient's with family history of AMD have an increased risk for AMD
<.001
3
Activity Level
Active patients have a decreased risk for AMD
<.001
4
Sun Exposure
Low sun exposure is associated with a decreased risk of AMD
<.001
5
Eye Color
Light eye color is associated with an increased risk of AMD
<.001
6
Cardiovascular Disease
Cardiovascular disease is associated with an increased risk for AMD
<.01
7
Blood Pressure
High blood pressure is associated with an increased AMD risk
<.01
8
Smoking
Non-Smokers are associated with a decreased risk for AMD
<.05
9
Diet
A healthy diet is associated with a decreased risk of AMD
<.05
10
BP Treatment
Patients on blood pressure treatment are at a decreased risk of AMD
<.05
Cholesterol
Gender
Ethnicity
Variables that are not significant
Cholesterol treatment
Weight
Cardiovascular treatment
n = 4,967 (276 distinct physicians)
Note: This ranks the statistical importance of the risk factor and not the clinical importance
40
Model Result Comparison
• The two models showed statistical agreement for
the majority of risk factors
(Model comparison table on next slide)
• 3 risk factors showed notable differences between
the models with respect to the significance ranking
– The Optometrist Assessment model placed higher
importance on the following risk factors than the AMD
Diagnosis model: Smoking, high blood pressure
– The Optometrist Assessment model placed lower
importance on the following risk factors than the AMD
Diagnosis model: Activity level
41
Model Comparison
Risk Factor
Age
Family History
Activity Level
Sun Exposure
Eye Color
Cardiovascular Disease
Blood Pressure
Smoking
Diet
BP Treatment
Ethnicity
Weight
Cholesterol
Gender
Cholesterol Treatment
Cardiovascular treatment
AMD Diagnosis
1
2
3
4
5
6
7
8
9
10
Not Significant
Not Significant
Not Significant
Not Significant
Not Significant
Not Significant
Model
Optometrist Risk Assessment
1
2
7
5
8
6
3
4
10
Not significant
9
11
Not significant
Not significant
Not significant
Not significant
Yellow highlighting indicates notable variation between model outcomes.
42
Physician Risk Level vs. AMD Stage
• To illustrate the proportion of diagnosed patients within
the AREDS stages of AMD, patients are grouped
according to optometrists’ assessed level of risk
(Outlined on next slide)
– Patients classified as high risk by physicians are fairly
evenly spread out across the five diagnosis groups
– A significant majority of patients classified as moderate
risk by optometrists are in the negative or Stage 1 AMD
diagnosis groups
– Most of the patients classified as low risk by optometrists
fall into the negative AMD diagnosis group
43
Optometrists Risk Level vs.
AMD Diagnosis
Optometrist
Risk
Assessment Negative
AMD Diagnosis
Stage 1: Early
Dry AMD
Stage 2:
Stage 3:
Intermediate Dry Advanced Dry
AMD
AMD
Wet AMD
High
24%
29%
21%
13%
13%
Moderate
62%
28%
7%
1%
2%
Low
84%
14%
1%
0.30%
0.45%
Patients classified by Optometrists as:
• High risk - are fairly evenly spread out across the five diagnosis groups
• Moderate risk - majority are in the negative or Stage 1 AMD diagnosis groups
• Low risk - most fall into the negative AMD diagnosis group
n = 4,967 patients
(276 distinct physicians)
44
Intervention and Follow-up
45
Supplements For Patients With AMD
•
AMD Risk Assessment: Vitalux® plus Omega-3 is recommended 44% of
the time for patients diagnosed with dry AMD
• PRN ™ Eye Omega Advantage
• PRN ™ Macular Vitamin Benefit
• Macula 2 ™ Essentials
• Macula 2 ™ Omega-3
• Private Label/Generic Store brands
• Referral for injectable medication
Q18b (Assessment). Medications/Supplements (n=290)
Q17 (Assessment). According to the AREDS Study, how would you classify this patient’s stage of AMD? (n=1662)
46
Additional Examinations/Test
•
More than half of the time doctors use/will use Dilated Eye Exam, Visual
Acuity and Retinal Digital Photography tests
Q18a (Assessment). Additional Examinations/Tests(n=290)
Q17 (Assessment). According to the AREDS Study, how would you classify this patient’s stage of AMD? (n=1662)
47
Additional Examinations/Test
•
More than half of the time doctors use/will use Dilated Eye Exam, Visual
Acuity and Retinal Digital Photography tests
Dilated Eye Exam (Today)
Dilated Eye Exam (In Future)
Retinal Digital Photography (Today)
Retinal Digital Photography (Future)
OCT (Today)
OCT (Future)
Visual acuity (Today)
Visual acuity (Future)
Amsler grid (Today)
Amsler grid (Future)
Angiography (Today)
Angiography (Future)
Annidis (Today)
Annidis (Future)
Other
60%
70%
Although Optical Coherence Tomography (OCT)
50% was used
only 11% of the time in the diagnosis of AMD the 62%
percentage of confirmed11%diagnosis was39%significant:
65%
• Stage1 - 18%
70%
• Stage2 - 28%
47%
• Stage 3 - 27%
60%
1%
• Wet AMD - 31%
6%
0%
0%
3%
0%
10%
20%
30%
40%
50%
Q18a (Assessment). Additional Examinations/Tests(n=290)
Q17 (Assessment). According to the AREDS Study, how would you classify this patient’s stage of AMD? (n=1662)
60%
70%
80%
48
Optometrists’ Consultation
Percentage of time Consulting
•
Practice Profile: Optometrists reported that they consult with patients on
the modifiable risk factors more than 70% of the time
98%
1
96%
90%
71%
74%
70%
0.5
0
Exercise
Regularly
Maintain a
Healthy Weight
Keep blood
pressure
controlled
Practice Profile
Smoking
Cessation
Lessen
Perform Amsler
exposure to
grid tests at
sunlight, wear
home
sunglasses and
hats
OD14 (Profile). How do you consult on the following modifiable risk factors issues (Exercise regularly, Maintain a healthy weight)? Select all that apply. (n=290)
49
Optometrists’ Consultation
•
•
Optometrists approach to consulting on the Modifiable Risk factors does
not vary between Patients at risk of AMD and those diagnosed with AMD
Only the use of the Amsler grid at home is recommended significantly more
often with Patients diagnosed with AMD
58%
Percentage of time Consulting
60%
47%
37%
32%
31%
28%
25%
27%
20%
12%11%
2%
0%
Exercise
Regularly
Maintain a
Healthy Weight
Keep blood
pressure
controlled
Patients With AMD
Smoking
Cessation
Lessen exposure Perform Amsler
to sunlight, wear grid tests at
sunglasses and
home
hats
Patients Without AMD
OD14 (Profile). How do you consult on the following modifiable risk factors issues (Exercise regularly, Maintain a healthy weight)? Select all that apply. (n=290)
Q18C (Assessment). Lifestyle Modification (Exercise regularly, Maintain a healthy weight) (n=1662)
50
Consultation: I do not Discuss
Modifiable Risk Factors that optometrists indicated they do not discuss:
Maintaining a Healthy Weight; Keeping blood pressure controlled;
and Exercising regularly
Percent of Optometrists
•
28%
26%
15%
Maintaining a healthy weight
Keeping blood pressure
controlled
Exercising regularly
OD14 (Profile). How do you consult on the following modifiable risk factors issues? (n=290)
51
Other Ocular Diseases Discovered
•
Almost half of the patients with AMD have cataracts which is significantly
higher than those patients without AMD
‒ Number of AMD patients who have retinopathy, dry eye disease and
systemic disease is significantly higher than those without AMD
100%
50%
47%
29%
24%
6%
8%
Retinopathy
Glaucoma
12%
6%
0%
n/a for this
patient
Cataract
Patients With AMD
100%
50%
Dry eye disease Systemic disease
(diabetes,
thyroid, cardio
vascular disease)
Other
46%
32%
13%
4%
5%
Retinopathy
Glaucoma
6%
7%
0%
n/a for this patient
Cataract
Patients Without
Dry eye disease Systemic disease
(diabetes, thyroid,
cardio vascular
AMD
disease)
Q17 (Assessment). According to the AREDS Study, how would you classify this patient’s stage of AMD? (n=1662)
Q19 (Assessment). Based on your Assessment, what other ocular diseases did you discover? Please select all that apply. (n=1662)
Other
52
Referral To An Ophthalmologist
•
Optometrists indicated that 20% of the time they refer their patients to
an Ophthalmologist for treatment of wet AMD or for AMD monitoring
Percentage Of Patients
40%
20%
20%
18%
0%
For treatment of Wet AMD
For AMD monitoring
Response Options
OD15 (Profile). What percentage of your AMD patients has required a referral to an Opthomologist (n=290)
53
Referring Patients With AMD
•
•
•
•
The percentage of referred patients goes up by the stage of AMD
The number of referred patients with stage 2 or stage 3 AMD to an
ophthalmologist or retina specialist is significantly higher than those for
stage 1 AMD and patients without AMD
62% of the time optometrists refer patients with stage 3 AMD to an
ophthalmologist or retina specialist
Optometrists seldom refer any patients with AMD to a nutritionist
100%
59%
50%
32%
15%
0%
Stage 1
Stage 2
Q17 (Assessment). According to the AREDS Study, how would you classify this patient’s stage of AMD? (n=1662)
Q20 (Assessment). Will you be referring this patient? (n=1662)
Stage 3
54
Follow Up: Patients With High Risk Of AMD
•
•
The percentage of Optometrists that schedule a follow up visit within 6
months increases by level of risk for AMD
For patients with high risk of AMD, 61% of follow ups are between 6 to 12
months and just 11% are more than 12 months
100%
61%
56%
45% 46%
50%
28%
22%
13%
3% 6%
11%
6%
4%
0%
Low
Less than 3 months
Moderate
3 to 6 months
6 to12 months
Q15 (Assessment). Based on your assessment what do you feel is this patient’s level of risk for AMD? (n=4955)
Q21 (Assessment). When are you scheduling a follow-up visit with this patient? (n=1662)
High
More than 12 months
55
Follow Up: Patients Diagnosed with AMD
•
•
The percentage of Optometrists that schedule a follow up visit within 3-6
months increases by the stage of AMD
For stage 3 AMD patients, 44% of follow ups are within the next 6 months
100%
68%
59%
44% 47%
50%
33%
17%
12%
5%
4%
6%
3%
3%
0%
Stage 1
Less than 3 months
Stage 2
3 to 6 months
6 to12 months
Stage 3
More than 12 months
Q17 (Assessment). According to the AREDS Study, how would you classify this patient’s stage of AMD? (n=1662)
Q21 (Assessment). When are you scheduling a follow-up visit with this patient? (n=1662)
56
Summary
57
MAP Conclusions
Prevalence of AMD in Practice
• Optometrists perceive that
– 26% of their patients are at risk of AMD
– 10% already have AMD
• In reality
– ~20% of patients are at high risk of AMD
– 34% have AMD
• Total Patients Assessed: 4,955
• Total Diagnosed with AMD: 1662
– Stage 1: 1,128
– Stage 2: 372
– Stage 3: 162
58
MAP Conclusions
• Optometrists perceive that:
– Age and Family History of AMD are the most
important Non-Modifiable risk factors for AMD
– Ethnicity and Eye Colour are moderately important
• MAP patients diagnosed with AMD
– 88% are Caucasian
– 56% have light eye colour
59
MAP Conclusions
• Optometrists perceive that the most important
Modifiable risk factors for AMD are:
– Smoking,
– High Sun Exposure
– Unhealthy Diet
• However, a large portion of MAP patients
diagnosed with AMD are
– inactive, and
– have high blood pressure and high cholesterol.
60
MAP Conclusions
Top 10 Risk Factor Prevalence Ranking
Risk Factor
AMD Diagnosis
Optometrists’
Assessment
Risk Factor
Age
1
1
Age
Family History
2
2
Family History
Activity Level
3
3
Blood Pressure
Sun Exposure
4
4
Smoking
Eye Color
5
5
Sun Exposure
Cardiovascular Disease
6
6
Cardiovascular Disease
Blood Pressure
7
7
Activity Level
Smoking
8
8
Eye Color
Diet
9
9
Ethnicity
BP Treatment
10
10
Diet
Scientific evidence points to chronic vascular disease, including cardiovascular disease, as
a potential cause. Scientists believe that slow degradation of the blood vessels in the
choroid, which provides blood to the retina, may lead to macular degeneration.5,
5.
Vascular endothelial growth factor in eye diseasehttp://www.lef.org/magazine/mag2009/dec2009_Halt-The-Leading-Cause-of-Age-Related-Blindness_01.htm.
61
MAP Conclusions
• Optometrists reported that they consult with
patients on the modifiable risk factors more than
70% of the time.
• However… a portion of optometrist also
indicated that they ‘Do Not Discuss’ the
following:
– Maintaining a healthy weight - 28%
– Keeping blood pressure controlled - 15%
– Exercising regularly - 26%
62
MAP Conclusions
• Top 5 Supplements recommended by Optometrists
Supplement
Vitalux plus Omega-3
Vitalux- S plus OMEGA-3
Vitalux AREDs
Omega 3 Fish Oil – any brand
Vitalux Healthy Eyes
% of time recommended
44%
13%
10%
10%
9%
63
References
References: Slide #19
1. Statistics Canada. An aging population. 2010. Available at: http://www.statcan.gc.ca/pub/11-402-x/2010000/chap/pop/pop02-eng.htm. Accessed February
29th, 2012.
2. Turcotte M, Schellenberg G. Portrait of Seniors in Canada 2006. Ottawa; Statistics Canada. Catalogue no. 89-519-XIE. February 2007.
References: Slide #20
3. Somani S, Hoskin-Mott A, Mishra A, et al. Managing patients at risk for age-related macular degeneration: a Canadian strategy. Canadian Journal of
Optometry. 2009: 71(2) 14-20.
4. Klein R, Klein BE, Linton KL. Prevalence of age-related maculopathy: The Beaver Dam Eye Study. Ophthalmology. 1992; 99: 933-943.
References: Slide #60
5. Vascular endothelial growth factor in eye disease. http://www.lef.org/magazine/mag2009/dec2009_Halt-The-Leading-Cause-of-Age-RelatedBlindness_01.htm
References: Slide #71
6. American Health Assistance Foundation (http://www.ahaf.org/macular/about/risk.html#risk)
Speaker Notes/References: Slide # 24
•
One third of adults over the age of 75 are affected by age-related macular degeneration*
*American Health Assistance Foundation http://www.ahaf.org/macular/about/risk.html#risk
•
An individual is more likely to be affected by age-related macular degeneration if someone in his or her immediate family has been affected*
*American Health Assistance Foundation http://www.ahaf.org/macular/about/risk.html#risk
•
Females are twice as likely as males to be affected by age-related macular degeneration
Women’s Eye Health.org http://www.womenseyehealth.org/causes/amd.php
•
Individuals with light-colored eyes are more likely to be affected by dry age-related macular degeneration. This may be due to the fact that lightpigmented eyes offer less protection from damaging UV light. *
*American Health Assistance Foundation http://www.ahaf.org/macular/about/risk.html#risk
•
Caucasians are more likely to be affected by age-related macular degeneration than other races. This may be due to differences in genetic background
or pigmentation*
*American Health Assistance Foundation http://www.ahaf.org/macular/about/risk.html#risk
64
References
Speaker Notes/References: Slide # 27
•
Smoking increases an individual’s chances of developing age-related macular degeneration by two to five-fold. Smoking causes oxidative damage, which is thought to
contribute to the development and progression of this disease *
* American Health Assistance Foundation http://www.ahaf.org/macular/about/risk.html#risk
•
Prolonged sun exposure enables ultra-violet (UV) light to damage retinal tissue directly, and can also lead to the accumulation of products that are harmful to the retina *
* American Health Assistance Foundation http://www.ahaf.org/macular/about/risk.html#risk
•
A high fat diet, and/or one that is low in nutrients and antioxidants - Individuals with diets high in fat, cholesterol and sugar, and low in antioxidants are more likely to be
affected by age-related macular degeneration. *
* American Health Assistance Foundation http://www.ahaf.org/macular/about/risk.html#risk
•
Overweight individuals are more likely to be affected by age-related macular degeneration. An individual with a body mass index (BMI is a measure of body fat) of greater
than 30 is 2.5 times more likely to be affected by age-related macular degeneration *
* American Health Assistance Foundation http://www.ahaf.org/macular/about/risk.html#risk
•
In dry age-related macular degeneration, the retina does not receive adequate oxygen, leading to the death of cells in the macula. It is known that exercise improves
cardiovascular health, and might prevent an individual from developing this disease. *
* American Health Assistance Foundation http://www.ahaf.org/macular/about/risk.html#risk
•
Individuals with high blood pressure are more likely to be affected by age-related macular degeneration. High blood pressure, like smoking, leads to a constriction, or
narrowing, of the blood vessels that nourish the retina, negatively affecting its health. *
* American Health Assistance Foundation http://www.ahaf.org/macular/about/risk.html#risk
•
Cholesterol exists within the drusen. Researchers suggest that the formation of AMD lesions and their aftermath may be a pathological response to the retention of a subendothelial apolipoprotein B, similar to a widely accepted model of atherosclerotic coronary artery disease. As such, researchers have now found that bio-markers
predictive of cardiovascular risk are risk factors for AMD. 
 Live Extension http://www.lef.org/protocols/eye_ear/macular_degeneration_02.htm
 C-Reactive Protein and Homocysteine are Associated With Dietary and Behavioral Risk Factors
for Age-Related Macular Degeneration (Seddon 2006) http://www.ncbi.nlm.nih.gov/pubmed/16530626
 Vascular endothelial growth factor in eye disease.
http://www.lef.org/magazine/mag2009/dec2009_Halt-The-Leading-Cause-of-Age-Related Blindness_01.htm
•
Scientific evidence points to chronic vascular disease, including cardiovascular disease, as a potential cause. Scientists believe that slow degradation of the blood vessels
in the choroid, which provides blood to the retina, may lead to macular degeneration
 Vascular endothelial growth factor in eye disease.
http://www.lef.org/magazine/mag2009/dec2009_Halt-The-Leading-Cause-of-Age-Related-Blindness_01.htm
65
Supplementary Slides
66
Appendix:
Practice Profile
67
Years In Practice
•
Almost 6 out of 10 doctors indicated that they have been in practice
for more than 10 years
Percentage Of Responses
60%
42%
30%
26%
15%
17%
0%
1 to 5
5 to 10
10 to 15
Response Options
More than 15
OD1 (Profile). How many years have you been in practice? (n=290)
68
Hours Of Practice Per Year
•
93% of doctors indicated that they practice more than 1000 hrs per
year
Percentage Of Responses
70%
63%
35%
30%
6%
1%
0%
<500
500 - 1,000 hrs
1,000 - 1,500 hrs
Response Options
> 1,500 hrs
OD2 (Profile). How many hours do you practice per year? (n=290)
69
Group Or Solo Practice
•
Almost 80% of doctors indicated that they practice as a group
• Optical chain
• Corporate chain
• Associate
Percentage Of Responses
100%
79%
50%
19%
2%
0%
Group
Solo
Response Options
Other
OD3 (Profile). Is your practice a group or solo practice? (n=290)
70
Number Of Doctors In Group Practice
•
On average, 3 optometrists are in a group practice
Mean of Responses
5.0
3.4
2.5
0.0
Optometrists
--
0.1
0.1
General
practitioner/family
medicine doctors
Ophthalmologists
Other
Response Options
OD4 (Profile). If group, how many of the following doctors are in your practice? (n=290)
71
Number Of Support Staff
•
On average, there are 9 support staff who interact with patients in a
doctor’s practice
10
Mean of Responses
8.5
5
0
Support Staff Mean
Response Options
OD5 (Profile). How many support staff, who interact with patients, are in your practice? (n=290)
72
Patient Volume
•
Doctors see a large number of active patients
─ 97% of doctors mention they see around 1000 patients or more
in their practice
Percentage Of Responses
50%
41%
25%
25%
15%
16%
3%
0%
-<500
500 to 1,000
1,000 to
5,000 to
5,000
10,000
Response Options
10,000 to
15,000
>15,000
OD6 (Profile). Approximately how many active patients do you have in your practice? (n=290)
73
Patient Age
•
•
Doctors state that 12% of their patients are over 75;
One third of adults over the age of 75 are affected by age-related
macular degeneration6
40%
Means of Responses
33%
20%
19%
19%
17%
12%
0%
Under 45 years 45 to 45 years 55 to 64 years 65 to 74 years 75 years old or
old
old
old
old
older
Response Options
OD7 (Profile). What percentage of your patients fall in the following age ranges? (n=290)
6. (http://www.ahaf.org/macular/about/risk.html#risk)
74
Number Of Patients, Who Have AMD
•
In the practice profile, doctors believe that 26% of their patients are
at risk of AMD and 10% already have AMD
30%
Means of Responses
26%
15%
10%
0%
At Risk of AMD
Have AMD
Response Options
OD8 (Profile). Approximately what percentage of all of your patients do you think are at risk of AMD? What percentage currently have
AMD? (n=290)
75
Equipment In Office
•
Most doctors have Amsler grid (99%) and Retinal Digital Photography
(89%) equipment in their office
• Foresee
Percentage Of Responses
100%
99%
89%
PHP
• Frequency Doubling Technology (FDT)
• Heidelberg Retinal Tomography (HRT)
• Humphrey Visual Field Analyzer
• Automated Visual Field Analyzer
•Optos / Optomap
• Visual fields / Full threshold Visual Fields
50%
32%
17%
1%
0%
Retinal Digital
Photography
Optical coherence
tomography (OCT)
Amsler grid
Angiography
Other
Response Options
OD9 (Profile). Which of the following equipment do you have in your office? Please select all that apply. (n=290)
76
Non-Modifiable Risk Factors
•
•
In the practice profile, doctors believe that Age (9.2) and family
history of AMD (9.0) are the most important risk factors for AMD
Ethnicity (7.2) and eye colour (7.2) are moderately important
Means of Responses
10
9.2
9.0
6.8
7.2
7.2
5
0
Age
Family history of
Gender
Light Eye Colour
AMD
Response Options
Ethnicity
OD10 (Profile). On a scale of 1 (Not at all important) to 10 (Very important), how important are the following risk factors for AMD?
(n=290)
77
Modifiable Risk Factors
•
•
In the practice profile, doctors believe that Smoker (9.1), high sun
exposure (8.4) and unhealthy diet (8.0) are the most important
modifiable risk factors for AMD
Obesity (7.3) and cardiovascular disease (7.2) are moderately
important
Means of Responses
10.0
9.1
8.4
8.0
7.3
7.0
7.0
7.0
7.2
Obesity
Lack Of
Exercise
High blood
pressure
High
Cholestrol
Cardiovascular
Diesease
5.0
0.0
Smoker
High Sun
Exposure
Unhealthy diet
Response Options
OD10 (Profile). On a scale of 1 (Not at all important) to 10 (Very important), how important are the following risk factors for AMD?
(n=290)
78
Injectable Medications For Patients With AMD
•
•
65% of the time patients are treated with lucentis
35% of the time patients are treated with avastin
65%
35%
Lucentis®
Lucentis

Avastin®
Avastin
--
--
Macugen®
Macugen
Other
Other
OD13 (Profile). When your patient is treated with injectable medication, what medication(s)is most often used? (n=290)
79
How Do You Consult On Maintaining A
Healthy Weight?
•
Almost 70% of the time doctors discuss maintaining a healthy
weight with their patients
67%
28%
11%
8%
3%
2%
OD14 (Profile). How do you consult on the following modifiable risk factors issues? (n=290)
80
How Do You Consult On Keeping Blood
Pressure Controlled?
•
70% of the time doctors discuss keeping blood pressure
controlled with their patients
70%
36%
15%
9%
2%
--
OD14 (Profile). How do you consult on the following modifiable risk factors issues? (n=290)
81
How Do You Consult On Maintaining A
Healthy Diet?
•
96% of the time doctors discuss maintaining a healthy diet with
their patients
96%
22%
4%
1%
3%
4%
2%
OD14 (Profile). How do you consult on the following modifiable risk factors issues? (n=290)
82
How Do You Consult On Exercising
Regularly?
•
71% of the time doctors discuss exercising regularly with their
patients
71%
26%
10%
2%
--
OD14 (Profile). How do you consult on the following modifiable risk factors issues? (n=290)
83
How Do You Consult On Lessening exposure to
sunlight, wear sunglasses and hats?
•
96% of the time doctors discuss lessening exposure to sunlight,
wear sunglasses and hats with their patients
96%
20%
3%
--
2%
OD14 (Profile). How do you consult on the following modifiable risk factors issues? (n=290)
84
How Do You Consult On Performing Amsler
grid tests at home?
•
•
90% of the time doctors discuss performing amsler grid tests at
home
Almost half of the time pamphlet are used to consult on modifiable
risk factors
90%
48%
2%
2%
OD14 (Profile). How do you consult on the following modifiable risk factors issues? (n=290)
85
Referral To An Ophthalmologist
•
Doctors indicates that 20% of the time they refer their patients for
treatment of wet AMD or for AMD monitoring
Percentage Of Patients
40%
20%
20%
18%
0%
For treatment of Wet AMD
For AMD monitoring
OD15 (Profile). What percentage of your AMD patients has required a referral to an Opthomologist (n=290)
86
Appendix:
AMD Risk Assessment
87
Last Visit
60%
Percentage Of Patients
51%
30%
20%
13%
6%
10%
0%
< 3 months ago 3 to 6 months 6 to 12 months
12 to 18
ago
ago
months ago
Response Options
>18 months
Q1 (Assessment). When did you last see this patient? (n=4955)
88
Age
20%
16%
Percentage Of Patients
15%
13%
12%
12%
11%
10%
10%
10%
0%
45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79
Response Options
>=80
Q2 (Assessment). Age (n=4955)
89
Family History
100%
Percentage Of Patients
77%
50%
23%
0%
Yes
No
Response Options
Q3 (Assessment). Family History (n=4955)
90
Gender
Percentage Of Patients
80%
59%
41%
40%
0%
Male
Female
Response Options
Q4 (Assessment). Gender (n=4955)
91
Eye Colour
60%
Percentage Of Patients
49%
29%
30%
22%
0%
Light
Medium
Response Options
Dark
Q5 (Assessment). Eye Colour (n=4955)
92
Ethnicity
100%
Percentage Of Patients
85%
50%
1%
1%
5%
3%
1%
2%
1%
0%
Response Options
Q6 (Assessment). Ethnicity (n=4955)
93
Smoker
Percentage Of Patients
100%
62%
50%
20%
7%
4%
1%
Current (1
Pack/day)
Current (>1
Pack/day)
1%
2%
3%
0%
Current (<1
Pack/day)
Past: not
Past: not
Past: not
Past: bit
smoked for < smoked for 1 smoked for 5 smoked for >
1 year
to 5 years
to 10 years
10 years
Never
Response Options
Q7 (Assessment). Smoker (n=4955)
94
Sun Exposure
60%
Percentage Of Patients
53%
32%
30%
15%
0%
High
Moderate
Response Options
Low
Q8 (Assessment). Sun Exposure (n=4955)
95
Healthy Diet
60%
Percentage Of Patients
53%
39%
30%
8%
0%
Yes
Somewhat
Response Options
Poor
Q9 (Assessment). Healthy Diet (n=4955)
96
Obesity
80%
Percentage Of Patients
66%
40%
27%
4%
4%
0%
Obese
Overweight
Normal
Response Options
Underweight
Q10 (Assessment). Obesity (n=4955)
97
Exercise
Percentage Of Patients
80%
52%
40%
30%
18%
0%
Active
Moderately Active
Response Options
In-Active
Q11 (Assessment). Exercise (n=4955)
98
High Blood Pressure
Percentage Of Patients
80%
55%
44%
40%
2%
0%
Yes
No
Response Options
Not available
Q12 (Assessment). High Blood Pressure (n=4955)
99
High Cholesterol
80%
Percentage Of Patients
66%
40%
32%
2%
0%
Yes
No
Response Options
Not available
Q13 (Assessment). High Cholesterol (n=4955)
100
History Of Cardiovascular Disease
100%
Percentage Of Patients
81%
50%
16%
3%
0%
Yes
No
Response Options
Not available
Q14 (Assessment). History of Cardiovascular Disease (n=4955)
101
Recommendation For Healthy Diet
•
More than half of time doctors recommend eating a varied and nutritious
diet that includes leafy green vegetables, and fruit,
Percentage Of Patients
60%
54%
41%
30%
30%
17%
14%
0%
None required at
this time
Required but not
discussed
Eat a varied and
nutritious diet that
includes leafy
green vegetables,
and fruit
Eat fish (omega-3
fatty acids)
Avoid saturated
fats
Response Options
Q18d (Assessment). Healthy Diet (n=4955)
102